Graded aerobic treadmill testing is safe, tolerable, and useful in evaluating and managing cases of sports-related concussion in children and adolescents according to a new study reported in the Journal of Neurosurgery: Pediatrics.
Sports-related concussion is a form of traumatic brain injury that is usually caused by a blow to the head or neck, or some other injury that causes the brain to suddenly shift position within the skull. Symptoms are associated with concussion include headache, dizziness, confusion, visual problems, concentration difficulties, irritability, depression.
‘Graded aerobic treadmill testing is safe and well tolerated in pediatric patients. It can be used to assess physiological recovery, classify concussion patients and successfully treat them with targeted rehabilitation strategies.’
Some young patients may experience concussion-related symptoms for only a short time, but in others symptoms linger for months or longer. When symptoms of concussion are prolonged, the condition is known as post-concussion syndrome. The authors stated "Clinical studies suggest that 21%-73% of children and adolescents who sustain a concussion will experience persistent symptoms at 1 month after injury or develop post-concussion syndrome."
The first goal of researchers was to assess the safety, tolerability, and clinical use of graded aerobic treadmill testing in young athletes with sports-related concussion; and second, to evaluate clinical outcomes in a subset of young patients with physiological post-concussion disorder who adhered to a submaximal aerobic exercise program. Similar studies have been performed but only in adults. This is the first study to focus exclusively on young athletes.
The researchers examined the use of graded aerobic treadmill testing in pediatric patients with sports-related concussion who had been referred to the multidisciplinary Pan Am Concussion Program in Winnipeg, Manitoba, Canada. Graded aerobic treadmill testing, along with the patient's clinical history, a complete physical examination, and a self-reported symptom inventory, was used to assess the concussion status of each of these patients.
Around 106 patients between 11 and 19 years of age underwent 141 treadmill tests between the years 2014-2016. The patients had a wide variety of concussion-related symptoms and were tested at various times during their recovery periods.
During graded aerobic treadmill testing, the intensity of each patient's workout was raised incrementally until maximal exhaustion was reached or until concussion-related symptoms appeared or were exacerbated.
Heart rate, blood pressure, and respiratory rate were monitored during or immediately after testing. In addition, the patients were asked to rate their perceived exertion during the test. The results of the treadmill test were then used "to assess physiological recovery, classify post-concussion syndrome (PCS) subtype, and reassess patients following treatment."
The researchers inform that there were no serious complications of graded aerobic treadmill testing. Of the 141 treadmill tests that were performed, 138 were well tolerated; the other three tests had to be terminated prematurely because the activity caused lower-extremity soreness related to earlier orthopedic injuries.
Sixty-five treadmill tests were performed with the specific purpose of assessing physiological recovery. Physiological recovery was confirmed in 63 patients, and 61 of these patients were medically cleared to return to play. None of the athletes who were medically cleared returned to the clinic for recurrent symptoms.
Dr. Michael Ellis provided the following comment said "Despite the explosion in concussion research in recent years, there remain limited objective tools that can help provide a view into the pathophysiology of concussion and post-concussion syndrome.
"Building on pioneering work at the University of Buffalo, this retrospective study demonstrates that graded aerobic treadmill testing is safe and well tolerated in pediatric patients, and it can be used to assess physiological recovery and classify concussion patients into operational physiologically based sub-types that, in the majority of cases, can be successfully treated with targeted rehabilitation strategies.
"This study suggests that persistent concussion symptoms are mediated by heterogeneous and often overlapping pathophysiological processes that must be identified and controlled for in future prospective studies examining targeted treatment options in this population."