Citation

DeMatteo CA, Volterman KA, Breithaupt PG, Claridge EA, Adamich J, Timmons BW. Med. Sci. Sports Exerc. 2015; 47(11): 2283-2290.

Affiliation

1CanChild, Center for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; 2School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; 3Child Health & Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.

Copyright

(Copyright © 2015, Lippincott Williams and Wilkins)

DOI

10.1249/MSS.0000000000000682

PMID

25871465

Abstract

PURPOSE: The decision regarding return to activity (RTA) following mild traumatic brain injuries (mTBI)/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. This study investigated how youth with Post-Concussion Syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA.

METHODS: Fifty-four youth (8.5 - 18.3 yrs) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Post-Concussion Symptom Scale (PCSS) at the following time points: pre-exertion (baseline), 5min, 30min and 24h post-exertion. A modified PCSS was administered at two-min intervals during exertion.

RESULTS: Participants had a mean ± SD symptom duration of 6.3 ± 6.9 months after the most recent concussive injury, with a median of 4.1 months (Range: 0.7-35 months). Sixty three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power (PMP). During acute assessment of symptoms (30-min post-exertion), headache (p = 0.39), nausea (p = 0.63) and dizziness (p = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24h, with 56.8% of youth showing improvements. The time from most recent injury had a significant impact on the symptom score at baseline, 30min post-exertion, and 24h post-exertion.

CONCLUSION: Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth.

Language: en