A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion

Summary

This article provides an overview of a multi-modal approach to assessing recovery following concussion in youth athletes. The described protocol uses pre- and post-concussion assessment of performance across a wide variety of domains and can inform the development of improved concussion rehabilitation protocols specific to the youth sport community.

Abstract

Concussion is one of the most commonly reported injuries amongst children and youth involved in sport participation. Following a concussion, youth can experience a range of short and long term neurobehavioral symptoms (somatic, cognitive and emotional/behavioral) that can have a significant impact on one’s participation in daily activities and pursuits of interest (e.g., school, sports, work, family/social life, etc.). Despite this, there remains a paucity in clinically driven research aimed specifically at exploring concussion within the youth sport population, and more specifically, multi-modal approaches to measuring recovery. This article provides an overview of a novel and multi-modal approach to measuring recovery amongst youth athletes following concussion. The presented approach involves the use of both pre-injury/baseline testing and post-injury/follow-up testing to assess performance across a wide variety of domains (post-concussion symptoms, cognition, balance, strength, agility/motor skills and resting state heart rate variability). The goal of this research is to gain a more objective and accurate understanding of recovery following concussion in youth athletes (ages 10-18 years). Findings from this research can help to inform the development and use of improved approaches to concussion management and rehabilitation specific to the youth sport community.

Introduction

Concussion can be defined as "a complex pathophysiologic process affecting the brain induced by traumatic biomechanical forces"¹, and can result in short and long-term somatic, cognitive and/or emotional/behavioral symptoms². Functionally, concussion and related symptoms can have a significant impact on one's participation in daily activities and pursuits³. It has been estimated that within the United States, between 1.6 and 3.8 million concussion occur each year as a result of sport participation⁴. Specific to children and youth involved in sports, concussion is one of the most commonly reported injuries^5-7....

Protocol

The described protocol includes pre-injury/baseline testing and post-injury follow-up assessment and is completed using three stations. This testing can be completed individually or in groups of four subjects at each station at a time. Subjects proceed through each station in the order listed below. Table 1 illustrates the protocol’s testing administration schedule. Ethics approval for this research was obtained from the Holland Bloorview Research Ethics Board at the Holland Bloorview Kids Rehabilitation Hospital. All participants and their legal guardians provide signed informed consent prior to completing the protocol and related data collection.

Results

The presented protocol is an ongoing investigation. Table 1 depicts the protocol’s testing administration schedule. Representative results are presented to demonstrate the feasibility of collecting baseline/pre-injury and post-concussion data across a variety of performance domains known to be impacted by concussion in youth. A single case of a concussed youth who has completed all stages of the protocol is presented to demonstrate recovery trajectories across selected outcome measures. Figure 1<.......

Discussion

This protocol presents a multi-modal approach to measuring recovery in youth athletes following a concussion. A critical feature of this protocol is the comparison of post-concussion data across a wide range of performance domains (cognition, balance, strength, agility, resting state heart rate variability, etc.) to pre-injury/baseline. These data serve as a means to indicate recovery amongst individual youth athletes following a concussion. By using common and readily available clinical measures of cognition, b.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Scale	Weight Watchers: Conair	WW30WB
Measuring Tape	Hi-Viz Lufkin	HVC716CME
Heart Rate Monitor (Chest Strap and Watch)	Polar	RS800CX GPS
Exercise/Yoga Mat	Pur Athletics	WTE10126
Sportline Stopwatch (Model 228)	EB Sport Group	#2787
Laptop - MacBook Pro	Apple	A1278
Computerized Cognitive Assessment- Immediate Post-Concussion Assessment and Cognitive Task	ImPACT Application's Inc.
Hand Grip Dynamometer	Sammons Preston- Smedley-Type	5032P
BioSway	Biodex Medical Supplies Inc.	950-510
Painter's Mate Green Tape	ShurTech Brands LLC	#49462
Pylons/Cones (12")	Canadian Tire	84-295-4
Basket	Canadian Tire	42-9919-2
Bean Bags	Eastpoint/Go Gater	1-1-16392