Use of Modified Acute Concussion Evaluation Tools in the Emergency Department in a Pediatric Population

In the pediatric population, mild traumatic brain injuries (concussions) make up 75%-90% of all acquired brain injuries evaluated in emergency departments (ER) in the US.  The Acute Concussion Evaluation (ACE) system published by the Centers for Disease Control and Prevention was developed to assist in identification and diagnosis of concussions. The ACE Care Plan tool was developed to guide management, including individualized recommendations for daily life, school, work and return to play. This tool was originally felt to be too time consuming for ER physicians. For this study a modified version was created and preformed on a patient population between ages 5-21. A primary concern of post ED management of concussions was the importance of ongoing outpatient rehabilitation, in this study it was found that this tool improved reported follow-up post-implementation for all patients. It also found an improvement in parent recall of concussion education. For full study.

Concussion rehab focusing on the inner ear and cervical spine

As the impact of concussions become more known in sports a major factor to look at has been time to return to sport. The researchers at the Sports Injury Prevention Research Center of University of Calgary looked at the effects of rehabilitating the cervical spine and vestibular system in a cohort of post-concussed athletes between the ages of 12-30 and the amount of time until they were medically cleared to return to sport.  18 males and 13 females were randomized between the control group and the intervention group. The intervention group received cervical spine and vestibular rehabilitation for 8-weeks or until they were medically cleared. Of the patients receiving therapy 73% were medically cleared to return to their sport in 8 weeks compared to only 4% of the control group.  An article discussing this study was written in the Globe and Mail or See original study

Current state of diagnostic testing in concussion management

Returning an athlete to the game should imply that who ever made the decision fully understands the nuances of the concussion. 

There are many ways we collect quantitative information that gets us closer to understanding the areas affected after brain injury. The information however needs to be interpreted and understood well to determine the type of rehabilitation that well assists injured individuals on returning their brain to pre injury state. In this attached manuscript, we are reviewing the state of concussion testing, diagnostic rating scales and tools available to identify the nuances of concussions. At Concussion Management of New York we are clinician rather than test centered. We utilize these tools collectively or individually when most appropriate.

Lasting effects after mild concussions

Abnormal brain structural patterns persist months after clinical symptoms had resolved from a mild concussion researchers found at the Lovelace Biomedical and Environmental Research Institute in Albuquerque, N.M.

Dr. Mayer and colleagues examined the underlying pathophysiology of mild traumatic brain injury through changes in gray matter diffusion and atrophy during the semiacute stage and found evidence that structural changes persist long past the improvement in neuropsychological tests. In a study that involved 50 participants, 26 patients showed evidence of increased cortical gray matter anisotropic diffusion 4 months post injury.

See full study

Traumatic-Triggered Migraines vs Concussions

Family history of migraines is a precursor to headaches in children and as per studies cited bellow, head trauma and concussions may increase the length of headaches and complicate treatment. The question is: are Traumatic-Triggered Migraines (TTM’s) different than headaches as a concussive characteristic? and should they be treated differently? The case study referenced by Lords, Q reported in Sports Health Multidisciplinary App.(Traumatic Migraine Versus Concussion: A Case Report.)   presented a different look at their diagnosis and treatment approach.  This report instead of actually  separating them apart it may be pointing out how related they are or that one is part of the other. Headaches post injury may be more or less severe, longer lasting and have a genetic component but should be dealt with in the contest of brain injury. The word “Concussion” can at this time, after it became a popular word in sports, complicate how we deal with it. Because concussions have the sports connotation is easy to fall into the trap of making us follow the light path others have taken and skip important steps toward treatment. In the brain injury world, per say, I can relate to the stance of wanting to distance ourselves from what the word “concussion” is becoming and try to separate its components, such as headaches, and give it another name as it clearly happens in the cited article. For example in this study the author seem to attempt to separate the diagnosis between what a concussion is and what traumatic related headaches or migraines are. Headaches and migraines most times are components of a concussion were its nature, historic and genetic component challenges current diagnosis and treatment methods.

Have you dealt with headaches and/or migraines pre and post injury? Can you separate them and what approaches have you tried with or without success?

Click for referenced studies here…