Researchers Uncover Deeper Understanding of Concussion Recovery

At Children’s Hospital Colorado, groundbreaking work in concussion research is setting new standards for pediatric care. At the forefront of this effort is the Colorado Concussion Research Laboratory, a multidisciplinary group of researchers, clinicians and students dedicated to understanding the effects of and treatments for pediatric and adolescent concussions.

Recent studies led by this team sought to better understand the science of concussion diagnosis and treatment, along with reshaping how young athletes recover and thrive after brain injuries. Katherine Smulligan, DPT, PT, PhD, Matthew Wingerson, MS, and Julie Wilson, MD, have each led studies that demonstrate this team’s deep commitment to child-centered care and establish Children’s Colorado as a national and international leader in pediatric concussion research. From return-to-learn timelines to mental health impacts, the team is discovering the impact of concussion recovery from every angle with four recent studies.

Factors in concussion recovery

Recovery is an important part of concussion research. The team investigated how factors that can be easily obtained by a healthcare professional, such as reaction time deficits in adolescent athletes recovering from concussions, can help inform clinical decision-making.

Findings indicated that continued reaction time deficits may be detected other more traditional measures of recovery. Developing and testing these feasible and objective measures, this approach aims to enhance clinical decision-making and support more holistic and individualized rehabilitation strategies for young athletes.

How seasonality affects concussion

To better understand the potential seasonal aspects of concussion, this team also compared differences in concussion recovery during the school year versus the summer when school is not in session. Through this investigation, they were able to determine if differences in concussion symptoms, particularly cognitive symptoms, were based on the season in which the injury occurred. They found that concussions sustained during the summer months were associated on average with less severe physical and cognitive concussion symptoms than those during the school year. While the exact reasons for this phenomenon are not entirely clear, the team suspects that the reduced academic load, better sleep health and faster access to clinical care during the summer months may each contribute to this reduction in symptom severity.

Research like this can help further refine recovery protocols based on seasonality. In addition, this work can help set appropriate expectations for recovery for patients and families, specifically equipping young athletes with strategies to optimize their own recovery.

Return-to-school timeline after a concussion

The return-to-learn timeline after a concussion isn’t always a clear decision, and there’s far less research looking at a concussion’s impact on academics than on other pathways during recovery, such as physical activity. But recent research from a multi-site study of several children’s hospitals across the United States led by Dr. Wilson and David Howell, PhD, Director of the Colorado Concussion Research Lab at the University of Colorado School of Medicine, identifies the critical balance between cognitive rest and timely return to an academic environment. During the study, children and adolescents reported missing an average of two days of school after a concussion, and a longer amount of time missed was associated with more severe symptoms and the perception that their grades were dropping. Based on these findings, current recommendations for returning to the classroom may change on a larger scale to allow for minimal delays in learning and encourage earlier return-to-school timelines than previously identified.

The anxiety and concussion connection

Concussions can affect a young athlete’s mental health both on and off the field. Anxiety, specifically, can be a symptom that manifests and evolves throughout concussion recovery and beyond. A recent study from this team examined the relationship between physical activity levels and anxiety symptoms in young athletes recovering from a concussion. The team found that engaging in more moderate-to-vigorous physical activity post-concussion was associated with lower levels of anxiety at a subsequent evaluation, suggesting that moderate-to-vigorous levels of physical activity can aid in the psychological recovery of young athletes. This speaks to the importance of integrating physical activity into post-concussion rehabilitation to support both physical and mental recovery.

Through the exploration of a variety of topics relevant to adolescents with concussion, the team hopes to continuously improve the guidance that patients receive after injury. In the future, these foundational studies will provide the basis to develop, test and implement patient-centered and individualized treatment plans that provide the optimal guidance necessary for adolescent and pediatric athletes to return to the activities they enjoy.