Concussion in School Age & Adolescents

With a lot of talk in the media regarding concussions, it is important to know the signs and symptoms for your children. Winter sport especially has a high risk for concussion, and all younger athletes that wish to return to sport should have a review with a physiotherapist specialising in concussion prior to doing so. Our specialist physios Amanda, Anna & Kelsey will help your children get back to the playing field and ensure their education is not interrupted.

Senior Physio Anna O'Loughlin runs you through the important Concussion facts below.

Concussion School Age Children and Adolescents

Brain development in the child (5–12 years) and adolescent (13–18 years) and necessitate guidance on return to school and a more conservative return to sport.

Paediatric athletes are less likely to have trained medical personnel available on the sideline, and it is strongly recommended that the CRT6 be used by all adults supervising child and adolescent sport. The Child SCAT6 (8–12 years) and SCAT6 (adolescents) should be used by health professionals.

Risk factors for increase risk of concussion:

· Prior concussion

· Younger age

· Female sex

Risk Factors for prolonger recovery include:

· Multiple symptoms

· Post-concussion memory dysfunction

· Headache and migraine symptoms

· Younger age and female sex.

New Updates Released on Management of Concussion in Children

RETURN-TO-LEARN (RTL)

The transition back to learning and to school following SRC is an important consideration for children, adolescents and young adults. If symptom exacerbation occurs during cognitive activity or screen time, difficulties with reading, concentration or memory or other aspects of learning are reported, a RTL strategy under the guidance of a concussion specialist should be considered. Returning to school can be more difficult for children with high acute symptom severity and a prior learning disability. Some students may require academic supports to promote RTL including:

• Environmental adjustments, such as; modified school attendance, frequent rest breaks from cognitive/thinking/deskwork tasks throughout the day and/or limited screen time on electronic devices.

• Physical adjustments to avoid any activities at risk of contact, collision or falls, such as contact sports or game play during physical education classes or after-school activities, while allowing for safe non-contact PA (eg, walking).

• Curriculum adjustments, such as extra time to complete assignments/homework and/or preprinted class notes.

• Testing adjustments, such as delaying tests/quizzes and/or permitting additional time to complete them.41

RETURN-TO-SPORT (RTS)

Athletes may begin Step 1 (ie, symptom-limited activity) within 24 hours of injury, with progression through each subsequent step typically taking a minimum of 24 hours. Progression through the later RTS strategy (Steps 4–6) should be monitored by an HCP.

Return-to-sport recommendations

RTS participation after SRC follows a graduated stepwise strategy, guided by a concussion specialist. The athlete should advance on a time course dictated by symptoms, cognitive function, examination findings and clinical judgement. Athletes having difficulty progressing through the RTS strategy or with symptoms and signs that are not progressively recovering may benefit from rehabilitation in addition to the RTL and RTS strategies.

Key Points:

· A Concussion Specialist may be warranted to assess and treat individuals with persisting cervicogenic symptoms, migraine and headache, cognitive and psychological difficulties, balance disturbances, vestibular signs and oculomotor manifestations. If dizziness, neck pain and/or headaches persist for more than 10 days, cervicovestibular rehabilitation is recommended

· If symptoms persist beyond 4 weeks in children and adolescents, active rehabilitation and collaborative care is recommended

· A multimodal clinical assessment, is indicated to characterise individuals with persisting symptoms, including the types, pattern and severity of symptoms, and any associated conditions or other factors that may be causing or contributing to the symptoms.

· Students should complete a full return to school prior to unrestricted return to sport.

· Treatment should be specific for the individuals; age, gender and symptom presentation.

· The systematic review of RTL and RTS found that continuing to play and delayed access to HCPs after SRC are associated with longer recovery

Who needs Concussion Rehabilitation?

· Children and adolescents with repeat concussions wishing to continue to play contact sport or to progress to the next age-level group or elite pathway programmes.

· Children and adolescents with a risk of prolonged recovery - Multiple symptoms, Post-concussion memory dysfunction, Headache and migraine symptoms, Younger age and female sex.

References:

Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022. British Journal of Sports Medicine 2023;57:695-711.

Scopaz KA, Hatzenbuehler JR. Risk modifiers for concussion and prolonged recovery. Sports Health. 2013 Nov;5(6):537-41. doi: 10.1177/1941738112473059. PMID: 24427429; PMCID: PMC3806172.