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We're focused on improving concussion prevention and treatment for children, adolescents and young adults to help minimize the occurrence and impact of these injuries. Researchers in our concussion program are leading various studies to better understand all aspects of concussions – from the social and physiological effects to the best environments for healing. The following are some of the research studies that are currently underway in our Concussion Program.
Study Title: AMSSM Publishes Updated Position Statement on Concussion in Sport
Purpose: The American Medical Society for Sports Medicine (AMSSM) selected Julie Wilson, MD, pediatric sports medicine physician at Children's Colorado, as a member of the writing group for the AMSSM Concussion in Sport 2019 position statement. AMSSM creates this statement to serve as a guide for sports medicine physicians who manage acute concussions from evaluation through return to play.
In this statement, the AMSSM writing group specifically addresses pediatric athletes. The experts highlight that pediatric athletes should be evaluated with age-appropriate instruments. Pediatric athletes may take longer to recover relative to adults and can benefit from school support during recovery. In this document, the AMSSM team emphasizes an active approach to concussion recovery and discusses the emerging concepts of clinical profiles of concussion and targeted treatment.
Study Title: Clinical Predictors of Symptom Resolution for Children and Adolescents with Sport-Related Concussion
Purpose: A notable minority of patients experience persistent post-concussion symptoms, in which symptoms continue for many weeks or months after a concussion. It's challenging to identify which adolescents are at risk for persistent symptoms in the early stages of treatment.
Thus, we examined which tests from a routine concussion evaluation were associated with symptom duration among patients seen at Children's Colorado. We found that an abnormal Romberg test (a simple balance test requiring less than one minute to complete) was associated with longer symptom duration. Since an abnormal Romberg test may indicate postural instability or symptom exaggeration, abnormal test performance within the first 10 days of a concussion may alert clinicians to potential development of persistent symptoms.
Study Title: Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A Scoping Review
Purpose: Over the past several years, two distinct areas of concussion research have emerged. First, we've learned that after an athlete sustains a concussion and returns to playing sports, they have a greater likelihood of sustaining another injury compared to athletes who did not sustain a concussion. Second, there are subtle, yet measurable, deficits that affect one's ability to control their neurological and musculoskeletal systems after a concussion. In this study, we explore these concepts and develop hypotheses about whether these two areas of research may be linked.
Study Title: Detection of Acute and Long-Term Effects of Concussion: Dual-Task Gait Balance Control Versus Computerized Neurocognitive Test
Purpose: Healthcare providers use various tests to evaluate dysfunction that occurs after a concussion. Among these, symptom checklists and computerized neurocognitive tests are the most common. However, few healthcare providers assess a patient's ability to do something that athletes do on a routine basis: walk and think simultaneously. In this study, we found that while there are neurocognitive deficits that exist immediately after a concussion, they tend to resolve over the course of the subsequent months. In contrast, the ability to walk and talk remain altered for up to two months post-injury.
Study Title: Worsening Dual-Task Gait Costs after Concussion and their Association with Subsequent Sport-Related Injury
Purpose: The ability to walk and think (dual-task) simultaneously appears to be affected for a prolonged period of time after concussion. However, the consequences of such dysfunction are not known. One theory is that altered abilities to walk and think may decrease one's ability to prevent future injuries after returning to sports. In this study, we measured dual-task abilities among youth athletes who sustained a concussion and returned to sports. We compared those who incurred an additional injury with those who did not. Worsening dual-task abilities during recovery were associated with sustaining a subsequent injury in the year after concussion.
Study Title: Continuing Play, Symptom Severity, and Symptom Duration After Concussion in Youth Athletes
Purpose: The effects of continuing to play during athletic competition after sustaining a concussion are not yet fully known. Thus, in this study, we evaluated whether continuing to play after concussion was associated with worsened clinical symptom severity or longer recovery times. Among a group of 516 adolescents, we found that those who reported that they continued to play despite sustaining a concussion reported to their clinical evaluation with significantly worse symptom burdens. Although symptom recovery times did not differ between groups, the worsened symptom burden suggests athletes should be removed from play immediately after a concussion.
Study Title: Using Concurrent Gait and Cognitive Assessments to Identify Impairments After Concussion: a Narrative Review
Purpose: It can be difficult for clinicians to identify the exact reason that an individual feels specific symptoms after a concussion, or to determine how long it will take them to recover from the injury. Among the different types of testing paradigms used by clinicians, dual-task assessments that require patients to perform two distinct tasks (for example, walking and thinking) may help with clinical decision-making. In this review article, we discuss how combined gait and cognitive tasks, as well as isolated motor and cognitive tasks, can help inform clinical management of sport-related concussion.