Children who experience concussions may find some symptoms fading relatively quickly while others emerge later in a progression that authors of a new study believe should inform how these children are cared for at home and school. This "significant burden of disease" tends to begin with physical symptoms that end soon after the injury, emotional symptoms occurring later, and cognitive symptoms beginning immediately at lasting for 1 month or more.
The new study, e-published in the May 12 issue of Pediatrics (abstract only available for free), tracked self-reports of 235 patients aged 11 to 22 who presented to a hospital emergency department (ED) with concussion. Patients (or their parents) filled out the Rivermead Post-Concussion Symptoms Questionnaire at or near the time of injury, and then at 1, 2, 4, 6, 8, and 12 weeks afterwards. Authors chose the Rivermead instrument because of its high inter-rater and test-retest reliability, and because the questionnaire asks participants to rate symptoms relative to their own pre-concussion "baseline."
Authors found that rather than experiencing many symptoms that gradually abated at different rates, patients often experienced a "course of symptoms," with some arising after others have diminished. "Although headache, fatigue, dizziness, and taking longer to think were the most common symptoms encountered at presentation, sleep disturbance, frustration, forgetfulness, and fatigue were the symptoms most likely to develop during the follow-up period that had not been present initially after the injury," they write.
For example, although fatigue was the second-highest reported symptom at the ED (headache was first) with 64.2% of patients reporting the symptom, another 15.4% of children who did not report fatigue at the ED did list the symptom in later weeks. Additionally, "a substantial number of children" (21.6%) also developed sleep disturbance after initial evaluation. "This finding suggests that children who have a concussion should be warned about the possibility of developing fatigue and sleep issues, and these symptoms should be specifically assessed during follow-up evaluation," authors state.
Other cognitive and emotional symptoms that developed after initial assessment included forgetfulness (15.8%), poor concentration (13.1%), taking longer to think (11.1%), frustration (17.1%), irritability (14.5%), and restlessness (14.1%). Of patients reporting these symptoms at or after presentation, 18.3% reported taking longer to think as a symptom 28 days after ED assessment, with frustration, irritability, and restlessness still present in 14.7%, 14.2%, and 10.6% of patients respectively.
"Cognitive symptoms were particularly significant in our cohort," the authors write. "They were present in substantial percentages initially, still went on to develop in many additional patients, and had greater than average duration of symptoms, with the exception of forgetfulness …. These findings support the importance of academic accommodations for children after concussion."
APTA believes that concussion should be managed and evaluated by a multidisciplinary team of licensed health care providers that includes a physical therapist (PT) and offers multiple resources. The association has developed policy resources at both state and federal levels, while practice-focused online concussion resources include a series of podcasts, a PT's guide to concussions, and access to evidence-based practice research through PTNow.
Research-related stories featured in News Now are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.
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