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Mavroudis I, Chatzikonstantinou S, Petridis F, Palade OD, Ciobica A, Balmus IM. Functional Overlay Model of Persistent Post-Concussion Syndrome. Brain Sci 2023; 13:1028. [PMID: 37508960 PMCID: PMC10377031 DOI: 10.3390/brainsci13071028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
Persistent post-concussion syndrome (PPCS) is a complex and debilitating condition that can develop after head concussions or mild traumatic brain injury (mTBI). PPCS is characterized by a wide range of symptoms, including headaches, dizziness, fatigue, cognitive deficits, and emotional changes, that can persist for months or even years after the initial injury. Despite extensive research, the underlying mechanisms of PPCS are still poorly understood; furthermore, there are limited resources to predict PPCS development in mTBI patients and no established treatment. Similar to PPCS, the etiology and pathogenesis of functional neurological disorders (FNDs) are not clear neither fully described. Nonspecific multifactorial interactions that were also seen in PPCS have been identified as possible predispositions for FND onset and progression. Thus, we aimed to describe a functional overlay model of PPCS that emphasizes the interplay between functional and structural factors in the development and perpetuation of PPCS symptoms. Our model suggests that the initial brain injury triggers a cascade of physiological and psychological processes that disrupt the normal functioning of the brain leading to persistent symptoms. This disruption can be compounded by pre-existing factors, such as genetics, prior injury, and psychological distress, which can increase the vulnerability to PPCS. Moreover, specific interventions, such as cognitive behavioral therapy, neurofeedback, and physical exercise can target the PPCS treatment approach. Thus, the functional overlay model of PPCS provides a new framework for understanding the complex nature of this condition and for developing more effective treatments. By identifying and targeting specific functional factors that contribute to PPCS symptoms, clinicians and researchers can improve the diagnosis, management, and ultimately, outcomes of patients with this condition.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals, Leeds LS2 9JT, UK
- Faculty of Medicine, Leeds University, Leeds LS2 9JT, UK
| | | | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Octavian Dragos Palade
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, 20th Carol I Avenue, 700506 Iasi, Romania
- Centre of Biomedical Research, Romanian Academy, B dul Carol I, No. 8, 700506 Iasi, Romania
- Academy of Romanian Scientists, Splaiul Independentei nr. 54, Sector 5, 050094 Bucuresti, Romania
| | - Ioana-Miruna Balmus
- Department of Exact Sciences and Natural Sciences, Institute of Interdisciplinary Research, "Alexandru Ioan Cuza" University of Iasi, Alexandru Lapusneanu Street, No. 26, 700057 Iasi, Romania
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2
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Psychometric Properties of the German Version of the Rivermead Post-Concussion Symptoms Questionnaire in Adolescents after Traumatic Brain Injury and Their Proxies. J Clin Med 2022; 12:jcm12010319. [PMID: 36615119 PMCID: PMC9821190 DOI: 10.3390/jcm12010319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) assesses post-concussion symptoms (PCS) after traumatic brain injury (TBI). The current study examines the applicability of self-report and proxy versions of the German RPQ in adolescents (13-17 years) after TBI. We investigated reliability and validity on the total and scale score level. Construct validity was investigated by correlations with the Post-Concussion Symptoms Inventory (PCSI-SR13), Generalized Anxiety Disorder Scale 7 (GAD-7), and Patient Health Questionnaire 9 (PHQ-9) and by hypothesis testing regarding individuals' characteristics. Intraclass correlation coefficients (ICC) assessed adolescent-proxy agreement. In total, 148 adolescents after TBI and 147 proxies completed the RPQ. Cronbach's α (0.81-0.91) and McDonald's ω (0.84-0.95) indicated good internal consistency. The three-factor structure outperformed the unidimensional model. The RPQ was strongly correlated with the PCSI-SR13 (self-report: r = 0.80; proxy: r = 0.75) and moderately-strongly with GAD-7 and PHQ-9 (self-report: r = 0.36, r = 0.35; proxy: r = 0.53, r = 0.62). Adolescent-proxy agreement was fair (ICC [2,1] = 0.44, CI95% [0.41, 0.47]). Overall, both self-report and proxy assessment forms of the German RPQ are suitable for application in adolescents after TBI. As proxy ratings tend to underestimate PCS, self-reports are preferable for evaluations. Only if a patient is unable to answer, a proxy should be used as a surrogate.
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Schulze KJ, Robinson M, MacKenzie HM, Dickey JP. Association of Preexisting Mental Health Conditions With Increased Initial Symptom Count and Severity Score on SCAT5 When Assessing Concussion. Orthop J Sports Med 2022; 10:23259671221123581. [PMID: 36157090 PMCID: PMC9490471 DOI: 10.1177/23259671221123581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Mental health conditions, such as depression, anxiety, and learning disabilities, are associated with symptoms that can overlap with those seen in persons with concussion. While concussion screening tools such as the Sport Concussion Assessment Tool–5th Edition (SCAT5) quantify the number of symptoms and symptom severity, it is not known whether these outcomes differ among individuals with concurrent mental health conditions compared with those without them. Purpose: To determine whether, during initial concussion assessment, individuals with a self-reported mental health condition have a significantly different number of self-reported concussion symptoms or symptom severity compared with those without a self-reported mental health condition (controls). Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review was performed on consecutive patients aged ≥13 years who underwent post-concussion assessment at the Fowler Kennedy Sport Medicine Clinic between May 2018 and March 2020 (N = 765). Most participants did not self-report a mental health condition (n = 606; 79.2%). Participants with a self-reported mental health condition (n = 159) were classified as having a learning disability (n = 14; 8.8%), anxiety (n = 62; 39.0%), depression (n = 20; 12.6%), or multiple conditions (≥2 conditions: n = 63; 39.6%). Each participant with a mental health condition was matched with 2 control participants (overall pool, n = 318) based on age, sex, student status, and sport-related risk. Mann-Whitney U tests were used to determine the statistical significance of differences between each subgroup and their matched controls for the self-reported number of concussion symptoms and symptom severity as measured using the SCAT5. Results: The anxiety and multiple-conditions subgroups had a significantly greater number of reported symptoms than their corresponding control subgroups (median, 17 vs 15 [P = .004] and 18 vs 14.5 [P < .001], respectively). Additionally, the SCAT5 symptom severity score was significantly greater in the anxiety and multiple-conditions subgroups than their corresponding controls (median, 49 vs 34.5 [P = .018] and 62 vs 32 [P < .001], respectively). Conclusion: During initial concussion assessment, both the number of concussion-related symptoms and the symptom severity were greater in study participants with anxiety and multiple mental health conditions than participants without these conditions.
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Affiliation(s)
| | - Michael Robinson
- Faculty of Health Science, Lawson Health Research Institute, Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada
| | - Heather M MacKenzie
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Parkwood Institute, St. Joseph's Health Care London, London, Ontario, Canada
| | - James P Dickey
- School of Kinesiology, Western University, London, Ontario, Canada
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Fyffe A, Carron MA, Orr R, Cassimatis M, Browne G. Greater symptom burden results in reduced exercise tolerance in adolescents following concussion. Brain Inj 2022; 36:368-374. [PMID: 35196195 DOI: 10.1080/02699052.2022.2034964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES To explore the relationship between symptoms and exercise tolerance in adolescents following concussion. METHODS A retrospective analysis of 417 adolescents who attended a concussion service between January 2015 and April 2021 was performed, with 149 meeting eligibility criteria for inclusion. Post-Concussion Symptom Scale (PCSS) and graded exercise tolerance time (min) were assessed at initial and follow-up visits. Spearman's correlation was used to examine the relationship between PCSS scores and exercise time. RESULTS Adolescents (n = 149, 13.9 ± 1.7 years, 66.4% male) presented at 28.6 ± 19.7 days post-injury. Statistically significant correlations were identified between initial (r = -0.36, p < .001) and follow-up (r = -0.41, p < .001) PCSS scores and exercise time among all participants. Initial PCSS and initial exercise time were inversely correlated for males (r = -0.24, p = .018) and females (r = -0.22, p = .127). Follow-up PCSS and follow-up exercise time were inversely correlated for males (r = -0.30, p = .003) and females (r = -0.35, p = .014). CONCLUSION There is a statistically significant relationship between higher PCSS and poorer exercise time and both factors should be considered together to provide the most accurate assessment, particularly in females.
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Affiliation(s)
- Andrew Fyffe
- Children's Hospital Institute of Sports Medicine, Sydney Children's Hospital Network, Children's Hospital Institute of Sports Medicine, the Royal Alexandra Hospital for Children, Children's Hospital Westmead, Sydney Australia.,Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Michael A Carron
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Rhonda Orr
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The Children's Hospital at Westmead Clinical School Sydney Medical School, the University of Sydney, Australia
| | - Maree Cassimatis
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gary Browne
- Children's Hospital Institute of Sports Medicine, Sydney Children's Hospital Network, Children's Hospital Institute of Sports Medicine, the Royal Alexandra Hospital for Children, Children's Hospital Westmead, Sydney Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, the University of Sydney, Australia
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Smulligan KL, Wingerson MJ, Seehusen CN, Magliato SN, Wilson JC, Howell DR. Patient perception of dizziness and imbalance does not correlate with gait measures in adolescent athletes post-concussion. Gait Posture 2021; 90:289-294. [PMID: 34564000 DOI: 10.1016/j.gaitpost.2021.09.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dizziness and gait impairments are commonly observed following a concussion, and both are associated with prolonged concussion recovery. RESEARCH QUESTION Is there a correlation between combined self-reported dizziness and balance impairment severity with objective gait impairments after concussion? METHODS Participants (n = 51; 15.4 ± 1.6 years; 51 % female; 7.3 ± 3.2 days post-injury) age 12-18 years self-reported ratings of dizziness and balance impairment using the Post-Concussion Symptom Inventory (PCSI) within 14 days of injury. Individual ratings of dizziness, balance impairment, and moving clumsily on the PCSI were combined to create a comprehensive dizziness and imbalance score. Participants also completed a smartphone-based gait evaluation under single-task and dual-task conditions. Correlation coefficients (Pearson r for normally distributed and Spearman rho for non-normally distributed variables) were calculated between self-reported symptoms and single and dual-task spatiotemporal gait parameters, specifically step velocity, step time, and step length. RESULTS Correlation coefficients indicated that there was low to no correlation between self-reported dizziness and imbalance impairment severity and smartphone-obtained gait parameters under single- or dual-task conditions, including step velocity (single-task: r=-0.22, p = 0.13; dual-task: r=-0.05, p = 0.72), step time (single-task: rho = 0.16, p = 0.27; dual-task: rho = 0.14, p = 0.33), and step length (single-task: r=-0.15, p = 0.30; dual-task: r = 0.03, p = 0.84). SIGNIFICANCE Self-reported dizziness and balance impairment severity within the first two weeks of concussion may not reflect objectively measured gait performance, given the lack of association between subjective symptom ratings and functional measures. Further, smartphone collected gait parameters may not provide the necessary sensitivity to detect an association with dizziness. The lack of significant correlation between self-reported symptoms and objective gait performance highlights the importance of using both objective and subjective measures to obtain a more complete picture of concussion deficits.
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Affiliation(s)
- Katherine L Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mathew J Wingerson
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, CO, USA
| | - Corrine N Seehusen
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, CO, USA
| | - Samantha N Magliato
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Julie C Wilson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA; Sports Medicine Center, Children's Hospital of Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA; Sports Medicine Center, Children's Hospital of Colorado, Aurora, CO, USA.
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Yumul JN, Crowe L, Catroppa C, Anderson V, McKinlay A. Post-concussive Signs and Symptoms in Preschool Children: A Systematic Review. Neuropsychol Rev 2021; 32:631-650. [PMID: 34390464 DOI: 10.1007/s11065-021-09518-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
Mild traumatic brain injury (mTBI) is common in children aged < 5 years, however, less is known about their experience of post-concussive signs and symptoms. This systematic review aims to identify post-concussive signs and symptoms experienced by preschool children up to 12 months post-injury, and to review the methods used to report this data. Relevant findings, including rates, progression, and possible predictors of post-concussive signs and symptoms were also identified. Databases (Ovid MEDLINE, EMBASE, PsycInfo, PubMed, Scopus) and reference lists were searched for relevant articles, which were screened based on specified criteria. Eleven articles met the inclusion criteria, being original studies published in English and presenting data on post-concussive signs and symptoms specific to preschool children with mTBI. Most reviewed studies investigated acute presentations of mTBI, and identified that preschool children demonstrate post-concussive symptoms (PCS) similar to other age groups. Post-traumatic amnesia duration of approximately one day was reported in preschool children following mTBI, as were changes in mood and behavior during the recovery period. Parents were the main informants, with data obtained through either interview or questionnaire. Review findings highlight the lack of empirical data regarding the presentation and progression of PCS in preschoolers following mTBI and evidence on how to best manage this group during recovery.
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Affiliation(s)
- Joy Noelle Yumul
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia. .,Murdoch Children's Research Institute, Melbourne, Australia.
| | - Louise Crowe
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Cathy Catroppa
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Audrey McKinlay
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Psychology, University of Canterbury, Christchurch, New Zealand
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7
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Smith A, Thomas J, Friedhoff C, Chin E. The Utility of the Test of Memory Malingering Trial 1 in Differentiating Neurocognitive, Emotional, and Behavioral Functioning in a Pediatric Concussion Population. Arch Clin Neuropsychol 2021; 37:322-337. [PMID: 34386811 DOI: 10.1093/arclin/acab065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 06/08/2021] [Accepted: 07/21/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In concussion populations, suboptimal task engagement detected by performance validity tests (PVTs) has been associated with poorer neuropsychological scores and greater post-concussive symptoms (PCS). This study examined if Pass/Fail status on the Test of Memory Malingering-TOMM Trial 1-differentiated the neurocognitive, emotional, and behavioral profile of pediatric patients with concussion. METHOD This study utilized archival data from 93 patients (mean age = 14.56 and SD = 2.01) with a history of concussion who were assessed at ~5-6 weeks post-injury (mean days = 40.27 and SD = 35.41). Individuals were divided into "Pass" and "Fail" groups based on TOMM Trial 1 performance. The testing battery included ACT, CPT-II and III, HVLT-R, WJ-III and IV ACH, ImPACT, BASC-2, and BRIEF. RESULTS The overall pass rate on Trial 1 was 70% (mean = 46.04 and SD = 4.55). Findings suggested that a passing score on Trial 1 may be associated with adequate performance across the remaining two trials of the TOMM. The Fail group scored significantly lower across attention, memory, and processing speed measures when compared with the Pass group. On rating scales, significantly more concerns were endorsed with the Fail group for attention and executive functioning relative to the Pass group. Parents generally endorsed significantly more concerns for executive functioning when compared with their children's self-reported symptoms. There was a trend for the Fail group to report more PCS; however, they did not significantly differ from the Pass group for depression, anxiety, or somatization. CONCLUSIONS This study highlights the importance of utilizing PVTs when evaluating concussion recovery.
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Affiliation(s)
- Alphonso Smith
- AMITA Health Neurosciences Institute - Center for Pediatric Brain, Hoffman Estates, IL, USA
| | - Julia Thomas
- AMITA Health Neurosciences Institute - Center for Pediatric Brain, Hoffman Estates, IL, USA
| | - Claire Friedhoff
- AMITA Health Neurosciences Institute - Center for Pediatric Brain, Hoffman Estates, IL, USA
| | - Esther Chin
- AMITA Health Neurosciences Institute - Center for Pediatric Brain, Hoffman Estates, IL, USA
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The Nocebo Effect and Pediatric Concussion. J Sport Rehabil 2021; 30:837-843. [PMID: 34050035 DOI: 10.1123/jsr.2020-0519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/01/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022]
Abstract
While placebo effects are well recognized within clinical medicine, "nocebo effects" have received much less attention. Nocebo effects are problems caused by negative expectations derived from information or treatment provided during a clinical interaction. In this review, we examine how nocebo effects may arise following pediatric concussion and how they may worsen symptoms or prolong recovery. We offer several suggestions to prevent, lessen, or eliminate such effects. We provide recommendations for clinicians in the following areas: terminology selection, explicit and implicit messaging to patients, evidence-based recommendations, and awareness of potential biases during clinical interactions. Clinicians should consider the empirically grounded suggestions when approaching the care of pediatric patients with concussion.
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Root JM, Gai J, Sady MD, Vaughan CG, Madati PJ. Identifying Risks for Persistent Postconcussive Symptoms in a Pediatric Emergency Department: An Examination of a Clinical Risk Score. Arch Clin Neuropsychol 2021; 37:30-39. [PMID: 33993203 DOI: 10.1093/arclin/acab032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/13/2021] [Accepted: 04/20/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE External examination of a clinical risk score to predict persistent postconcussive symptoms (PPCS) in a pediatric emergency department (ED). METHODS Prospective cohort study of 5- to 18-year-old patients diagnosed with an acute concussion. Risk factors were collected at diagnosis and participants (n = 85) were followed to determine PPCS 30 days postinjury. Univariate logistic regression analyses were completed to examine associations of risk factors with PPCS. RESULTS Headache and total clinical risk score were associated with increased odds of PPCS in the univariate analyses, OR 3.37 (95% CI 1.02, 11.10) and OR 1.25 (95% CI 1.02, 1.52), respectively. Additionally, teenage age group, history of prolonged concussions, and risk group trended toward association with PPCS, OR 4.79 (95% CI 0.93, 24.7), OR 3.41 (95% CI 0.88, 13.20), and OR 2.23 (95% CI 0.88, 5.66), respectively. CONCLUSION Our study supports the use of multiple variables of a clinical risk score to assist with ED risk stratification for pediatric patients at risk for PPCS.
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Affiliation(s)
- J M Root
- Division of Emergency Medicine, Children's National Health System, Washington, DC, USA
| | - J Gai
- Children's Research Institute, Children's National Health System, Washington, DC, USA
| | - M D Sady
- Division of Pediatric Neuropsychology, Children's National Health System, Washington, DC, USA
| | - C G Vaughan
- Division of Pediatric Neuropsychology, Children's National Health System, Washington, DC, USA
| | - P J Madati
- Division of Emergency Medicine, Children's National Health System, Washington, DC, USA
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Patsimas T, Howell DR, Potter MN, Provance AJ, Kirkwood MW, Wilson JC. Concussion-Symptom Rating Correlation Between Pediatric Patients and Their Parents. J Athl Train 2021; 55:1020-1026. [PMID: 32031884 DOI: 10.4085/1062-6050-200-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
CONTEXT Understanding how parents and their children perceive concussion symptoms may provide insights into optimal concussion-management strategies. OBJECTIVE To examine patient-parent correlations and agreement on concussion-symptom ratings, to identify differences in patient-parent symptom reporting between children (8-12 years of age) and adolescents (13-18 years of age), and to evaluate the correlation between patient and parent initial symptom-severity ratings with symptom duration and return-to-play time. DESIGN Cross-sectional study. SETTING Primary care sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS A total of 267 patients aged 8 to 18 years seen for care within 21 days of sustaining a concussion. Patients were classified as children (n = 65; age = 11.3 ± 1.4 years; age range, 8-12 years) or adolescents (n = 202; age = 15.5 ± 1.4 years; age range, 13-18 years). MAIN OUTCOME MEASURE(S) Each patient and his or her parent (or legal guardian) completed a concussion-symptom-frequency inventory, the Health and Behavior Inventory (HBI), at the initial postinjury examination. Patients were followed until they no longer reported concussion symptoms (symptom-resolution time) and were allowed to return to unrestricted sport participation (return-to-play time). RESULTS At the initial examination (8.9 ± 5.2 days postinjury), the symptom-frequency correlation between children and their parents was high (rs = 0.88; 95% confidence interval [CI] = 0.80, 0.95). Adolescents' symptom-frequency reports were also highly correlated with those of their parents (rs = 0.78; 95% CI = 0.71, 0.85). However, the child-parent correlation was higher than the adolescent-parent agreement (z = 2.21, P = .03). Greater patient (consolidated child and adolescent) HBI ratings were associated with longer symptom-resolution times (coefficient = 0.019; 95% CI = 0.007, 0.031; P = .002) and longer return-to-play times (coefficient = 0.012; 95% CI = 0.002, 0.022; P = .02), whereas parent HBI ratings were not. CONCLUSIONS Our findings may help to set expectations regarding concussion-symptom durations and return-to-play timing for pediatric patients and their families. Given the patient-parent correlations in our sample, substantial reporting discrepancies between patients and their parents may be a relevant factor for clinicians to investigate further during concussion evaluations.
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Affiliation(s)
- Tatiana Patsimas
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, Aurora.,Sports Medicine Center, Children's Hospital Colorado, Aurora
| | - Morgan N Potter
- Sports Medicine Center, Children's Hospital Colorado, Aurora
| | - Aaron J Provance
- Department of Orthopedics, University of Colorado School of Medicine, Aurora.,Sports Medicine Center, Children's Hospital Colorado, Aurora
| | - Michael W Kirkwood
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora.,Rehabilitation Medicine, Children's Hospital Colorado, Aurora
| | - Julie C Wilson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora.,Department of Orthopedics, University of Colorado School of Medicine, Aurora.,Sports Medicine Center, Children's Hospital Colorado, Aurora
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Serrano burneo DC, Bowden SC, Simpson LC. Incremental Validity of the Minnesota Multiphasic Personality Inventory, Second Edition (MMPI‐2) Relative to the Beck Depression Inventory‐Second Edition (BDI‐II) in the Detection of Depressive Symptoms. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Daniela C. Serrano burneo
- Centre for Clinical Neurosciences & Neurological Research, St Vincent's Hospital Melbourne, Fitzroy, Australia,
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia,
| | - Stephen C. Bowden
- Centre for Clinical Neurosciences & Neurological Research, St Vincent's Hospital Melbourne, Fitzroy, Australia,
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia,
| | - Leonie C. Simpson
- Centre for Clinical Neurosciences & Neurological Research, St Vincent's Hospital Melbourne, Fitzroy, Australia,
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia,
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12
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Factors Influencing Primary Care Follow-Up After Pediatric Mild Traumatic Brain Injury. J Head Trauma Rehabil 2020; 34:E11-E19. [PMID: 30608309 DOI: 10.1097/htr.0000000000000461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify socioeconomic, demographic, and caregiver factors associated with children attending primary care provider (PCP) follow-up after emergency department (ED) evaluation for mild traumatic brain injury (mTBI). SETTING Pediatric trauma center ED. PARTICIPANTS Children 8 to 18 years of age sustaining mTBI less than 48 hours prior to an ED visit. Mean age of the 183 participants was 12 years with no significant differences between those who attended follow-up and those who did not in race, ethnicity, insurance provider, or PCP office setting. DESIGN Thirty-day longitudinal cohort study. MAIN MEASURES Insurance type, PCP practice setting, and a caregiver attitudes survey regarding mTBI recovery and management (5 questions each scored on a 5-point Likert scale). The primary outcome was attending a PCP follow-up visit within 1 month of injury. RESULTS Females were more likely than males to attend PCP follow-up (adjusted odds ratio: 2.27 [95% confidence interval: 1.00-5.18]). Increasing scores on the caregiver attitudes survey indicating greater concerns about recovery were significantly associated with attending PCP follow-up (adjusted odds ratio: 1.12 per unit increase in composite score [95% confidence interval: 1.02-1.23]). No other socioeconomic, demographic, or injury characteristics were associated with attending PCP follow-up. CONCLUSIONS The ED counseling regarding PCP follow-up of mTBI should stress the importance of follow-up care to monitor recovery and identify presence of lingering symptoms.
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13
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McCaffrey RJ, Lynch JK. Base Rates of Performance Validity Test Failure Among Children and Young Adult Litigants with Histories of Elevated Blood Lead Levels. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2020. [DOI: 10.1007/s40817-020-00091-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE To evaluate the feasibility and potential benefits of a manualized, brief cognitive-behavioral therapy-based intervention program for children and adolescents with persistent postconcussive symptoms. SETTING Two outpatient pediatric concussion programs in the United States. PARTICIPANTS Patients aged 8 to 17 years who sustained concussions between 2 and 12 months prior to enrollment. DESIGN Pre-/postretrospective study. MAIN MEASURES SCAT-3; HBI; PedsQL 4.0 Generic Core Scales; and RCADS. RESULTS Thirty children and adolescents completed the treatment program. Self- and parent-reported postconcussive symptoms, quality of life, and internalizing symptoms significantly improved with treatment. Mixed-effects models revealed a significant decline in self-reported postconcussive symptoms across treatment sessions, a = -2.07, SE = 0.25, P < .001. The largest change occurred between sessions 2 and 3, following the session focusing on concussion psychoeducation and sleep hygiene (estimated mean change between sessions 2 and 3 = -4.72, P < .0001). CONCLUSIONS Our findings indicate that a 6-session manualized cognitive behavioral intervention is feasible to initiate in an outpatient clinic 1 to 12 months following a pediatric mild traumatic brain injury. With a manualized format, clinicians at most levels of training should be able to implement this treatment manual and flexibly adapt as needed when working with children and adolescents who are experiencing delayed symptom recovery following concussion.
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15
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MacAllister WS, Désiré N, Vasserman M, Dalrymple J, Salinas L, Brooks BL. The use of the MSVT in children and adolescents with epilepsy. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 9:323-328. [PMID: 32297798 DOI: 10.1080/21622965.2020.1750127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Pediatric neuropsychologists are increasingly recognizing the importance of performance validity testing during evaluations. The use of such measures to detect insufficient effort is of particular importance in pediatric epilepsy evaluations, where test results are often used to guide surgical decisions and failure to detect poor task engagement can result in postsurgical cognitive decline. The present investigation assesses the utility of the Medical Symptom Validity Test (MSVT) in 104 clinically referred children and adolescents with epilepsy. Though the overall failure rate was 15.4% of the total group, children with 2nd grade or higher reading skills (a requirement of the task) passed at a very high rate (96.6%). Of the three failures, two were unequivocally deemed true positives, while the third failed due to extreme somnolence during testing. Notably, for those with ≥2nd grade reading levels, MSVT validity indices were unrelated to patient age, intellectual functioning, or age of epilepsy onset, while modest relations were seen with specific memory measures, number of epilepsy medications, and seizure frequency. Despite these associations, however, this did not result in more failures in this population of children and adolescents with substantial neurologic involvement, as pass rates exceeded 92% for those with intellectual disability, high seizure frequency, high medication burden, and even prior surgical resection of critical memory structures.
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Affiliation(s)
- William S MacAllister
- Neuropsychology Service, Alberta Children's Hospital, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Naddley Désiré
- Neuropsychology Service, Alberta Children's Hospital, Calgary, Canada
| | - Marsha Vasserman
- Neuropsychology Service, Alberta Children's Hospital, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | | | - Lilian Salinas
- New York University Comprehensive Epilepsy Center, New York, New York, USA
| | - Brian L Brooks
- Neuropsychology Service, Alberta Children's Hospital, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Department of Psychology, University of Calgary, Calgary, Canada
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16
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Weber Ku E, Oliveira JS, Cook NE, McCurdy K, Kavanaugh B, Cancilliere MK, Holler KA. Assessing performance validity with the TOMM and automatized sequences task in a pediatric psychiatric inpatient setting. Child Neuropsychol 2020; 26:801-816. [PMID: 31937183 DOI: 10.1080/09297049.2020.1712345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examined the performance of children consecutively admitted to an inpatient psychiatric unit on the Test of Memory Malingering (TOMM) (aged 5-12; n = 96) and Automatized Sequences Task (aged 8-12; n = 67). Eighty-three percent of children passed the TOMM Trial 2 (M raw score = 47.7, SD = 4.7) and 76% of children passed the Automatized Sequences Task total time (M = 23.1 seconds; SD = 8.2). The concordance rate between the TOMM and the total time on the Automatized Sequences Task was 73.1%. Receiver operating characteristic curves indicated that of the Automatized Sequences Task subtests, only Counting 1-20 significantly differentiated children who passed Trial 2 of the TOMM from those who did not pass Trial 2 of the TOMM (area under the curve = .756, p = .006). Performance on both PVTs was unrelated to demographic characteristics and measures of psychological and neuropsychological functioning on both the TOMM and Automatized Sequences Task. Further research is needed to determine whether the nearly 1 in 4 children (23.9%) who performed below recommended cutoffs on Automatized Sequences Task reflects genuine suboptimal effort, cognitive difficulties among these children, and/or other factors.
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Affiliation(s)
- Elyssa Weber Ku
- Clinical Psychology, University of Massachusetts Boston , Boston, MA, USA
| | - Jane S Oliveira
- Clinical Psychology, Antioch University - New England, Keene, NH, USA
| | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital and Harvard Medical School , Boston, USA
| | - Kyle McCurdy
- Department of Counseling, Leadership, & Expressive Arts, Salve Regina , Newport, RI, USA
| | - Brian Kavanaugh
- Department of Psychiatry & Human Behavior E.P. Bradley Hospital/ Alpert Medical School of Brown University , Providence, RI, USA
| | | | - Karen A Holler
- Department of Psychiatry & Human Behavior E.P. Bradley Hospital/ Alpert Medical School of Brown University , Providence, RI, USA
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17
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Laatsch L, Dodd J, Brown T, Ciccia A, Connor F, Davis K, Doherty M, Linden M, Locascio G, Lundine J, Murphy S, Nagele D, Niemeier J, Politis A, Rode C, Slomine B, Smetana R, Yaeger L. Evidence-based systematic review of cognitive rehabilitation, emotional, and family treatment studies for children with acquired brain injury literature: From 2006 to 2017. Neuropsychol Rehabil 2019; 30:130-161. [PMID: 31671014 DOI: 10.1080/09602011.2019.1678490] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper updates guidelines for effective treatments of children with specific types of acquired brain injury (ABI) published in 2007 with more recent evidence. A systematic search was conducted for articles published from 2006 to 2017. Full manuscripts describing treatments of children (post-birth to 18) with acquired brain injury were included if study was published in peer-reviewed journals and written in English. Two independent reviewers and a third, if conflicts existed, evaluated the methodological quality of studies with an Individual Study Review Form and a Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Strength of study characteristics was used in development of practice guidelines. Fifty-six peer-reviewed articles, including 27 Class I studies, were included in the final analysis. Established guidelines for writing practice recommendations were used and 22 practice recommendations were written with details of potential treatment limitations. There was strong evidence for family/caregiver-focused interventions, as well as direct interventions to improve attention, memory, executive functioning, and emotional/behavioural functioning. A majority of the practice standards and guidelines provided evidence for the use of technology in delivery of interventions, representing an important trend in the field.
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Affiliation(s)
- Linda Laatsch
- Department of Neurology, University of Illinois, Chicago, IL, USA
| | | | - Tanya Brown
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Angela Ciccia
- Department of Psychological Science and Communication Science Program, Case Western Reserve University, Cleveland, OH, USA
| | - Felicia Connor
- Rusk Rehabilitation, Langone Health, Outpatient Psychology and Neuropsychology, New York, NY, USA
| | - Kim Davis
- Department of Pediatrics, Psychology Section, Baylor College of Medicine, Houston, TX, USA
| | - Meghan Doherty
- Occupational Therapy and Occupational Science, Saint Louis University, Saint Louis, MO, USA
| | - Mark Linden
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Gianna Locascio
- Department of Neurology, New York University, New York, NY, USA
| | - Jennifer Lundine
- Department of Speech and Hearing Science, Ohio State University, Columbus, OH, USA
| | - Samantha Murphy
- Department of Psychology, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Drew Nagele
- Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Janet Niemeier
- Department of Physical Medicine & Rehabilitation, Carolinas Medical Center, Charlotte, NC, USA
| | - Adam Politis
- National Institutes of Health, Bethesda, MD, USA
| | - Catrin Rode
- Center on Brain Injury Research and Training, University of Oregon, Eugene, OR, USA
| | - Beth Slomine
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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18
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Abstract
Neuropsychologists play an important role in the clinical evaluation of many children and adolescents who have sustained concussions. This paper discusses clinical approaches and concerns in conducting neuropsychological evaluations of middle and high school aged students during the acute, subacute, and more chronic phases of concussion recovery. Issues of baseline testing and validity assessment are reviewed. Typical clinical recommendations arising from the neuropsychological evaluation are outlined, with an emphasis on the relationship between test findings and common academic accommodations.
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Affiliation(s)
- Neal McGrath
- Sports Concussion New England, Brookline, MA; Robert C. Cantu Concussion Center, Emerson Hospital, Concord, MA.
| | - Janelle Eloi
- Sports Concussion New England, Brookline, MA; Robert C. Cantu Concussion Center, Emerson Hospital, Concord, MA; William James College, Newton, MA
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19
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Lippa SM, Lange RT, French LM, Iverson GL. Performance Validity, Neurocognitive Disorder, and Post-concussion Symptom Reporting in Service Members with a History of Mild Traumatic Brain Injury. Arch Clin Neuropsychol 2019; 33:606-618. [PMID: 29069278 DOI: 10.1093/arclin/acx098] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/26/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To examine the influence of different performance validity test (PVT) cutoffs on neuropsychological performance, post-concussion symptoms, and rates of neurocognitive disorder and postconcussional syndrome following mild traumatic brain injury (MTBI) in active duty service members. Method Participants were 164 service members (Age: M = 28.1 years [SD = 7.3]) evaluated on average 4.1 months (SD = 5.0) following injury. Participants were divided into three mutually exclusive groups using original and alternative cutoff scores on the Test of Memory Malingering (TOMM) and the Effort Index (EI) from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): (a) PVT-Pass, n = 85; (b) Alternative PVT-Fail, n = 53; and (c) Original PVT-Fail, n = 26. Participants also completed the Neurobehavioral Symptom Inventory. Results The PVT-Pass group performed better on cognitive testing and reported fewer symptoms than the two PVT-Fail groups. The Original PVT-Fail group performed more poorly on cognitive testing and reported more symptoms than the Alternative PVT-Fail group. Both PVT-Fail groups were more likely to meet DSM-5 Category A criteria for mild and major neurocognitive disorder and symptom reporting criteria for postconcussional syndrome than the PVT-Pass group. When alternative PVT cutoffs were used instead of original PVT cutoffs, the number of participants with valid data meeting cognitive testing criteria for neurocognitive disorder or postconcussional syndrome decreased dramatically. Conclusion PVT performance is significantly and meaningfully related to overall neuropsychological outcome. By using only original cutoffs, clinicians and researchers may miss people with invalid performances.
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Affiliation(s)
- Sara M Lippa
- Defense and Veterans Brain Injury Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Rael T Lange
- Defense and Veterans Brain Injury Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Louis M French
- Defense and Veterans Brain Injury Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA.,Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Grant L Iverson
- Defense and Veterans Brain Injury Center, Bethesda, MD, USA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
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20
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Howell DR, Potter MN, Kirkwood MW, Wilson PE, Provance AJ, Wilson JC. Clinical predictors of symptom resolution for children and adolescents with sport-related concussion. J Neurosurg Pediatr 2019; 24:54-61. [PMID: 30994475 DOI: 10.3171/2018.11.peds18626] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/29/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to determine which variables assessed during an initial clinical evaluation for concussion are independently associated with time until symptom resolution among pediatric patients. METHODS Data collected from a prospective clinical registry of pediatric patients with concussion were analyzed. The primary outcome variable was time from injury until symptom resolution. Predictor variables assessed within 10 days after injury included preinjury factors, Health and Behavior Inventory scores, headache severity, and balance, vestibular, and oculomotor test performances. The researchers used univariate Cox proportional models to identify potential predictors of symptom resolution time and constructed a multivariate Cox proportional hazards model in which total duration of concussion symptoms remained the outcome variable. RESULTS The sample consisted of 351 patients (33% female, mean age 14.6 ± 2.2 years, evaluated 5.6 ± 2.6 days after concussion). Univariate Cox proportional hazards models indicated that several variables were associated with a longer duration of symptoms, including headache severity (hazard ratio [HR] 0.90 [95% CI 0.85-0.96]), headache frequency (HR 0.83 [95% CI 0.71-0.96]), confusion (HR 0.79 [95% CI 0.69-0.92]), forgetfulness (HR 0.79 [95% CI 0.68-0.92]), attention difficulties (HR 0.83 [95% CI 0.72-0.96]), trouble remembering (HR 0.84 [95% CI 0.72-0.98]), getting tired often (HR 0.86 [95% CI 0.76-0.97]), getting tired easily (HR 0.86 [95% CI 0.76-0.98]), dizziness (HR 0.86 [95% CI 0.75-0.99]), and abnormal performance on the Romberg test (HR 0.59 [95% CI 0.40-0.85]). A multivariate Cox proportional hazards model indicated that an abnormal performance on the Romberg test was independently associated with a longer duration of symptoms (HR 0.65 [95% CI 0.44-0.98]; p = 0.038). CONCLUSIONS For children and adolescents evaluated within 10 days after receiving a concussion, abnormal performance on the Romberg test was independently associated with a longer duration of symptoms during recovery. In line with findings of other recent studies investigating predictors of symptom resolution, postural stability tests may provide useful prognostic information for sports medicine clinicians.
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Affiliation(s)
- David R Howell
- 1Sports Medicine Center and.,2Department of Orthopedics and
| | | | - Michael W Kirkwood
- 3Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado.,4Rehabilitation Medicine, Children's Hospital Colorado; and
| | - Pamela E Wilson
- 3Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado.,4Rehabilitation Medicine, Children's Hospital Colorado; and
| | | | - Julie C Wilson
- 1Sports Medicine Center and.,2Department of Orthopedics and
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21
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MacAllister WS, Vasserman M, Armstrong K. Are we documenting performance validity testing in pediatric neuropsychological assessments? A brief report. Child Neuropsychol 2019; 25:1035-1042. [DOI: 10.1080/09297049.2019.1569606] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- William S. MacAllister
- Neuropsychology Service, Alberta Children’s Hospital
- Department of Paediatrics, University of Calgary
- Alberta Children’s Hospital Research Institute
- Department of Neurology, Comprehensive Epilepsy Center, New York University School of Medicine
| | - Marsha Vasserman
- Neuropsychology Service, Alberta Children’s Hospital
- Alberta Children’s Hospital Research Institute
- Department of Child Adolescent Psychiatry, Child Study Center, New York University School of Medicine
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22
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Emhoff SM, Lynch JK, McCaffrey RJ. Performance and Symptom Validity Testing in Pediatric Assessment: A Review of the Literature. Dev Neuropsychol 2018; 43:671-707. [DOI: 10.1080/87565641.2018.1525612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Stephanie M. Emhoff
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
| | - Julie K. Lynch
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
- Albany Neuropsychological Associates, Albany, New York, USA
| | - Robert J. McCaffrey
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
- Albany Neuropsychological Associates, Albany, New York, USA
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23
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Detecting Invalid Performance in Youth with Traumatic Brain Injury Using the Child and Adolescent Memory Profile (ChAMP) Lists Subtest. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2018. [DOI: 10.1007/s40817-018-0056-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Brooks BL, Sherman EMS. Using the Memory Validity Profile (MVP) to detect invalid performance in youth with mild traumatic brain injury. APPLIED NEUROPSYCHOLOGY-CHILD 2018; 8:319-325. [DOI: 10.1080/21622965.2018.1476865] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Brian L. Brooks
- Neuropsychology Service, Alberta Children’s Hospital, Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Alberta Children’s Hospital Research Institute University of Calgary, Calgary, Alberta, Canada
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25
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Macartney G, Simoncic V, Goulet K, Aglipay M. Concussion Symptom Prevalence, Severity and Trajectory: Implications for Nursing Practice. J Pediatr Nurs 2018; 40:58-62. [PMID: 29776480 DOI: 10.1016/j.pedn.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe the symptom severity and trajectory in concussed children who were followed during a one year period at a concussion clinic. DESIGN AND METHODS A retrospective chart review was completed to describe the symptom trajectory up to three months during the recovery. RESULTS One hundred and thirty-six patients were included (74 female, 62 male) with a median age of 15.4years (range 13-17). The most common mechanisms of injury included: falls (19.9%), hockey injuries (15.4%), soccer (14.0%) and football injuries (6.6%). Most concussion symptoms decreased in severity or improved over time. Four symptoms including fatigue/low energy, drowsiness, concentration difficulties and irritability had the highest symptoms scores at both 28 and 84days post-injury in patients with persistent symptoms. Emotionality and nervousness/anxiousness and nausea/vomiting scores were seen to increase over time in patients with persistent symptoms. IMPLICATIONS Clinical use of standardized assessment tools can help caregivers track and monitor concussion symptoms over time. Appropriate management strategies need to be devised for symptoms that are prevalent or increasing over time.
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Affiliation(s)
- Gail Macartney
- Children's Hospital of Eastern Ontario (CHEO), Canada; CHEO Research Institute, Canada.
| | | | - Kristian Goulet
- Children's Hospital of Eastern Ontario (CHEO), Canada; CHEO Research Institute, Canada
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26
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The Diagnosis of Concussion in Pediatric Emergency Departments: A Prospective Multicenter Study. J Emerg Med 2018; 54:757-765. [PMID: 29685472 DOI: 10.1016/j.jemermed.2018.02.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/14/2018] [Accepted: 02/23/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The accurate identification of children with a concussion by emergency physicians is important to initiate appropriate anticipatory guidance and management. OBJECTIVES We compared the frequency of persistent concussion symptoms in children who were provided the diagnosis of concussion by an emergency physician versus those who met Berlin/Zurich international criteria for this diagnosis. We also determined the clinical variables independently associated with a physician-diagnosed concussion. METHODS This was a planned secondary analysis of a prospective, multicenter cohort study. Participants were 5-17 years of age and met the Zurich/Berlin International Consensus Statement criteria for concussion. RESULTS There were 2946 enrolled children. In those with physician-diagnosed concussion vs. no concussion, the frequency of persistent symptoms was 62.5% vs. 38.8% (p < 0.0001) at 1 week, 46.3% vs. 25.8% (p < 0.0001) at 2 weeks, and 33.0% vs. 23.0% (p < 0.0001) at 4 weeks. Of those meeting international criteria, 2340 (79.4%) were diagnosed with a concussion by an emergency physician and 12 variables were associated with this diagnosis. Five had an odds ratio (OR) > 1.5: older age (13-17 vs. 5-7 years, OR 2.9), longer time to presentation (≥16 vs. <16 h, OR 2.1), nausea (OR 1.7), sport mechanism (OR 1.7), and amnesia (OR 1.6). CONCLUSIONS Relative to international criteria, the more selective assignment of concussion by emergency physicians was associated with a greater frequency of persistent concussion symptoms. In addition, while most children meeting international criteria for concussion were also provided this diagnosis for concussion by an emergency physician, the presence of 5 specific variables made this diagnosis more likely.
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27
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Vollmer BL, Kirkwood MW, Comstock RD, Currie D, Grubenhoff JA. Assessing the Clinical Utility of the Question, "Is Your Child/Are You Back to Normal?" in Pediatric Concussion Symptom Resolution. Clin Pediatr (Phila) 2018; 57:146-151. [PMID: 28198194 DOI: 10.1177/0009922817693300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigates the relationship between the general question, "Is your child/are you back to normal?" and a validated postconcussive symptom scale when assessing symptom resolution following concussion. Children with acute concussion were enrolled during an emergency department visit. Sensitivity and specificity analyses compared the true/false question, "My child is/I am back to normal" at 3 days postinjury with the Concussion Symptom Inventory (CSI; gold standard). A total of 201 participants were enrolled in the study with complete data. The true/false questions of "My child is/I am back to normal" had sensitivities of 78.4% and 59.3% and specificities of 75.0% and 86.4% for caregiver and child responses, respectively, when compared with their corresponding CSI. This study demonstrates that asking a parent or child if the child is back to normal has poor sensitivity and modest specificity in determining if a child's symptoms have resolved within 3 days of sustaining a concussion relative to a standardized symptom scale.
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Affiliation(s)
- Brandi L Vollmer
- 1 Colorado School of Public Health, Aurora, CO, USA.,2 University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael W Kirkwood
- 2 University of Colorado School of Medicine, Aurora, CO, USA.,3 Children's Hospital Colorado, Aurora, CO, USA
| | - R Dawn Comstock
- 1 Colorado School of Public Health, Aurora, CO, USA.,2 University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Joseph A Grubenhoff
- 2 University of Colorado School of Medicine, Aurora, CO, USA.,3 Children's Hospital Colorado, Aurora, CO, USA
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28
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Chase D, Schatz P, Smyk N, Franks RR. The stability of engagement over comprehensive neuropsychological assessment in student athletes diagnosed with sports related concussion. Dev Neuropsychol 2018; 43:345-355. [DOI: 10.1080/87565641.2018.1428326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Philip Schatz
- Department of Psychology, Saint Joseph’s University, Philadelphia, PA, USA
| | - Nathan Smyk
- Department of Psychology, Saint Joseph’s University, Philadelphia, PA, USA
| | - R. Robert Franks
- Rothman Institute, Orthopedics Department, Philadelphia, PA, USA
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29
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Paquin H, Taylor A, Meehan WP. Office-based concussion evaluation, diagnosis, and management: pediatric. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:107-117. [PMID: 30482337 DOI: 10.1016/b978-0-444-63954-7.00011-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
More children and adolescents are participating in competitive sports than ever before, causing an overall increase in sport-related injuries. Concussion is a common injury in the pediatric population and its prevalence has increased with increased visibility and awareness. This chapter will discuss the clinical presentation, evaluation, and management of concussions sustained by pediatric athletes, while addressing the distinctive factors that pertain to this population. Management of concussion should be tailored to patients' symptoms and should focus on an early and gradual return to both cognitive and noncontact low-risk physical activity. A multidisciplinary approach is often helpful in addressing more specific symptoms, which fall into the somatic, cognitive, vestibular, emotional, and sleep domains. A prolonged recovery is defined by symptoms lasting more than 4 weeks. Individualized return-to-play decisions should focus on the safety of the young athlete.
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Affiliation(s)
- Hugo Paquin
- Division of Pediatric Emergency Medicine, CHU Ste-Justine, Montreal, QC, Canada.
| | - Alex Taylor
- Division of Neurology and Psychiatry, Boston Children's Hospital, Boston, MA, United States
| | - William P Meehan
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States
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30
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Berkner J, Meehan WP, Master CL, Howell DR. Gait and Quiet-Stance Performance Among Adolescents After Concussion-Symptom Resolution. J Athl Train 2017; 52:1089-1095. [PMID: 29154694 DOI: 10.4085/1062-6050-52.11.23] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Concussions affect a large number of US athletes each year. Returning an athlete to activity once self-reported symptoms have resolved can be problematic if unrecognized neurocognitive and balance deficits persist. Pairing cognitive and motor tasks or cognitive and quiet-stance tasks may allow clinicians to detect and monitor these changes postconcussion. OBJECTIVE To prospectively examine adolescent athletes' gait and quiet-stance performance while concurrently completing a cognitive task acutely after concussion and after symptom resolution. DESIGN Case-control study. SETTING Sport concussion clinic. PATIENTS OR OTHER PARTICIPANTS Thirty-seven athletes (age = 16.2 ± 3.1 years; 54% female) were diagnosed with a concussion, and their performance was compared with that of a group of 44 uninjured control participants (age = 15.0 ± 2.0 years; 57% female). INTERVENTION Participants diagnosed with a concussion completed a symptom inventory and single- and dual-task gait and quiet-stance evaluations within 21 days of injury and then again after symptom resolution. Gait and postural-control measurements were quantified using an inertial sensor system and analyzed using multivariate analyses of covariance. MAIN OUTCOME MEASURE(S) Post-Concussion Symptom Scale, single-task and dual-task gait measures, quiet-stance measures, and cognitive task performance. RESULTS At the initial postinjury examination, single-task gait stride length (1.16 ± 0.14 versus 1.25 ± 0.13 m, P = .003) and dual-task gait stride length (1.02 ± 0.13 m versus 1.10 ± 0.13 m, P = .011) for the concussion group compared with the control group, respectively, were shorter. After symptom resolution, no single-task gait differences were found, but the concussion group demonstrated slower gait velocity (0.78 ± 0.15 m/s versus 0.92 ± 0.14 m/s, P = .005), lower cadence (92.5 ± 12.2 steps/min versus 99.3 ± 7.8 steps/min, P < .001), and a shorter stride length (0.99 ± 0.15 m versus 1.10 ± 0.13 m, P = .003) during dual-task gait than the control group. No between-groups differences were detected during quiet stance at either time point. CONCLUSIONS Acutely after concussion, single-task and dual-task stride-length alterations were present among youth athletes compared with a control group. Although single-task gait alterations were not detected after symptom resolution, dual-task gait differences persisted, suggesting that dual-task gait alterations may persist longer after concussion than single-task gait or objective quiet-stance alterations. Dual-task gait assessments may, therefore, be a useful component in monitoring concussion recovery after symptom resolution.
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Affiliation(s)
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Division of Sports Medicine, Boston Children's Hospital, Waltham, MA
| | - Christina L Master
- Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine
| | - David R Howell
- The Micheli Center for Sports Injury Prevention, Division of Sports Medicine, Boston Children's Hospital, Waltham, MA.,Sports Medicine Center, Department of Orthopedics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora
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McNally KA, Patrick KE, LaFleur JE, Dykstra JB, Monahan K, Hoskinson KR. Brief cognitive behavioral intervention for children and adolescents with persistent post-concussive symptoms: A pilot study. Child Neuropsychol 2017; 24:396-412. [DOI: 10.1080/09297049.2017.1280143] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Kelly A. McNally
- Section of Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Kristina E. Patrick
- Section of Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Jacob E. LaFleur
- The Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Jana B. Dykstra
- Section of Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Kerry Monahan
- Section of Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Kristen R. Hoskinson
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- The Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
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Predictors of Post-concussive Symptoms in Young Children: Injury versus Non-injury Related Factors. J Int Neuropsychol Soc 2016; 22:793-803. [PMID: 27619107 DOI: 10.1017/s1355617716000709] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES A notable minority of children will experience persistent post-concussive symptoms (PCS) following mild traumatic brain injury (mTBI), likely maintained by a combination of injury and non-injury related factors. Adopting a prospective longitudinal design, this study aimed to investigate the relative influence of child, family, and injury factors on both acute and persistent PCS in young children. METHODS Participants were 101 children aged 2-12 who presented to an Emergency Department, with either mTBI or minor bodily trauma (control). PCS were assessed at time of injury, 1 week, and 1, 2, and 3 months post-injury. Predictors included injury and demographic variables, premorbid child behavior, sleep hygiene, and parental stress. Random effects ordinal logistic regression models were used to analyze the relative influence of these predictors on PCS at early (acute - 1 week) and late (1-3 month) post-injury phases. RESULTS Presence of mTBI was a stronger predictor of PCS in the early [odds ratio (OR)=18.2] compared with late (OR=7.3) post-injury phase. Older age at injury and pre-existing learning difficulties were significant predictors of PCS beyond 1 month post-injury. Family factors, including higher levels of parental stress, higher socio-economic status, and being of Anglo-Saxon descent, consistently predicted greater PCS. CONCLUSIONS Injury characteristics were significantly associated with PCS for 3 months following mTBI but the association weakened over time. On the other hand, pre-existing child and family factors displayed an increasingly strong association with PCS over time. Follow-up for these "at-risk" children which also addresses family stress may minimize longer-term complications. (JINS, 2016, 22, 793-803).
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Zonfrillo MR. "Tertiary Precision Prevention" for Concussion: Customizing Care by Predicting Outcomes. J Pediatr 2016; 174:6-7. [PMID: 27179548 DOI: 10.1016/j.jpeds.2016.04.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 04/21/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Mark R Zonfrillo
- Department of Emergency Medicine and Injury Prevention Center, Hasbro Children's Hospital, Providence, Rhode Island; Alpert Medical School of Brown University, Providence, Rhode Island.
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Root JM, Zuckerbraun NS, Wang L, Winger D, Brent D, Kontos A, Hickey R. History of Somatization Is Associated with Prolonged Recovery from Concussion. J Pediatr 2016; 174:39-44.e1. [PMID: 27059916 PMCID: PMC4925238 DOI: 10.1016/j.jpeds.2016.03.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 02/22/2016] [Accepted: 03/04/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine the association between a history of somatization and prolonged concussion symptoms, including sex differences in recovery. STUDY DESIGN A prospective cohort study of 10- to 18-year-olds with an acute concussion was conducted from July 2014 to April 2015 at a tertiary care pediatric emergency department. One hundred twenty subjects completed the validated Children's Somatization Inventory (CSI) for pre-injury somatization assessment and Postconcussion Symptoms Scale (PCSS) at diagnosis. PCSS was re-assessed by phone at 2 and 4 weeks. CSI was assessed in quartiles with a generalized estimating equation model to determine relationship of CSI to PCSS over time. RESULTS The median age of our study participants was 13.8 years (IQR 11.5, 15.8), 60% male, with separate analyses for each sex. Our model showed a positive interaction between total CSI score, PCSS and time from concussion for females P < .01, and a statistical trend for males, P = .058. Females in the highest quartile of somatization had higher PCSS than the other 3 CSI quartiles at each time point (B -26.7 to -41.1, P values <.015). CONCLUSIONS Patients with higher pre-injury somatization had higher concussion symptom scores over time. Females in the highest somatization quartile had prolonged concussion recovery with persistently high symptom scores at 4 weeks. Somatization may contribute to sex differences in recovery, and assessment at the time of concussion may help guide management and target therapy.
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Affiliation(s)
- Jeremy M Root
- Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, DC.
| | - Noel S. Zuckerbraun
- Division of Pediatric Emergency Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Li Wang
- Office of Clinical Research, Heath Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Dan Winger
- Office of Clinical Research, Heath Sciences, University of Pittsburgh, Pittsburgh, PA
| | - David Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Anthony Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Robert Hickey
- Division of Pediatric Emergency Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA
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Abstract
BACKGROUND Youth have been assumed historically to be less capable of deception than adults, even though acts of deception in childhood are not uncommon. Relatively little attention has focused on how frequently they feign or exaggerate during healthcare evaluations. PURPOSE The current article reviews the literature relevant to using validity tests in children and adolescents, as well as provides a case example of a young adolescent providing noncredible effort and exaggerated symptomatology during neuropsychological evaluation after a mild traumatic brain injury. CONCLUSION Numerous case reports and case series have documented clearly that medical and neuropsychological noncredible presentations occur in children, likely more often than many practitioners believe. Thus far, research has found that the base rates of pediatric noncredible presentations are highest in children seen frequently by rehabilitation providers (i.e., children with persistent problems after mild traumatic brain injury and children from families seeking disability benefits on their behalf). Subjective clinical judgment is apt to be ineffective in consistently detecting noncredible presentations. Fortunately, recent research supports the use of several stand-alone validity tests in identifying noncredible pediatric data including the Test of Memory Malingering, Word Memory Test, and Medical Symptom Validity Test. If feigning and exaggeration are not considered in work-ups by rehabilitation practitioners, mismanagement and iatrogenic harm to the child can result.
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Connery AK, Peterson RL, Baker DA, Kirkwood MW. The impact of pediatric neuropsychological consultation in mild traumatic brain injury: a model for providing feedback after invalid performance. Clin Neuropsychol 2016; 30:579-98. [PMID: 27142647 DOI: 10.1080/13854046.2016.1177596] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In recent years, pediatric practitioners have increasingly recognized the importance of objectively measuring performance validity during clinical assessments. Yet, no studies have examined the impact of neuropsychological consultation when invalid performance has been identified in pediatric populations and little published guidance exists for clinical management. Here we provide a conceptual model for providing feedback after noncredible performance has been detected. In a pilot study, we examine caregiver satisfaction and postconcussive symptoms following provision of this feedback for patients seen through our concussion program. METHODS Participants (N = 70) were 8-17-year-olds with a history of mild traumatic brain injury who underwent an abbreviated neuropsychological evaluation between 2 and 12 months post-injury. We examined postconcussive symptom reduction and caregiver satisfaction after neuropsychological evaluation between groups of patients who were determined to have provided noncredible effort (n = 9) and those for whom no validity concerns were present (n = 61). RESULTS We found similarly high levels of caregiver satisfaction between groups and greater reduction in self-reported symptoms after feedback was provided using the model with children with noncredible presentations compared to those with credible presentations. CONCLUSION The current study lends preliminary support to the idea that the identification and communication of invalid performance can be a beneficial clinical intervention that promotes high levels of caregiver satisfaction and a reduction in self-reported and caregiver-reported symptoms.
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Affiliation(s)
- Amy K. Connery
- Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
| | - Robin L. Peterson
- Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
| | - David A. Baker
- Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
| | - Michael W. Kirkwood
- Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
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The Role of Neuropsychological Evaluation in the Clinical Management of Concussion. Phys Med Rehabil Clin N Am 2016; 27:475-86. [DOI: 10.1016/j.pmr.2015.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kirkwood MW, Peterson RL, Connery AK, Baker DA, Forster J. A Pilot Study Investigating Neuropsychological Consultation as an Intervention for Persistent Postconcussive Symptoms in a Pediatric Sample. J Pediatr 2016; 169:244-9.e1. [PMID: 26541427 DOI: 10.1016/j.jpeds.2015.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/21/2015] [Accepted: 10/05/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the efficacy of a one-time neuropsychological consultation as an intervention for youth with persistent postconcussive symptoms following mild traumatic brain injury. STUDY DESIGN Using a prospective interrupted time series design, we enrolled 80 patients aged 8-17 years referred consecutively for clinical neuropsychological consultation. Patients needed to have sustained injury between 2 and 12 months prior to enrollment. Parent and child postconcussive symptom ratings were used as the primary outcome measures and were collected at 6 time points, 3 before the neuropsychological consultation and 3 after. Repeated measure ANOVA was used to estimate the magnitude of change in symptom ratings before and after the neuropsychological intervention. RESULTS The decrease in symptoms for the week prior to consultation was nonsignificant by both child (P = .63) and parent (P = .19) report. In contrast, for both reporters, the decrease in symptoms at 1 week and 3 months postconsultation was significant (P < .0001). The difference in reported change was also significant when comparing the week before the intervention to the 3 months after (child: P < .0001; parent: P = .0009). CONCLUSIONS Postconcussive symptoms decreased significantly following the neuropsychological consultation. The primary limitation of the study is that it lacked randomization and a control group. The results warrant further research into the benefits of neuropsychological consultation after mild traumatic brain injury and provide justification for clinical providers to consider referring to neuropsychologists in the face of persistent postconcussive symptoms.
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Affiliation(s)
- Michael W Kirkwood
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
| | - Robin L Peterson
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Amy K Connery
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - David A Baker
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Jeri Forster
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
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Kirkwood MW, Peterson RL, Baker DA, Connery AK. Parent satisfaction with neuropsychological consultation after pediatric mild traumatic brain injury. Child Neuropsychol 2016; 23:273-283. [PMID: 26739699 DOI: 10.1080/09297049.2015.1130219] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Few studies have focused on consumer satisfaction following neuropsychological evaluation. We sought to examine parent satisfaction with neuropsychological consultation following a mild traumatic brain injury (TBI) in school-age children. We surveyed 71 parents of 8- to 17-year-olds participating in a prospective longitudinal study examining neuropsychological consultation as an intervention for persistent postconcussive symptoms. Children had sustained injuries between 2 and 12 months prior to enrollment. Neuropsychological consultation occurred on average 5 months post-injury. Parent satisfaction data were collected via telephone approximately 4 months after the neuropsychological consultation. The vast majority of parents were quite satisfied with the service (e.g., 94% overall satisfaction rate; 96% rated the service as good or excellent). Satisfaction rates were associated positively with time since injury and negatively with parental education. No other child, parent, or provider variable correlated with satisfaction. The results add to the relatively sparse literature on parent satisfaction with neuropsychological evaluation. A pressing future need in pediatric neuropsychology is to examine the satisfaction of other consumers of the service, including healthcare personnel, educators, and the child patients themselves.
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Affiliation(s)
- Michael W Kirkwood
- a Department of Physical Medicine & Rehabilitation , University of Colorado School of Medicine and Children's Hospital Colorado , Aurora , CO , USA
| | - Robin L Peterson
- a Department of Physical Medicine & Rehabilitation , University of Colorado School of Medicine and Children's Hospital Colorado , Aurora , CO , USA
| | - David A Baker
- a Department of Physical Medicine & Rehabilitation , University of Colorado School of Medicine and Children's Hospital Colorado , Aurora , CO , USA
| | - Amy K Connery
- a Department of Physical Medicine & Rehabilitation , University of Colorado School of Medicine and Children's Hospital Colorado , Aurora , CO , USA
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Rose SC, Weber KD, Collen JB, Heyer GL. The Diagnosis and Management of Concussion in Children and Adolescents. Pediatr Neurol 2015; 53:108-18. [PMID: 26088839 DOI: 10.1016/j.pediatrneurol.2015.04.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Concussion is a complex brain injury that results in more than 100,000 emergency department visits for school-aged children each year in the United States. All 50 US states have passed concussion legislation designed to promote safety in youth sports. Most of these laws require medical clearance by a licensed health care provider before returning to sport, which may have contributed to an increase in pediatric subspecialty referrals, particularly referrals to the child neurologist. METHODS We reviewed the literature on pediatric concussion. RESULTS This review summarizes the current knowledge and recommendations for concussion diagnosis and management in children and adolescents, athletes and nonathletes. It highlights concussion epidemiology, pathophysiology, advances in neuroimaging, and potential health risks including second impact syndrome and chronic traumatic encephalopathy. It also underscores clinical areas where evidence is lacking. CONCLUSIONS The diagnosis and management of concussion requires specific considerations in children. Further concussion research must be done to minimize injury risk and to optimize medical care for this common problem.
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Affiliation(s)
- Sean C Rose
- Departments of Pediatrics and Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Kevin D Weber
- Department of Neurology, The Ohio State University, Columbus, Ohio
| | - James B Collen
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Geoffrey L Heyer
- Departments of Pediatrics and Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio.
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Silver JM. Invalid symptom reporting and performance: What are we missing? NeuroRehabilitation 2015; 36:463-9. [DOI: 10.3233/nre-151234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Boutis K, Weerdenburg K, Koo E, Schneeweiss S, Zemek R. The diagnosis of concussion in a pediatric emergency department. J Pediatr 2015; 166:1214-1220.e1. [PMID: 25919731 DOI: 10.1016/j.jpeds.2015.02.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/12/2015] [Accepted: 02/05/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare the proportion of children diagnosed with a concussion by pediatric emergency physicians vs the proportion who met criteria for this injury as recommended by Zurich Fourth International Conference on Concussion consensus statement and to determine clinical variables associated with a physician diagnosis of a concussion. STUDY DESIGN This was a prospective, cross-sectional study conducted at a tertiary care pediatric emergency department. We enrolled children ages 5 through 17 who presented with a head injury and collected data on demographics, mechanism of injury, head injury-related symptoms/signs, physician diagnosis, and discharge advice. RESULTS We identified 495 children whose mean age was 10.1 years (SD 3.4 years); 308 (62.2%) were male. Emergency physicians diagnosed concussion in 200 (40.4%; 95% CI 36.1, 44.7) children, and 443 (89.5%; 95% CI 86.8, 92.2) met criteria for concussion in accordance with the Zurich consensus statement (P<.0001). Age≥10 years (OR 1.8), presentation≥1 day after injury (OR 2.4), injury from collision sports (OR 5.6), and symptoms of headache (OR 2.2) or amnesia (OR 3.4) were the variables significantly associated with an emergency physician's diagnosis of concussion. CONCLUSIONS Pediatric emergency physicians diagnosed concussion less often relative to international consensus-based guidelines and used a limited number of variables to make this diagnosis compared with current recommendations. Thus, pediatric emergency physicians may be missing cases of concussion and the corresponding opportunity to provide critical advice for cognitive and physical management.
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Affiliation(s)
- Kathy Boutis
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada.
| | - Kirstin Weerdenburg
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ellen Koo
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Suzan Schneeweiss
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Roger Zemek
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario and the University of Ottawa, Ottawa, Canada
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Gidley Larson JC, Flaro L, Peterson RL, Connery AK, Baker DA, Kirkwood MW. The Medical Symptom Validity Test Measures Effort Not Ability in Children: A Comparison Between Mild TBI and Fetal Alcohol Spectrum Disorder Samples. Arch Clin Neuropsychol 2015; 30:192-9. [DOI: 10.1093/arclin/acv012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 11/13/2022] Open
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Bigler ED. Effort, symptom validity testing, performance validity testing and traumatic brain injury. Brain Inj 2014; 28:1623-38. [PMID: 25215453 PMCID: PMC4673569 DOI: 10.3109/02699052.2014.947627] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 05/09/2014] [Accepted: 07/20/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND To understand the neurocognitive effects of brain injury, valid neuropsychological test findings are paramount. REVIEW This review examines the research on what has been referred to a symptom validity testing (SVT). Above a designated cut-score signifies a 'passing' SVT performance which is likely the best indicator of valid neuropsychological test findings. Likewise, substantially below cut-point performance that nears chance or is at chance signifies invalid test performance. Significantly below chance is the sine qua non neuropsychological indicator for malingering. However, the interpretative problems with SVT performance below the cut-point yet far above chance are substantial, as pointed out in this review. This intermediate, border-zone performance on SVT measures is where substantial interpretative challenges exist. Case studies are used to highlight the many areas where additional research is needed. Historical perspectives are reviewed along with the neurobiology of effort. Reasons why performance validity testing (PVT) may be better than the SVT term are reviewed. CONCLUSIONS Advances in neuroimaging techniques may be key in better understanding the meaning of border zone SVT failure. The review demonstrates the problems with rigidity in interpretation with established cut-scores. A better understanding of how certain types of neurological, neuropsychiatric and/or even test conditions may affect SVT performance is needed.
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Affiliation(s)
- Erin D. Bigler
- Department of Psychology
- Neuroscience Center
- Magnetic Resonance Imaging Research Facility, Brigham Young University
Provo, UTUSA
- Department of Psychiatry
- The Brain Institute of Utah, University of Utah
Salt Lake City, UTUSA
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