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      Graded aerobic treadmill testing in pediatric sports-related concussion: safety, clinical use, and patient outcomes

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          A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome.

          To evaluate the safety and effectiveness of subsymptom threshold exercise training for the treatment of post-concussion syndrome (PCS). Prospective case series. University Sports Medicine Concussion Clinic. Twelve refractory patients with PCS (6 athletes and 6 nonathletes). Treadmill test to symptom exacerbation threshold (ST) before and after 2 to 3 weeks of baseline. Subjects then exercised 5 to 6 days per week at 80% ST heart rate (HR) until voluntary peak exertion without symptom exacerbation. Treadmill testing was repeated every 3 weeks. Adverse reactions to exercise, PCS symptoms, HR, systolic blood pressure (SBP), achievement of maximal exertion, and return to work/sport. Pretreatment, ST occurred at low exercise HR (147 + or - 27 bpm) and SBP (142 + or - 6 mm Hg). After treatment, subjects exercised longer (9.75 + or - 6.38 minutes to 18.67 + or - 2.53 minutes, P = .001) and achieved peak HR (179 + or - 17 bpm) and SBP (156 + or - 13 mm Hg), both P < .001 versus pretreatment, without symptom exacerbation. Time series analysis showed significant change in rate of symptom reduction for all subjects and reduced mean symptom number in 8/11. Rate of PCS symptom improvement was related to peak exercise HR (r = -0.55, P = .04). Athletes recovered faster than nonathletes (25 + or - 8.7 vs 74.8 + or - 27.2 days, P = .01). No adverse events were reported. Athletes returned to sport and nonathletes to work. Treatment with controlled exercise is a safe program that appears to improve PCS symptoms when compared with a no-treatment baseline. A randomized controlled study is warranted.
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            Pediatric sports-related concussion produces cerebral blood flow alterations.

            The pathophysiology of sports-related concussion (SRC) is incompletely understood. Human adult and experimental animal investigations have revealed structural axonal injuries, decreases in the neuronal metabolite N-acetyl aspartate, and reduced cerebral blood flow (CBF) after SRC and minor traumatic brain injury. The authors of this investigation explore these possibilities after pediatric SRC. Twelve children, ages 11 to 15 years, who experienced SRC were evaluated by ImPACT neurocognitive testing, T1 and susceptibility weighted MRI, diffusion tensor imaging, proton magnetic resonance spectroscopy, and phase contrast angiography at 30 days after SRC. Pediatric SRC is primarily a physiologic injury, affecting CBF significantly without evidence of measurable structural, metabolic neuronal or axonal injury. Further study of CBF mechanisms is needed to explain patterns of recovery.
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              Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department.

              To determine the acute predictors associated with the development of postconcussion syndrome (PCS) in children and adolescents after mild traumatic brain injury.
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                Author and article information

                Journal
                Journal of Neurosurgery: Pediatrics
                Journal of Neurosurgery: Pediatrics
                Journal of Neurosurgery Publishing Group (JNSPG)
                1933-0707
                1933-0715
                December 2016
                December 2016
                : 18
                : 6
                : 693-702
                Article
                10.3171/2016.5.PEDS16139
                27620871
                bf670f59-3d74-4c5b-b1e4-fcfc50c96518
                © 2016
                History

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