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

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 postinjury/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. Video LinkThe video component of this article can be found at

Heart rate variability following youth concussion: how do autonomic regulation and concussion symptoms differ over time postinjury?

“…Participants were part of a larger preinjury baseline testing study and completed a multimodal assessment consisting of physical, neurocognitive, subjective symptom reporting and physiological (HRV) measures (Reed et al , 2014). 21 This study solely focused on the relationship between subjective concussion symptom reporting and objective HRV measures. Inclusion criteria were the following: male or female; ages 13–18 years old.…”

“…On receiving their informed consent, all participants completed a baseline/preinjury assessment 21 that included the completion of the demographic collection form (age [years], sex, concussion history [yes/no], number of previous concussions, type of sport and level of competition in their primary sport), PCSI, and participants were fitted with a Polar RS800CX watch and chest strap (RS800CX; Polar Electro, Kemple, Finland). Due to the group-based testing environment of the larger baseline study, individual availability and school schedules, the start and stop time of the HRV data collection varied.…”

Concussion-Like Symptoms in Child and Youth Athletes at Baseline: What Is “Typical”?

“…10 Testing occurred at either a hospital-based concussion research center or the participant's school or sports arena. A consistent team of trained assessors with backgrounds in rehabilitation or kinesiology or both conducted the testing in all settings.…”

“…The age-appropriate version of the PCSI was administered as part of the baseline testing protocol. 10 Although most participants were able to complete the test independently, assessors were available to assist as needed. For questions relating to health, previous concussion, and learning-related factors, participants were asked if they were ever told by a health care or educational professional that they had condition X (ie, previously diagnosed concussion, learning disability, attention-deficit or attention-deficit/hyperactivity disorder).…”

“…Baseline assessment may include computerized neurocognitive assessment (eg, ImPACT; ImPACT Applications Inc, Pittsburgh, PA) 6 and measures of physical function (eg, balance, coordination). 10 After concussion, these measures are readministered and self-reported symptoms are collected and compared with preinjury scores to guide decision making regarding return to activity (eg, school or sport). 3,4,6,7 Scales to quantify subjective symptom reporting have been developed to help clinicians detect and monitor the presence of changes in symptoms and are often used as part of the preseason baseline assessment for athletes.…”