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 “While it has been long-understood that brain injuries may
negatively impact quality-of-life (especially in those patients with
severe injuries who have required surgery), we were surprised to see
that the quality-of-life following concussion may have prolonged
effects (3 months or more) on school even in those children who had
recovered within one month,” said senior author Dr. Roger Zemeck of
the Children’s Hospital of Eastern Ontario Research Institute in
Ottawa.
“Fortunately, most children recover fairly quickly following
concussion; only about 30 percent of children exhibit multiple
symptoms lasting beyond one month from the time of their injury,”
and meet the criteria for persistent postconcussion syndrome, Zemeck
told Reuters Health by email.
The researchers evaluated quality of life factors for about 2,000
kids aged 5 to 18 years who had presented to an emergency department
within two days of suffering an acute concussion.
Doctors assessed their symptoms in physical, emotional, thinking and
sleep areas four weeks after their injuries, and again eight and 12
weeks afterward. Kids with three or more symptoms that had not
resolved at the four-week mark were considered to have “persistent
postconcussion syndrome.” Of the total group, 510 kids fell into
this category.
Quality of life was assessed with a questionnaire completed by
parents of kids younger than 8, and by older children themselves.
Responses yielded an overall score of zero to 100, with higher
scores representing better quality of life. The inventory also rated
subcategories of quality of life, including physical, emotional,
social and school-related.
Kids with postconcussion syndrome scored about 10 points lower in
overall quality of life, with a mean score of 70, compared with
those who had recovered from a concussion quickly and had a mean
score of 80.3, the study team reports in JAMA Pediatrics. These kids
also had lower scores on all the quality of life subcategories at
four, eight and 12 weeks.
Even kids who recovered quickly from a concussion averaged scores
three to four points lower than normal scores for healthy kids who
haven’t had a concussion, the study found.
School–related functioning remained significantly lower for kids who
recovered from concussions at all the time points, researchers note.
“It is important to remember that by definition, a concussion is a
brain injury, and the brain controls all aspects of life.
Unfortunately, we still do not yet know what are the causes for why
quality of life is impacted,” Zemeck said.
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“Once we better understand why it happens, we can then formulate
interventions in order to target these causes with the hope of
improving outcomes for these youth,” he said.
After a diagnosed concussion, initial management calls for a brief
period of rest, missing some school, some physical rest and not
engaging in contact-risk activities, so it’s not surprising that
physical, social, emotional and school functioning dips in this
time, said Dr. Christopher C. Giza of the University of California,
Los Angeles, who coauthored an accompanying editorial.
“(Parents and teachers) should be aware of these possibilities and
work together and with health care providers to both monitor kids’
symptoms and function as well as devise an individualized ‘return to
normalcy progression’,” Giza told Reuters Health by email. This plan
should provide guidance for gradual reintroduction to school, then
gradual non-contact aerobic exercise, then gradual return to play
progression, and finally, if desired, return to contact risk, he
said.
“Again, it has been shown that one of the strongest interventions to
promote more rapid recovery is anticipating improvement and managing
activity; so finding the right balance of monitoring a child’s
recovery without onerous, frequent questioning about symptoms or
excessive restrictions on non-risky activities is a laudable goal,”
Giza said.
SOURCE: http://bit.ly/2eIb2Yf and http://bit.ly/2dFFjZQ JAMA
Pediatrics, online October 24, 2016.
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