Pediatric concussion

From Wikipedia, the free encyclopedia

A pediatric concussion, also known as pediatric mild traumatic brain injury (mTBI), is a head trauma that impacts the brain capacity. The concussion can affect the patient on multiple factors such as functional, emotional, cognitive and physical, that occurs in infant, adolescent and child patients.[1] Symptoms following after the concussion include confusion, disorientation, lightheadedness, nausea, vomiting, blurred vision, loss of consciousness (LOC) and environment sensitivity, but these clinical manifestations may vary on the type, severity and location of the trauma.[2] These indications potentially appear immediately, while others may arise multiple days following the injury leading to a concussion and can be diagnosed through various methods by health professionals to estimate the recovery.[3] The majority of pediatric patients recover from the symptoms within one to three months subsequently following the injury but few patients risk delayed recovery or symptoms that persist.[4]

Common causes of a pediatric concussion result from falls, motor vehicle accidents, sports-related injuries, and blunt force trauma.[2] Approximately 48% of concussions consequently originate from falls in pediatric patients.[5] Within the United States, concussions resulting from sports-related injuries indicate that 3.8 million patients sustain this trauma each year.[6]

Concussions is a common head trauma with an estimated amount of 16% of children over the age of 10 already experienced at least one head injury requiring immediate medical attention.[7] Prevention for concussions involves reducing common risks in the youth; wearing a helmet to avoid sports-related head trauma.[8] Treatment includes physical rest for adolescents experiencing a concussion continuously for 24 to 48 hours under supervision while progressive return to activities.[9]

Patients experiencing acute concussions may develop persistent symptoms, or post-concussion syndrome, last generally longer than 4 weeks; this prevalence range from 10 to 30%.[10] In higher levels of PCS following a concussion, as a result of loss of consciousness or motor-vehicle related injuries, pediatric patients symptoms include depressive mood, sleep disturbance, light sensitivity, forgetfulness and dizziness.[11] Multiple occurrences of concussions in pediatric patients increase the risk of long-term consequences that affect basic activities of daily living and memory.[12]

Symptoms and signs[]

The symptoms can typically be included in four major categories: physical, cognitive, emotional, and sleep-related changes.[1] Depending on the age group of the patient, the display of symptoms and signs may vary.

Table showing commonly reported symptoms of pediatric concussion [1][13]
Physical Cognitive Emotional Sleep
  • Confusion
  • Difficulty focusing
  • Difficulty in recalling information
  • Stagnant behaviour
  • Problems in academics
  • More emotionally sensitive
  • Easily frustrated
  • Often upset or nervous
  • Irritable
  • Irregular sleep patterns
  • Abnormally long or short sleep durations
  • Easily awoken during sleep
  • Feeling of somnolence

A pediatric concussion can lead to an immediate or delayed onset of symptoms.[14] Immediate onset of symptoms includes physical impacts, such as dizziness, headache, anterograde or retrograde amnesia, loss of consciousness, vomiting and more.[1] Delayed onset of symptoms may occur a few hours or days after the injury.[15] The delayed symptoms involve all the physical, emotional and cognitive changes.

The symptoms of pediatric concussion can differ between babies, toddlers and older children. Babies, aged from birth to one-year-old, are usually unable to communicate their pain or emotions verbally. Therefore, more physical symptoms of pediatric concussion will be administered. This includes excessive crying when slightly moving the baby’s head, different portrayal of irritability such as persistent crying, fever, or poor appetite,[15][16] distinctive changes in the baby’s sleeping habits, vomiting, or a visible physical injury on the baby’s head.[15]

Toddlers, aged from 12 to 36 months, might be able to communicate vocally about symptoms.[15] Symptoms will potentially include a headache, nausea, vomiting as physical symptoms.[15] The portrayal of behavioral changes, such as a sudden change in sleeping patterns or excessive crying, and a loss of interest, such as hobbies, may also be seen.[15]

In older children, aged two or more, a pediatric concussion may lead to detectable modifications in the patients’ cognition and behavior.[15] Similar to toddlers, they may be vocal about symptoms. This includes feelings of dizziness, problems balancing, having blurry vision, increased sensitivity to light and noise, trouble paying attention, difficulty in memory, various mood changes, fatigue, and irregular sleep patterns.[13][15]

Diagnosis of pediatric concussion[]

All children and adolescents with suspected concussion require a medical assessment from a physician or nurse practitioner to accurately diagnose concussion and ensure that the child or adolescent does not have a more severe form of brain injury (TBI), an injury to their cervical spine, or other mental health or neurological conditions that may have similar symptoms to concussion.[4] There is no single physical or physiological test, imaging technique, or bodily fluids test to directly diagnose a pediatric concussion.[17]

Glasgow coma scale[]

The Glasgow coma scale (GCS) is a clinical scale utilized to measure the severity of the concussion.[18] The normal GCS can be used for children above the age of two, and a pediatric GCS has also been developed to assess the symptoms for children under the age of two.[19][20]

Both the normal and pediatric GCS aims to test the eye, verbal and motor responses. For each test, the scale value ranges from not testable (NT) to six, increasing in severity with higher numbers.[20] Each of the values recorded is indicative of the person’s best response provided during the examination. If the sum of the GCS is below eight or nine, the brain injury, such as concussion, is classified as severe, such as being in a coma. If the sum of the GCS is above or same as thirteen, it is classified to be a minor brain injury. Any value of GCS between nine and thirteen will be classified as moderate injury.[21]

Sideline testing[]

Sideline testing is one of the physical assessments that can be made immediately, which usually utilized for a sports-related injury.[1][22] There are various examples of sideline testing, including Sideline Concussion Assessment Tool (SCAT5), Child Sideline Concussion Assessment Tool (ChildSCAT5), Balance Error Score System, Test of Individual Stability, King-Devick Test (KD), and Test of Visual-Motor function.[1]

SCAT5 / ChildSCAT5[]

SCAT5 has two major categories of carrying out an on-field assessment and off-field assessment.[23] For the on-field, immediate assessment, several different physical examinations such as noting observable concussion signs, memory tests and observation of the level of consciousness using GCS as well as a cervical spine assessment can be done.[23] For off-field assessments, it can be carried out in a clinical setting, with assessments such as careful evaluation of the symptoms, and the utilization of a neurological screen.[23]The SCAT5 test is used for children above age thirteen. ChildSCAT5 is similar to the use of SCAT5, however, it is only used to evaluate children from age five to thirteen.[24]

Balance Error Score System[]

The Balance Error Score System (BESS) examination measures postural stability which can be affected with the occurrence of a concussion.[1] BESS aims to demonstrate the individual’s stability by testing the balancing ability of the individual for three different positions on firm and foam surfaces.[1]

King-Devick test[]

The King-Devick test is to assess the visual-motor function of the individual.[1][25] Different sets of test cards are provided to the individuals, with different form of lines that have numbers in the middle. The individual is told to read the numbers of the card from the top-left corner to the bottom-right corner, as fast as possible and as accurately as possible. The time taken to complete this is measured, and any symptoms that occurred during the test is noted.[26] The test assists the evaluation of impairment in the eye movements, language abilities as well as attention,[27] which is important to assess, as such factors can be affected by a concussion.

Office evaluation[]

The office evaluation is conducted to confirm that the individual has a sustained concussion.[1] To do this, it requires a comprehensive concussion evaluation, including detailed records of the injury, symptomatic scale, neurological exam, evaluation of the behavior and cognition, visual-motor function evaluation, balancing tests, and assessment for risk factors for slower recovery.[1]

Detailed records of the initial injury[]

It is critical to record down details of the initial injury, such as whether the symptoms of concussion were present immediately, how the injury occurred, or the severity of the symptoms presented. These records may be necessary and helpful for medical professionals to accurately identify the significance of the injury, as well as predict the recommended duration of recovery. [1]

Symptom scales[]

Symptom scales can be varied among various age groups, and it can be provided to help health care providers to assess.[1][28] Different checklists can be used to measure the symptoms of concussion, such as the Graded Symptom Checklist (GSC), Post-Concussion Symptoms Survey (PCSS), and Rivermead Post-Concussion Symptom Questionnaire (RPCSQ). The GSC rates the symptoms based on severity, and it can be self-reported for individual ages 13 and over.[28]The PCSS is also a self-report that measures the severity of symptoms; however, it has not been yet tested in individuals under the age of eleven.[28]RPCSQ asks individuals to report the comparisons of the severity of symptoms prior to the injury and after the injury.[28]These questionnaires can be self-reported or be reported by the parent or guardian.[1]

Neurological exam[]

Image to show the medical professional conducting a fundoscopic exam using a fundoscope. The fundoscopic method is used to examine the back of your eye, which consists of the retina, optic disc, and blood vessels.[29] This examination can detect any eye problems, such as glaucoma, optic nerve problems or macular degeneration.[30] It can be useful when recognizing any eye injuries caused by a concussion.

Various neurological examinations can be initiated to indicate areas affected by pediatric concussion.[1][31] This includes the examination of the mental status, fundoscopic (ophthalmoscopy) exam to assess eye coordination, cranial nerve testing to evaluate the brain, strength, sensory analysis, reflexes and coordination, and walking.[1]

Vestibular ocular evaluation[]

The vestibular ocular evaluation is the screening of visual-motor functions.[32][33]Visual-motor screening evaluates the cognitive control of the eye movement which utilizes several pathways of the brain. These pathways, such as the frontoparietal circuits and subcortical nuclei, are susceptible to injuries in concussion. Therefore, the evaluation of the visual-motor function, the King-Devick Test as an example,[1] can indicate the severity of the concussion, which can then be associated with the duration needed for recovery.

Balance assessment[]

The balance assessment is useful in observing the abnormalities in balancing abilities, which is a commonly reported symptom of concussed individuals.[34] When conducting the balance test, it is important to focus on the footwear of the individual, as it may impact the results of the balance test.[1][35] Therefore, it is recommended to remove footwear prior to balance testing. Such balance assessments include SCAT5, and the BESS.[1]

Cognitive screen[]

The Acute Concussion Evaluate (ACE) tool and the SCAT5 can be utilized to screen the cognitive status of the individual.[1] These assessment tools can evaluate cognition, such as memory. Nonetheless, it lacks in its ability to judge attention, a factor that may be affected due to concussion. Poor performance in the cognitive screen testing can suggest slower recovery or even a referral to a neuropsychologist.[1]

Neuropsychological evaluation[]

The neuropsychological evaluation facilitates the analysis of factors that may be affected by concussion such as learning, memory, efficacy, thinking process, reaction time, and attention.[1][36] This is achieved through different assessments such as the Performance Validity Test (PVTs) and Symptom Validity Tests (SVTs), which allows the interpretation of any injuries made by concussion.[1][36] It can recognize the cognitive status of the patients as well as indicate the recommended duration of recovery based on the severity of the injury.[36]

Neuroimaging[]

Main article: Neuroimaging
Image to show the MRI machine, which can be used to identify any brain injuries through imaging. As MRI involves a strong magnetic field, the patients to take precautions, as the strong magnetic field can exert strong power on magnetizable objects. Moreover, patients with claustrophobia can face difficulties staying inside the machine for a long time, due to its limited space. Different methods of familiarizing the patient with the machine or easing the discomfort should be adapted prior to the use of an MRI machine.[37]

There are various methods of neuroimaging, commonly including magnetic resonance imaging (MRI) and computed tomography (CT).[38] Neuroimaging techniques can detect changes occurring in the brain through technology, further implying brain damage caused by a concussion.[38]Neuroimaging is a less common technique utilized for pediatrics, as there may be obstacles such as procedural difficulties or discomfort of a pediatric patient.[39]

Treatment[]

Infants, adolescents and children suspected of experiencing a moderate to severe concussion are recommended to seek immediate medical attention to reduce or reverse potential brain trauma inflicted by the injury.[40] Following initial diagnosis when signs and symptoms arise within hours, or immediately, following the head trauma, observation of the patient is continued intensely as symptoms can develop and alter days after.[41] Treatments vary to provide recovery from the trauma; specific treatment depends on the severity and area of injury.[42] Patients experiencing prolonged symptoms for three to four weeks succeeding injury and diagnosis are encouraged from ‘active rehabilitation’ rather than complete physical and mental rest.[43] Medical clearance is not necessary to return to school for pediatric patients. However, observation is required to monitor return-to-school and activities.[6] Re-injury should be avoided to prevent long-term consequences and permanent brain damage.[44]

Rest and return to activities[]

Following immediately after a concussion resulting from an injury, pediatric patients caretakers are recommended to seek medical assessment after displaying symptoms.[42] Subsequently, pediatric patients are required to rest over the next 24 - 48 hours both physically and mentally prior to returning to activities. Activities involving contact, collision and energy expenditure should be avoided.[45]

Return-to-school[]

Students should only return to school after the initial rest is taken for 24-48 hours; activities are required to be at low-risk to avoid re-injury and worsening of symptoms.[46] Long absences are discouraged to avoid deterioration of the manifestations and are recommended to take an active rehabilitation instead.[47]

Medication[]

Pharmacologic treatment at the present stage has been shown to be unable to speed the recovery of pediatric concussion; nevertheless, the medication can be prescribed to alleviate signs and symptoms of sleep disturbances, headaches, cognitive and emotional inflictions, of the injury.[48] Melatonin can assist patients experiencing sleep disturbances.[49] Medication utilized for headaches like naproxen, ibuprofen, acetaminophen, and oxaprozin can be applied to lessen symptoms in the short term; though, recent studies indicate patients improved in the ailment after discontinuation of the treatment.[11] However, medication and other forms of drugs are advised to not be administered unless prescribed by a doctor due to the potential detrimental implications on recovery.[50]

Prognosis[]

The majority of pediatric patients recover completely from concussion; some may experience prolonged recuperation.[51] Around 70-80% recover without difficulties after one to three months after suffering from the concussion.[4] Each child’s recovery follows a unique direction; an accurate prediction based on a single factor is unable to determine the outcome of the child.[52]

Health care professionals may occasionally employ prognostic tools to provide assistance to determine a predictive outcome, such as validated symptoms scales, cognitive tests and balance testing.[52] Although these tests are incapable of being a strong predictive tool for outcomes, they are able to assess recovery from the pediatric concussion.[53] These tools display greater benefits towards older adolescents for determining predictions for prognosis.[52]

In pediatric patients at risk for persistent symptoms, including factors such as premorbid history, demographics and injury characteristics, health care professionals may closely monitor these children and refer to interventions if indications do not resolve within four to six weeks.[51] Children suspected of a threat for delayed recovery are highly likely for intervention and will assess prognostic risk factors for effectively counselling patients.

Presently, there is no test to accurately determine the recovery estimate of pediatric patients who suffered from a concussion.[54]

Epidemiology[]

Concussions are one of the most common traumatic head injuries involved with sports or injuries; young children having the highest rate among all age groups.[55] Among children attending school following a pediatric concussion, 13.7% continued to be symptomatic 3 months afterwards; this could not be explained by trauma, family dysfunction, or psychological adjustment.[56] The rate of incidence of concussions, in general, decreases with age; the younger generation experience head traumas more often.[57]

See also[]

References[]

  1. ^ a b c d e f g h i j k l m n o p q r s t u v w Haas, Rochelle; Zayat, Maya; Sevrin, Amanda (2019-09-24). "Current Concepts in the Evaluation of the Pediatric Patient with Concussion". Current Reviews in Musculoskeletal Medicine. 12 (3): 340–345. doi:10.1007/s12178-019-09561-7. ISSN 1935-9748. PMC 6684694. PMID 31342314.
  2. ^ a b "What are common symptoms of traumatic brain injury (TBI)?". National Institute of Health. Retrieved 2021-03-27.{{cite web}}: CS1 maint: url-status (link)
  3. ^ "Symptoms of Traumatic Brain Injury (TBI) | Concussion | Traumatic Brain Injury | CDC Injury Center". www.cdc.gov. 2019-03-11. Retrieved 2021-03-27.
  4. ^ a b c Lumba-Brown, Angela; Yeates, Keith Owen; Sarmiento, Kelly; Breiding, Matthew J.; Haegerich, Tamara M.; Gioia, Gerard A.; Turner, Michael; Benzel, Edward C.; Suskauer, Stacy J.; Giza, Christopher C.; Joseph, Madeline (2018-11-05). "Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children". JAMA Pediatrics. 172 (11): e182853. doi:10.1001/jamapediatrics.2018.2853. ISSN 2168-6203. PMC 7006878. PMID 30193284.
  5. ^ "TBI: Get the Facts | Concussion | Traumatic Brain Injury | CDC Injury Center". www.cdc.gov. 2019-03-11. Retrieved 2021-03-27.
  6. ^ a b "Pediatric Concussion - Conditions and Treatments | Children's National Hospital". childrensnational.org. Retrieved 2021-03-27.
  7. ^ "Traumatic Brain Injury / Concussion | Concussion | Traumatic Brain Injury | CDC Injury Center". www.cdc.gov. 2020-09-01. Retrieved 2021-03-27.
  8. ^ Lumba-Brown, Angela; Yeates, Keith Owen; Sarmiento, Kelly; Breiding, Matthew J.; Haegerich, Tamara M.; Gioia, Gerard A.; Turner, Michael; Benzel, Edward C.; Suskauer, Stacy J.; Giza, Christopher C.; Joseph, Madeline (2018-11-05). "Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children". JAMA Pediatrics. 172 (11): e182853. doi:10.1001/jamapediatrics.2018.2853. ISSN 2168-6203. PMC 7006878. PMID 30193284.
  9. ^ McCrory, Paul; Meeuwisse, Willem; Dvorak, Jiří; Aubry, Mark; Bailes, Julian; Broglio, Steven; Cantu, Robert C; Cassidy, David; Echemendia, Ruben J; Castellani, Rudy J; Davis, Gavin A (2017-04-26). "Consensus statement on concussion in sport—the 5 th international conference on concussion in sport held in Berlin, October 2016". British Journal of Sports Medicine. 51 (11): bjsports–2017–097699. doi:10.1136/bjsports-2017-097699. ISSN 0306-3674. PMID 28446457. S2CID 42329667.
  10. ^ Davis, Gavin A.; Anderson, Vicki; Babl, Franz E.; Gioia, Gerard A.; Giza, Christopher C.; Meehan, William; Moser, Rosemarie Scolaro; Purcell, Laura; Schatz, Philip; Schneider, Kathryn J.; Takagi, Michael (2017). "What is the difference in concussion management in children as compared with adults? A systematic review". British Journal of Sports Medicine. 51 (12): 949–957. doi:10.1136/bjsports-2016-097415. ISSN 1473-0480. PMID 28455361.
  11. ^ a b Polinder, Suzanne; Cnossen, Maryse C.; Real, Ruben G. L.; Covic, Amra; Gorbunova, Anastasia; Voormolen, Daphne C.; Master, Christina L.; Haagsma, Juanita A.; Diaz-Arrastia, Ramon; von Steinbuechel, Nicole (2018-12-19). "A Multidimensional Approach to Post-concussion Symptoms in Mild Traumatic Brain Injury". Frontiers in Neurology. 9: 1113. doi:10.3389/fneur.2018.01113. ISSN 1664-2295. PMC 6306025. PMID 30619066.
  12. ^ Semple, Bridgette D.; Lee, Sangmi; Sadjadi, Raha; Fritz, Nora; Carlson, Jaclyn; Griep, Carrie; Ho, Vanessa; Jang, Patrice; Lamb, Annick; Popolizio, Beth; Saini, Sonia (2015-04-02). "Repetitive Concussions in Adolescent Athletes – Translating Clinical and Experimental Research into Perspectives on Rehabilitation Strategies". Frontiers in Neurology. 6: 69. doi:10.3389/fneur.2015.00069. ISSN 1664-2295. PMC 4382966. PMID 25883586.
  13. ^ a b "What are the effects of concussion in children?". Mayo Clinic. Retrieved 2021-04-11.
  14. ^ Rose, Sean C.; Weber, Kevin D.; Collen, James B.; Heyer, Geoffrey L. (2015-08-01). "The Diagnosis and Management of Concussion in Children and Adolescents". Pediatric Neurology. 53 (2): 108–118. doi:10.1016/j.pediatrneurol.2015.04.003. ISSN 0887-8994. PMID 26088839.
  15. ^ a b c d e f g h "Signs of Concussion in Children: Warnings for Parents". Healthline. 2016-03-09. Retrieved 2021-04-11.
  16. ^ "Babies' Warning Signs". www.nationwidechildrens.org. Retrieved 2021-03-27.
  17. ^ "CEArticlePrint". nursingcenter.com. Retrieved 2021-04-11.
  18. ^ "Diagnosis and Management of Pediatric Concussions in the ED". www.reliasmedia.com. Retrieved 2021-03-27.
  19. ^ "Clinical Practice Guidelines : Head injury". www.rch.org.au. Retrieved 2021-04-13.
  20. ^ a b Borgialli, Dominic A.; Mahajan, Prashant; Hoyle, John D.; Powell, Elizabeth C.; Nadel, Frances M.; Tunik, Michael G.; Foerster, Adele; Dong, Lydia; Miskin, Michelle; Dayan, Peter S.; Holmes, James F. (2016). "Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma". Academic Emergency Medicine. 23 (8): 878–884. doi:10.1111/acem.13014. hdl:2027.42/133544. ISSN 1553-2712. PMID 27197686.
  21. ^ "What Is the Glasgow Coma Scale?". BrainLine. 2018-02-13. Retrieved 2021-04-11.
  22. ^ Graham, Robert; Rivara, Frederick P.; Ford, Morgan A.; Spicer, Carol Mason; Youth, Committee on Sports-Related Concussions in; Board on Children, Youth; Medicine, Institute of; Council, National Research (2014-02-04). Concussion Recognition, Diagnosis, and Acute Management. National Academies Press (US).
  23. ^ a b c "Sport Concussion Assessment Tool 5 (SCAT5)". Physiopedia. Retrieved 2021-04-11.
  24. ^ "Sport concussion assessment tool for childrens ages 5 to 12 years". British Journal of Sports Medicine. 51 (11): bjsports–2017–097492childscat5. 2017-04-26. doi:10.1136/bjsports-2017-097492childscat5. ISSN 0306-3674. PMID 28446448. S2CID 49341257.
  25. ^ Dhawan, Priya S.; Leong, Danielle; Tapsell, Lisa; Starling, Amaal J.; Galetta, Steven L.; Balcer, Laura J.; Overall, Trenton L.; Adler, Jennifer S.; Halker-Singh, Rashmi B.; Vargas, Bert B.; Dodick, David (2017-12-01). "King-Devick Test identifies real-time concussion and asymptomatic concussion in youth athletes". Neurology: Clinical Practice. 7 (6): 464–473. doi:10.1212/CPJ.0000000000000381. ISSN 2163-0402. PMC 5800721. PMID 29431168.
  26. ^ Galetta, K.M.; Barrett, J.; Allen, M.; Madda, F.; Delicata, D.; Tennant, A.T.; Branas, C.C.; Maguire, M.G.; Messner, L.V.; Devick, S.; Galetta, S.L. (2011-04-26). "The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters". Neurology. 76 (17): 1456–1462. doi:10.1212/WNL.0b013e31821184c9. ISSN 0028-3878. PMC 3087467. PMID 21288984.
  27. ^ "Sideline Assessment – King-Devick technologies, Inc". Retrieved 2021-04-11.
  28. ^ a b c d Graham, Robert; Rivara, Frederick P.; Ford, Morgan A.; Spicer, Carol Mason; Youth, Committee on Sports-Related Concussions in; Board on Children, Youth; Medicine, Institute of; Council, National Research (2014-02-04). Clinical Evaluation Tools. National Academies Press (US).
  29. ^ "Ophthalmoscopy: Purpose, Procedure, and Risks". Healthline. 2016-12-19. Retrieved 2021-04-13.
  30. ^ "Funduscopy". National Cancer Institute. 2011-02-02. Retrieved 2021-04-13.{{cite web}}: CS1 maint: url-status (link)
  31. ^ "Concussion Diagnostic Exams | Neurological Tests at Beaumont | Beaumont Health". www.beaumont.org. Retrieved 2021-04-13.
  32. ^ "Vestibular Ocular Motor Screening (VOMS) | Concussion Diagnosis". UPMC Sports Medicine. Retrieved 2021-04-13.
  33. ^ Mucha, Anne; Collins, Michael W.; Elbin, R.J.; Furman, Joseph M.; Troutman-Enseki, Cara; DeWolf, Ryan M.; Marchetti, Greg; Kontos, Anthony P. (2014-10-26). "A Brief Vestibular/Ocular Motor Screening (VOMS) Assessment to Evaluate Concussions". The American Journal of Sports Medicine. 42 (10): 2479–2486. doi:10.1177/0363546514543775. ISSN 0363-5465. PMC 4209316. PMID 25106780.
  34. ^ Ruhe, Alexander; Fejer, René; Gänsslen, Axel; Klein, Wolfgang (2014-09-06). "Assessing Postural Stability in the Concussed Athlete". Sports Health. 6 (5): 427–433. doi:10.1177/1941738114541238. ISSN 1941-7381. PMC 4137680. PMID 25177420.
  35. ^ "BESS Test for Balance Assessment". Tekscan. 2018-06-13. Retrieved 2021-03-27.
  36. ^ a b c Schaefer, Lynn A.; Thakur, Tanu; Meager, Michael R. (2021), "Neuropsychological Assessment", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30020682, retrieved 2021-04-13
  37. ^ "Magnetic Resonance Imaging (MRI)". www.nibib.nih.gov. Retrieved 2021-04-12.
  38. ^ a b Churchill, Nathan W.; Hutchison, Michael G.; Richards, Doug; Leung, General; Graham, Simon J.; Schweizer, Tom A. (2017-08-24). "Neuroimaging of sport concussion: persistent alterations in brain structure and function at medical clearance". Scientific Reports. 7 (1): 8297. Bibcode:2017NatSR...7.8297C. doi:10.1038/s41598-017-07742-3. ISSN 2045-2322. PMC 5571165. PMID 28839132.
  39. ^ Raschle, Nora; Zuk, Jennifer; Ortiz-Mantilla, Silvia; Sliva, Danielle D.; Franceschi, Angela; Grant, P. Ellen; Benasich, April A.; Gaab, Nadine (2013-04-01). "Pediatric neuroimaging in early childhood and infancy: challenges and practical guidelines". Annals of the New York Academy of Sciences. 1252: 43–50. doi:10.1111/j.1749-6632.2012.06457.x. ISSN 0077-8923. PMC 3499030. PMID 22524338.
  40. ^ "Traumatic Brain Injury Information Page | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Retrieved 2021-03-27.
  41. ^ Bressan, Silvia; Babl, Franz E (2015-07-14). "Diagnosis and management of paediatric concussion: Paediatric concussion". Journal of Paediatrics and Child Health. 52 (2): 151–157. doi:10.1111/jpc.12967. PMID 26174579. S2CID 8030881.
  42. ^ a b "What are the treatments for traumatic brain injury (TBI)?". National Institute of Health. Retrieved 2021-03-27.{{cite web}}: CS1 maint: url-status (link)
  43. ^ Makdissi, Michael; Cantu, Robert C; Johnston, Karen M; McCrory, Paul; Meeuwisse, Willem H (2013-04-01). "The difficult concussion patient: what is the best approach to investigation and management of persistent (>10 days) postconcussive symptoms?". British Journal of Sports Medicine. 47 (5): 308–313. doi:10.1136/bjsports-2013-092255. ISSN 0306-3674. PMID 23479490. S2CID 9177143.
  44. ^ CDC (2020-10-02). "Responding to a Concussion and Action Plan for Coaches". Centers for Disease Control and Prevention. Retrieved 2021-03-27.
  45. ^ Gupta, Anjali; Summerville, Greg; Senter, Carlin (2019-03-18). "Treatment of Acute Sports-Related Concussion". Current Reviews in Musculoskeletal Medicine. 12 (2): 117–123. doi:10.1007/s12178-019-09545-7. ISSN 1935-9748. PMC 6542872. PMID 30887284.
  46. ^ Zimmerman, Stessie Dort; Vernau, Brian T.; Meehan, William P.; Master, Christina L. (2021-01-01). "Sports-Related Concussions and the Pediatric Patient". Clinics in Sports Medicine. 40 (1): 147–158. doi:10.1016/j.csm.2020.08.010. PMID 33187605. S2CID 226947984.
  47. ^ DeMatteo, Carol; Bednar, E Dimitra; Randall, Sarah; Falla, Katie (2020-02-24). "Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review". BMJ Open Sport & Exercise Medicine. 6 (1): e000667. doi:10.1136/bmjsem-2019-000667. ISSN 2055-7647. PMC 7047486. PMID 32153982.
  48. ^ Beauchamp, Kathryn; Mutlak, Haitham; Smith, Wade R.; Shohami, Esther; Stahel, Philip F. (2008-11-01). "Pharmacology of Traumatic Brain Injury: Where Is the "Golden Bullet"?". Molecular Medicine. 14 (11–12): 731–740. doi:10.2119/2008-00050.Beauchamp. ISSN 1076-1551. PMC 2527342. PMID 18769636.
  49. ^ Meehan, William P. (2011-01-01). "Medical Therapies for Concussion". Clinics in Sports Medicine. 30 (1): 115–124. doi:10.1016/j.csm.2010.08.003. PMC 3359788. PMID 21074086.
  50. ^ "Concussion in children and adolescents: Management". www.uptodate.com. Retrieved 2021-03-27.{{cite web}}: CS1 maint: url-status (link)
  51. ^ a b Iverson, Grant L; Gardner, Andrew J; Terry, Douglas P; Ponsford, Jennie L; Sills, Allen K; Broshek, Donna K; Solomon, Gary S (2017-06-01). "Predictors of clinical recovery from concussion: a systematic review". British Journal of Sports Medicine. 51 (12): 941–948. doi:10.1136/bjsports-2017-097729. ISSN 0306-3674. PMC 5466929. PMID 28566342.
  52. ^ a b c Babikian, Talin; Satz, Paul; Zaucha, Ken; Light, Roger; Lewis, Richard S.; Asarnow, Robert F. (2011-09-04). "The UCLA Longitudinal Study of Neurocognitive Outcomes Following Mild Pediatric Traumatic Brain Injury". Journal of the International Neuropsychological Society. 17 (5): 886–895. doi:10.1017/S1355617711000907. ISSN 1355-6177. PMC 4579245. PMID 21813031.
  53. ^ Zemek, Roger L.; Farion, Ken J.; Sampson, Margaret; McGahern, Candice (2013-03-01). "Prognosticators of Persistent Symptoms Following Pediatric Concussion: A Systematic Review". JAMA Pediatrics. 167 (3): 259–265. doi:10.1001/2013.jamapediatrics.216. ISSN 2168-6203. PMID 23303474.
  54. ^ Kamins, Joshua; Bigler, Erin; Covassin, Tracey; Henry, Luke; Kemp, Simon; Leddy, John J; Mayer, Andrew; McCrea, Michael; Prins, Mayumi; Schneider, Kathryn J; Valovich McLeod, Tamara C (2017-06-01). "What is the physiological time to recovery after concussion? A systematic review". British Journal of Sports Medicine. 51 (12): 935–940. doi:10.1136/bjsports-2016-097464. ISSN 0306-3674. PMID 28455363.
  55. ^ Ropper, Allan H.; Gorson, Kenneth C. (2007-01-11). "Concussion". New England Journal of Medicine. 356 (2): 166–172. doi:10.1056/NEJMcp064645. ISSN 0028-4793. PMID 17215534.
  56. ^ Barlow, K. M.; Crawford, S.; Stevenson, A.; Sandhu, S. S.; Belanger, F.; Dewey, D. (2010-08-01). "Epidemiology of Postconcussion Syndrome in Pediatric Mild Traumatic Brain Injury". Pediatrics. 126 (2): e374–e381. doi:10.1542/peds.2009-0925. ISSN 0031-4005. PMID 20660554. S2CID 36915304.
  57. ^ Gordon, Kevin E.; Dooley, Joseph M.; Wood, Ellen P. (2006). "Descriptive Epidemiology of Concussion". Pediatric Neurology. 34 (5): 376–378. doi:10.1016/j.pediatrneurol.2005.09.007. PMID 16647998.
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