Athletes with concussion appear to still show navigational deficits in environments well after being considered fully recovered according to current return-to-play protocols. Although still preliminary and requiring further study, the present findings suggest that functional assessment within complex environment contexts could be considered before sending athletes back to play following a concussion, even in the absence of postconcussion symptoms or with normal clinical outcomes.

Background. There is a lack of scientific evidence in the literature on the involvement of the cervical spine in mTBI; however, its involvement is clinically accepted. Objective. This paper reviews evidence for the involvement of the cervical spine in mTBI symptoms, the mechanisms of injury, and the efficacy of therapy for cervical spine with concussion-related symptoms. Methods. A keyword search was conducted on PubMed, ICL, SportDiscus, PEDro, CINAHL, and Cochrane Library databases for articles published since 1990. The reference lists of articles meeting the criteria (original data articles, literature reviews, and clinical guidelines) were also searched in the same databases. Results. 4,854 records were screened and 43 articles were retained. Those articles were used to describe different subjects such as mTBI's signs and symptoms, mechanisms of injury, and treatments of the cervical spine. Conclusions. The hypothesis of cervical spine involvement in post-mTBI symptoms and in PCS (postconcussion syndrome) is supported by increasing evidence and is widely accepted clinically. For the management and treatment of mTBIs, few articles were available in the literature, and relevant studies showed interesting results about manual therapy and exercises as efficient tools for health care practitioners.

Mild traumatic brain injury (mTBI) is common in youth, especially in those who participate in sport. Recent investigations from our group have shown that asymptomatic children and adolescents with mTBI continue to exhibit alterations in neural activity and cognitive performance compared with those without a history of mTBI. This is an intriguing finding, given that current return-to-learn and return-to-play protocols rely predominately on subjective symptom reports, which may not be sensitive enough to detect subtle injury-related changes. As a result, youth may be at greater risk for re-injury and long-term consequences if they are cleared for activity while their brains continue to be compromised. It is currently unknown whether mTBI also affects brain microstructure in the developing brain, particularly cortical thickness, and whether such changes are also related to cognitive performance. The present study examined cortical thickness in 13 asymptomatic youth (10-14 years old) who had sustained an mTBI 3-8 months prior to testing compared with 14 age-matched typically developing controls. Cortical thickness was also examined in relation to working memory performance during single and dual task paradigms. The results show that youth who had sustained an mTBI had thinner cortices in the left dorsolateral prefrontal region and right anterior and posterior inferior parietal lobes. Additionally, cortical thinning was associated with slower reaction time during the dual-task condition in the injured youth only. The results also point to a possible relationship between functional and structural alterations as a result of mTBI in youth, and lend evidence for neural changes beyond symptom resolution.

Gait fluidity may be a more sensitive variable than gait speed for revealing executive dysfunction following mTBI in EA. Assessing DTW in level walking also seems to show a potential to reveal executive dysfunctions in this age group. These results provide direction for future research on clinical assessment using DTW post-mTBI in adolescents.

Objective. The aim of this study was to identify whether the addition of an individualised Active Rehabilitation Intervention to standard care influences recovery of young patients who are slow-to-recover following a mTBI. Methods. Fifteen participants aged 15 ± 2 years received standard care and an individualised Active Rehabilitation Intervention which included (1) low- to high-intensity aerobic training; (2) sport-specific coordination exercises; and (3) therapeutic balance exercises. The following criteria were used to measure the resolution of signs and symptoms of mTBI: (1) absence of postconcussion symptoms for more than 7 consecutive days; (2) cognitive function corresponding to normative data; and (3) absence of deficits in coordination and balance. Results. The Active Rehabilitation Intervention lasted 49 ± 17 days. The duration of the intervention was correlated with self-reported participation (truex-=84.64±19.63%, r = −0.792, p < 0.001). The average postconcussion symptom inventory (PCSI) score went from a total of 36.85 ± 23.21 points to 4.31 ± 5.04 points after the intervention (Z = −3.18, p = 0.001). Conclusion. A progressive submaximal Active Rehabilitation Intervention may represent an important asset in the recovery of young patients who are slow-to-recover following a mTBI.

Introduction Approximately 25% of people with sport-related concussion (SRC) experiences persistent symptoms. The 2016 Berlin consensus on SRC recommends symptom-limited aerobic exercise as a rehabilitation option for persistent symptoms after concussion. However, this recommendation is based on a limited body of knowledge because there is uncertainty about the effectiveness of such interventions. The objective of this systematic review is to assess the effects of symptom-limited aerobic exercise programs compared with control interventions on symptom intensity in individuals with SRC. Methods A structured search was conducted in MEDLINE, EMBASE, CINHAL, and EBM reviews. Randomized clinical trials (RCT) including aerobic exercise programs as an intervention for SRC were included. After selection, the risk of bias and Grading of Recommendations, Assessment, Development and Evaluation recommendations were applied to pooled studies for quantitative analysis. Standard mean differences (SMD) and 95% confidence interval (CI) were calculated. A descriptive analysis was also performed. Results Seven RCT (326 participants) in adolescent populations were included. Three of seven RCT had a high risk of bias. Symptom-limited aerobic exercise programs have a significant beneficial effect on the perception of symptoms (6 studies, 277 participants, low-quality evidence; pooled SMD, −0.44; 95% CI, −0.68 to −0.19). When introduced in the acute phase, symptom-limited aerobic exercise programs have a significant beneficial effect on symptomatic recovery compared with control interventions (3 studies, 206 participants, moderate quality evidence, pooled SMD, −0.43; 95% CI, −0.71 to −0.15). Conclusions Symptom-limited aerobic exercise programs are beneficial in improving symptoms of adolescents after an SRC. Good-quality studies are needed to determine effects on adults and on other outcomes.

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Mild traumatic brain injury (mTBI) is a common cause of injury in youth athletes. Much of what is known about the sequelae of mTBI is yielded from the adult literature, and it appears that it is mainly those with persistent post-injury symptoms who have ongoing cognitive and neural abnormalities. However, most studies have employed single-task paradigms, which may not be challenging enough to uncover subtle deficits. We sought to examine the neural correlates of dual-task performance in male athletes aged 9-15 years using a functional neuroimaging protocol. Participants included 13 youths with a history of mTBI three to six months prior to testing and 14 typically-developing controls. All participants completed a working memory task in isolation (single-task) and while completing a concurrent motor task (dual-task); neural activity during performance was then compared between groups. Although working memory performance was similar during the single-task condition, increased working memory load resulted in an altered pattern of neural activation in key working memory areas (i.e., dorsolateral prefrontal and parietal cortices) in youth with mTBI relative to controls. During the dual-task condition, accuracy was similar between groups but injured youth performed slower than typically-developing controls, suggesting a speed-accuracy tradeoff in the mTBI group only. The injured youths also exhibited abnormal recruitment of brain structures involved in both working memory and dual-tasking. These data show that the dual-task paradigm can uncover functional impairments in youth with mTBI who are not highly symptomatic and who do not exhibit neuropsychological dysfunction. Moreover, neural recruitment abnormalities were noted in both task conditions, which we argue suggests mTBI-related disruptions in achieving efficient cognitive control and allocation of processing resources.