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Episode 41: Children and the Persistent Post-concussive Syndrome

What children are at risk for development of the Persistent Post-Concussive Syndrome following a sport related concussion?

That’s a good question that clinicians and parents need to consider in determine when it is safe to allow a child to return to play, and when further intervention is required.

There is very limited research so a new research article published in the British Journal of Medicine from the Buffalo Concussion Management Clinic attempts to develop a decision rule tree to answer these important questions.
The researchers have developed a brief, standardized physical examination to determine what players would develop the Persistent Post-Concussive Syndrome

But first, what is the Persistent Post-Concussive Syndrome? It is the persistence of post concussive symptoms physical, cognitive, emotional, and behavioral beyond the predicted normal course of recovery. Cognitive symptoms can include difficulties with attention, memory and focus. The post-concussion syndrome often causes patients to sleep more than usual at first, and then many develop issues falling asleep. It’s very common after concussion to be more irritable and with the syndrome many can experience anxiety and depression. Physical symptoms can include headaches, dizziness, and sensitivity to light and sound.

What the “normal” course of recovery should be is also an interesting and vexing question since many studies have shown that recovery can take months or even years to take place while others claim recovery should take place in weeks.

The Buffalo group recognized that children take longer to recover from a concussion than adults and many practitioners wait a month or longer to determine how the child is recovering before making any judgments or decisions about further care.

But, the group believes this delay may lead to a higher risk of persistent impairment and poor outcome including persistent physical and cognitive symptoms, difficulties with academic work and in their social life.

So, they have developed a scoring system based upon their observation of concussed student athletes, their symptoms and recovery time. Something simple that could easily be used by school personnel, trainers, and medical professionals.

I want to be clear, I am not voicing an opinion on the merits of this simple testing procedure because I have observed in discussions, and in my readings, often a concussion is misdiagnosed by emergency department personnel and children’s complaints go ignored, or even children are reluctant to inform parents, school personnel and medical personnel about the problems they are having, but I still want to pass this information along to those interested in this subject.

The researchers found the primary signs that indicate a child or adolescent with a concussion will have a delayed recovery were:

– Lightheadedness and dizziness on standing up from a lying downing position.
– Problems with balance and vision
– Difficulty in performing what is known as a tandem gain test, where an individual is instructed to walk heel to toe.

A child with these difficulties is more likely to develop the post concussive syndrome so more observation, attention and intervention needs to be happen.

A concussion, even one concussion can cause serious and permanent consequences, so it is important that this research continue for the proper screening of children who sustain a sports related concussion.

Audio version

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