New Approaches in The Management of Paediatric Concussion



Naznin Virji-Babul


Naznin Virji-Babul
Isabelle Gagnon
Carol DeMatteo



Children and youth are known to be at a greater risk of concussions than adults, and once injured, take longer to recover. The increased incidence of sports-related concussion in youth and the potentially serious long-term negative impact on their developing brains has enormous repercussions. While most young athletes recover within several days, many continue to experience symptoms for many months post-concussion. Headaches, dizziness, sleep disturbances, and fatigue often occurs immediately post injury and may be severe. Attention, memory and executive functions (i.e. working memory, cognitive flexibility, etc.) are also compromised early and recover inconsistently. Such persistent cognitive deficits can affect learning and future academic and vocational success. Additionally, there is an increased risk for repeat concussion after an initial concussion, with subsequent injuries resulting in more complicated and prolonged recovery. Despite the increasingly clear evidence that brain injury can adversely impact physical, cognitive and social development, there is limited evidence available for clinicians to determine how best to manage pediatric concussion. The objective of this symposium will be to discuss recent studies on exercise and activity restrictions as well as to introduce non-invasive brain stimulation as a novel method for concussion management.

Professor DeMatteo will present recent research evidence and perspectives on the use of Return to Activity/Play (RTA) and Return to School/Learn(RTS) protocols. Although these protocols are the most commonly used first line of management for youth after concussive injury, the evidence suggests that adherence to following guidelines is quite poor as measured by accelerometers yet there is some evidence supporting the continued use of protocols when examining incidence of repeat injury and symptom duration. It is also important to discuss how RTA and RTS can be integrated and followed together making management simpler and more successful for parents, teachers, coaches and of course the youth themselves.

Dr. Gagnon will present guidelines and recommendations that promote the use of early physical activity as a means to optimize recovery and return to activity following concussion. Despite an increasing interest in using physical activity-based interventions large variations exist regarding the modes and intensity of the exercise used. More recently, the benefits of both general activation, and of specifically prescribed exercises provided earlier in the recovery period have been explored, but the clinical uptake of this approach remains uneven at best. Recent evidence and avenues for future research will be discussed.

Dr. Virji-Babul will present preliminary findings on the application of transcranial direct current stimulation (tDCS). tDCS is a safe, non-invasive neurostimulation technique that can modulate neural excitability in the brain to positively impact cognition, behaviour and mood, particularly when combined with a behavioural intervention. The issues and potential therapeutic application of managing concussion using this technique will be discussed.



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