INS NYC 2024 Program

Symposium	Symposia 5 Program Schedule 02/15/2024 11:45 am - 01:15 pm Room: West Side Ballroom - Salon 4 Symposia 5: Concussion in children and youth: an update on evidence for diagnosis, assessment and treatment Simposium #1 Pediatric Sport-related Concussion: Evidence and Recommendations for Neuropsychologists from the Amsterdam Consensus Statement 2023 Keith Yeates, University of Calgary, Calgary, Canada Vicki Anderson, Murdoch Children's Research Institute, Melbourne, Australia Gavin Davis, Murdoch Children's Research Institute, Melbourne, Australia Category: Concussion/Mild TBI (Child) Keyword 1: head injury (closed) Keyword 2: concussion/ mild traumatic brain injury Objective: Objective: To summarize the evidence and recommendations regarding sport-related concussion in children (5-12 years) and adolescents (13-18 years) based on the consensus statement of the 6^th International Conference on Concussion in Sport, Amsterdam 2022 Participants and Methods: Participants and Methods: The consensus statement on concussion in sport was preceded by 10 systematic reviews, with topics predetermined via a modified Delphi methodology, followed by the consensus meeting and expert panel deliberations. Each systematic review included a section on pediatric considerations, which were also addressed briefly in the consensus statement itself. Along with a larger group of co-authors, we recently consolidated the elements of the systematic reviews and consensus statement pertaining to children and adolescents, and present the results here, with a particular emphasis on evidence and recommendations relevant to neuropsychologists. Results: Results: Routine, across-the-board, mandatory baseline testing is not recommended in children and adolescents. However, neurocognitive test batteries have potential value in assessing sport-related concussion and its sequelae. The Sport Concussion Assessment Tools (SCAT^TM), particularly their symptom scales, show robust diagnostic discrimination within the first 72 hours post-injury. The newly-developed Sport Concussion Office Assessment Tools (SCOAT^TM) provide multimodal tools for subacute evaluation (>72 hours) that include symptom scales and cognitive, balance, oculomotor/vestibular, mental health, and sleep mesaures. Strict physical and cognitive rest is not recommended acutely; instead, early return to light physical activity and reduced screen time in the first 48 hours, followed by prescribed exercise treatment, facilitate recovery. Cervico-vestibular rehabilitation, active rehabilitation, and collaborative care also can promote recovery in certain children and adolescents. Most children and adolescents demonstrate resolution of concussion-related symptoms within 1 month; the most consistent predictor of a longer recovery is a greater initial symptom burden. Standardised symptom rating scales are valid for assessing persisting symptoms after concussion, but no other measures are demonstrably valid for that purpose; fluid and imaging biomarkers currently have limited clinical utility for diagnosis or assessing recovery. Return-to-learn and return-to-sport strategies have been updated to promote early but supported return to activity. Limitations common to all the systematic reviews included few studies in the 5-12-year age group; results not being stratified by age in studies with mixed age populations; and potential selection bias in studies with patients presenting to specialty clinic settings. Additionally, many potentially relevant studies were excluded because the majority of participants did not have sport-related concussions. Many studies included predominantly male athletes and most studies were from North America, limiting generalizability. Conclusions: Conclusions: The updated consensus statement on concussion in sport reflects advances in the assessment and management of pediatric concussion that should inform the care provided by neuropsychologists. However, the paucity of studies in younger children and lack of studies that are stratified by age, as well as the lack of diversity in terms of sex, gender, disability status, ethnicity, and socioeconomic status, highlight the urgent need for more research to clarify the specific modifications to care required for pediatric concussion.

Symposium

02/15/2024
11:45 am - 01:15 pm
Room: West Side Ballroom - Salon 4

Symposia 5: Concussion in children and youth: an update on evidence for diagnosis, assessment and treatment

Simposium #1

Pediatric Sport-related Concussion: Evidence and Recommendations for Neuropsychologists from the Amsterdam Consensus Statement 2023

Keith Yeates, University of Calgary, Calgary, Canada
Vicki Anderson, Murdoch Children's Research Institute, Melbourne, Australia
Gavin Davis, Murdoch Children's Research Institute, Melbourne, Australia

Category: Concussion/Mild TBI (Child)

Keyword 1: head injury (closed)
Keyword 2: concussion/ mild traumatic brain injury

Objective:

Objective: To summarize the evidence and recommendations regarding sport-related concussion in children (5-12 years) and adolescents (13-18 years) based on the consensus statement of the 6^th International Conference on Concussion in Sport, Amsterdam 2022

Participants and Methods:

Participants and Methods: The consensus statement on concussion in sport was preceded by 10 systematic reviews, with topics predetermined via a modified Delphi methodology, followed by the consensus meeting and expert panel deliberations. Each systematic review included a section on pediatric considerations, which were also addressed briefly in the consensus statement itself. Along with a larger group of co-authors, we recently consolidated the elements of the systematic reviews and consensus statement pertaining to children and adolescents, and present the results here, with a particular emphasis on evidence and recommendations relevant to neuropsychologists.

Results:

Results: Routine, across-the-board, mandatory baseline testing is not recommended in children and adolescents. However, neurocognitive test batteries have potential value in assessing sport-related concussion and its sequelae. The Sport Concussion Assessment Tools (SCAT^TM), particularly their symptom scales, show robust diagnostic discrimination within the first 72 hours post-injury. The newly-developed Sport Concussion Office Assessment Tools (SCOAT^TM) provide multimodal tools for subacute evaluation (>72 hours) that include symptom scales and cognitive, balance, oculomotor/vestibular, mental health, and sleep mesaures. Strict physical and cognitive rest is not recommended acutely; instead, early return to light physical activity and reduced screen time in the first 48 hours, followed by prescribed exercise treatment, facilitate recovery. Cervico-vestibular rehabilitation, active rehabilitation, and collaborative care also can promote recovery in certain children and adolescents. Most children and adolescents demonstrate resolution of concussion-related symptoms within 1 month; the most consistent predictor of a longer recovery is a greater initial symptom burden. Standardised symptom rating scales are valid for assessing persisting symptoms after concussion, but no other measures are demonstrably valid for that purpose; fluid and imaging biomarkers currently have limited clinical utility for diagnosis or assessing recovery. Return-to-learn and return-to-sport strategies have been updated to promote early but supported return to activity. Limitations common to all the systematic reviews included few studies in the 5-12-year age group; results not being stratified by age in studies with mixed age populations; and potential selection bias in studies with patients presenting to specialty clinic settings. Additionally, many potentially relevant studies were excluded because the majority of participants did not have sport-related concussions. Many studies included predominantly male athletes and most studies were from North America, limiting generalizability.

Conclusions:

Conclusions: The updated consensus statement on concussion in sport reflects advances in the assessment and management of pediatric concussion that should inform the care provided by neuropsychologists. However, the paucity of studies in younger children and lack of studies that are stratified by age, as well as the lack of diversity in terms of sex, gender, disability status, ethnicity, and socioeconomic status, highlight the urgent need for more research to clarify the specific modifications to care required for pediatric concussion.