Clinician-to-Clinician Update Clinician-to-Clinician Update

Neuropsychology Evaluations Aid Recovery in Pediatric Concussion Patients

June 2016

Concussion is a growing public health concern, particularly as it affects the pediatric population. Among teenagers and young adults, sports injuries are the second-leading cause of concussions. According to one large study of U.S. high school athletes who had participated in any of 20 different sports during the 2008-2010 academic years, athletic-related concussions occur at an overall incidence of 2.5 per 10,000 exposures (practices or competitions).1 Although attempts to characterize the condition have generated debate, the definition posed in a 2014 Institute of Medicine, National Research Council report may reflect a recent consensus: “a clinical syndrome involving a disturbance in brain function that is generally time-limited and results from biomechanical forces, such as a bump, blow, or jolt to the head or body.”2 (p27) Of note, loss-of-consciousness has been reported to occur in less than 5% of sport-related cases of concussion.3

Symptoms-of-Concussions-Table-1-June-2016-Peds-Issue-Opt-2

Concussion is generally diagnosed based on the presence of multiple signs and symptoms that occur across four domains.2 (p100, 105), 4 (See Table 1.) Imaging studies are typically used to rule out more advanced brain injury.2 (p102-104) Cognitive signs and symptoms include difficulty thinking clearly, a feeling of slow cognition, and difficulty learning new information. Physical signs and symptoms include headache, blurred vision, nausea and vomiting, fatigue, dizziness, or unusual sensitivity to noise and light. Patients with concussion may have emotional disturbances, such as irritability, depression, anxiety, or emotional lability. Sleep problems may include difficulty falling asleep or sleeping more or less than usual. Precautions should be taken against returning too quickly to sports or activities that carry a risk of additional head injury.4 A number of studies have reported associations between recurrent sport-related concussions and an increased risk of deleterious cognitive and neurological outcomes, including depression5, cognitive impairment5, 6, Alzheimer’s disease6, 7, dementia6, 7, and parkinsonism7.

Recent studies show that most patients will recover from a sports-related concussion within 13 to 18 days; however, sometimes persistent symptoms can last for weeks or months8, 9 (see Case Study). These patients should be referred promptly for further multimodal neuropsychology and concussion-care evaluations. Such evaluations may include a neuropsychological evaluation, assessment of patient-reported symptoms, and assessments of balance and posture.2 (p105)

References

  1. Marar M, et al. Epidemiology of concussions among United States high school athletes in 20 sports. Am J Sports Med. 2012;40:747-755.
  2. Committee on Sports-Related Concussions in Youth; Board on Children, Youth, and Families; Institute of Medicine; National Research Council; Graham R, Rivara FP, Ford MA, Spicer CM, editors. Sports-related concussions in youth: improving the science, changing the culture. Institute of Medicine Report, 2013.
  3. Meehan WP III, et al. High school concussions in the 2008-2009 academic year: mechanism, symptoms, and management. Am J Sports Med. 2010;38:2405-2409.
  4. The Centers for Disease Control and Prevention. Traumatic Brain Injury & Concussion. What are the Signs and Symptoms of Concussion? Available at http://www.cdc.gov/traumaticbraininjury/symptoms.html.
  5. Decq P, et al. Long-term consequences of recurrent sports concussion. Acta Neurochir (Wien). 2016;158:289-300.
  6. Abner EL, et al. Self-reported head injury and risk of late-life impairment and AD pathology in an AD center cohort. Dement Geriatr Cogn Disord. 2014;37:294-306.
  7. Simma B, et al. Mild head injury in pediatrics: algorithms for management in the ED and in young athletes. Am J Emerg Med. 2013;31:1133-1138.
  8. Eisenberg MA, et al. Time interval between concussions and symptom duration. Pediatrics. 2013;132:8-17.
  9. Heyer GL, et al. Specific factors influence postconcussion symptom duration among youth referred to a sports concussion clinic. J Pediatr. 2016 Apr 4.

When to refer

At University of Minnesota Masonic Children’s Hospital, patients with concussion benefit from our multidisciplinary care team of neuropsychology specialists. Our comprehensive approach to concussion evaluation includes a close collaboration with the referring physician, family members, school officials, and teachers. In addition, we continue to perform leading-edge research, providing your patients access to current clinical trials.

All patients with concussion can benefit from a comprehensive evaluation; however, patients who continue to have physical, cognitive, emotional, or sleep-related symptoms more than 14 days postinjury should be referred promptly.

We are available to patients at our locations in Minneapolis and Burnsville. For more information, please visit childrens.mhealth.org/care/specialties/ neuropsychology-pediatrics.

Collaborative Care

The concussion care team at University of Minnesota Masonic Children’s Hospital includes clinicians from developmental medicine, emergency medicine, neurology, neuropsychology, orthopaedics, psychology, rehabilitation, and sports medicine. We consider the referring provider to be a critical part of the care team, and we strive to be your partner in caring for your patients and supporting your practice. Patients with concussion will be seen at our clinic promptly, generally within 1 week if requested. We are committed to partnering with you to design the best care plan for your patients, and we are also available to consult about your patients, with or without a referral.

To view current clinical trials available through M Health providers, visit studyfinder.umn.edu.

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