Medical Therapies for Concussion

Meehan, William P.

doi:10.1016/j.csm.2010.08.003

Cited by 114 publications

(113 citation statements)

References 78 publications

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“…Such accommodations allow for relative cognitive rest in the setting of the school year and are an important first step in the management of concussion. 13,[22][23][24] Given our findings, it is likely that academic accommodations can speed the recovery process. It is worth noting, however, that although those in the highest quartile of cognitive activity experienced a substantially longer duration of symptoms, those engaged in the 3 lower quartiles of cognitive activity had similar trajectories of symptom duration (Fig 1).…”

Section: Discussionmentioning

confidence: 96%

“…11 Although it is difficult to quantify, cognitive rest entails limiting activities that require attention and concentration, such as reading, text messaging, video game playing, working online, and performing schoolwork. 12,13 One of the most commonly cited hypotheses regarding the pathophysiology of concussion postulates that shear forces experienced at the time of injury lead to ionic fluxes, the indiscriminant releases of excitatory neurotransmitters, and a spreading depression-like phenomenon. [14][15][16][17][18] Adenosine triphosphate (ATP) is required to restore homeostasis, but there is decreased cerebral blood flow after injury.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms

et al. 2014

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To determine the effect of cognitive activity level on duration of post-concussion symptoms. METHODS:We conducted a prospective cohort study of patients who presented to a Sports Concussion Clinic within 3 weeks of injury between October 2009 and July 2011. At each visit, patients completed a scale that recorded their average level of cognitive activity since the previous visit. The product of cognitive activity level and days between visits (cognitive activity-days) was calculated and divided into quartiles. Kaplan-Meier Product Limit method was used to generate curves of symptom duration based on cognitive activity level. To adjust for other possible predictors of concussion recovery, we constructed a Cox proportional hazard model with cognitive activity-days as the main predictor. RESULTS:Of the 335 patients included in the study, 62% were male, 19% reported a loss of consciousness, and 37% reported experiencing amnesia at the time of injury. The mean age of participants was 15 years (range, 8-23) and the mean number of previous concussions was 0.76; 39% of athletes had sustained a previous concussion. The mean Post-Concussion Symptom Scale score at the initial visit was 30 (SD, 26). The overall mean duration of symptoms was 43 days (SD, 53). Of all variables assessed, only total symptom burden at initial visit and cognitive activity level were independently associated with duration of symptoms.CONCLUSIONS: Increased cognitive activity is associated with longer recovery from concussion. This study supports the use of cognitive rest and adds to the current consensus opinion. Pediatrics 2014;133:e299-e304 AUTHORS:

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms

et al. 2014

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“…Sportrelated concussion was the most common mechanism, accounting for 30% of all concussions in persons between 5 and 19 years old. 45 In high school athletes, Powell and Barber-Foss 151 reported that AT-diagnosed concussions accounted for 5.5% of all sports injuries. More recently, data from High School Reporting Information Online (RIO) indicated that concussions in interscholastic athletes were responsible for 8.9% of all athletic injuries 67 and that the overall concussion incidence rate according to RIO was 0.23 concussions per 1000 athlete exposures, with a game rate of 0.53 and a practice rate of 0.11 per 1000 athlete exposures.…”

Section: Other Considerationsmentioning

confidence: 99%

National Athletic Trainers' Association Position Statement: Management of Sport Concussion

Broglio

Cantu

Gioia

et al. 2014

Journal of Athletic Training

724

625

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Objective:To provide athletic trainers, physicians, and other health care professionals with best-practice guidelines for the management of sport-related concussions.Background: An estimated 3.8 million concussions occur each year in the United States as a result of sport and physical activity. Athletic trainers are commonly the first medical providers available onsite to identify and evaluate these injuries. Recommendations:The recommendations for concussion management provided here are based on the most current research and divided into sections on education and prevention, documentation and legal aspects, evaluation and return to play, and other considerations.

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“…Many medications presently prescribed for severe postconcussive symptoms 102 have known effects on CBF, including stimulants, b blockers, calcium channel blockers, and triptans. Additionally, the prescription of "cognitive rest" has become commonplace 1 and is based on the concept of reducing cerebral metabolic demand.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Sports-Related Concussion Produces Cerebral Blood Flow Alterations

2011

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT:The pathophysiology of pediatric sports-related concussion (SRC) is largely unknown. Studies of concussed adults have identified neuronal and axonal injury and time-limited metabolic disruptions. An experimental animal model has also demonstrated physiologic perturbations, including reduced cerebral blood flow (CBF). WHAT THIS STUDY ADDS:Using MRI techniques, we found no evidence of neuronal, axonal, or metabolic disruptions in 12 children with SRC. However, when compared with controls, statistically significant alterations in CBF were defined and frequently persisted beyond 30 days after injury.abstract OBJECTIVE: The pathophysiology of sports-related concussion (SRC) is incompletely understood. Human adult and experimental animal investigations have revealed structural axonal injuries, decreases in the neuronal metabolite N-acetyl aspartate, and reduced cerebral blood flow (CBF) after SRC and minor traumatic brain injury. The authors of this investigation explore these possibilities after pediatric SRC. PATIENTS AND METHODS:Twelve children, ages 11 to 15 years, who experienced SRC were evaluated by ImPACT neurocognitive testing, T1 and susceptibility weighted MRI, diffusion tensor imaging, proton magnetic resonance spectroscopy, and phase contrast angiography at ,72 hours, 14 days, and 30 days or greater after concussion. A similar number of age-and gender-matched controls were evaluated at a single time point. RESULTS:ImPACT results confirmed statistically significant differences in initial total symptom score and reaction time between the SRC and control groups, resolving by 14 days for total symptom score and 30 days for reaction time. No evidence of structural injury was found on qualitative review of MRI. No decreases in neuronal metabolite N-acetyl aspartate or elevation of lactic acid were detected by proton magnetic resonance spectroscopy. Statistically significant alterations in CBF were documented in the SRC group, with reduction in CBF predominating (38 vs 48 mL/100 g per minute; P = .027). Improvement toward control values occurred in only 27% of the participants at 14 days and 64% at .30 days after SRC.CONCLUSIONS: Pediatric SRC is primarily a physiologic injury, affecting CBF significantly without evidence of measurable structural, metabolic neuronal or axonal injury. Further study of CBF mechanisms is needed to explain patterns of recovery.

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Medical Therapies for Concussion

Cited by 114 publications

References 78 publications

Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms

Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms

National Athletic Trainers' Association Position Statement: Management of Sport Concussion

Pediatric Sports-Related Concussion Produces Cerebral Blood Flow Alterations

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