, November 2009; 23(12): 956–964
Active rehabilitation for children who are slow to recover followingsport-related concussion
, CARLO GALLI
, DEBBIE FRIEDMAN
, LISA GRILLI
, &GRANT L. IVERSON
Montreal Children’s Hospital, Montreal, Canada,
McGill University, Montreal, Canada, and
University of British Columbia and British Columbia Mental Health & Addiction Services, Vancouver, Canada
(Received 25 February 2009; revised 29 August 2009; accepted 27 September 2009)
: To present an innovative approach to the management of children who are slow to recover after a sport-related concussion.
: The article describes the underlying principles and the development of specific interventions for a newrehabilitation programme as well as preliminary data on pre- and post-rehabilitation changes in outcome measures.
Methods and procedures
: Development of the intervention was done using multiple perspectives including that of theliterature, of experts in the field of traumatic brain injury and of experienced clinicians involved with the paediatric andadolescent MTBI clientele. A logic model was developed providing sound theoretical background to the intervention. Theintervention was implemented and evaluated with a sample of 16 children and adolescents.
Main outcomes and results
: The presented cases suggest that involvement in controlled and closely monitored rehabilitation inthe post-acute period may promote recovery in children and adolescents who present with atypical recovery following aconcussion. All 16 of the children and adolescents who participated in the programme experienced a relatively rapidrecovery and returned to their normal lifestyles and sport participation.
: A gradual, closely-supervised active rehabilitation programme in the post-acute period (i.e. after 1 monthpost-injury) appears promising to improve the care provided to children who are slow to recover.
Concussion, mild traumatic brain injury, paediatric, rehabilitation, sports
Sport-related concussions (i.e. mild traumatic braininjuries (MTBI)) occur fairly commonly, particularlyin football, soccer, rugby and hockey [1–3]. Themajority of the literature to date suggests thatathletes recover quickly from concussions, withsome recovering in 1–2 days and most recoveringwithin 7–10 days [4, 5]. There is concern, however,that concussions in children might be different and might be associated with slower recovery.Professionals providing services to children andadolescents after a concussion have long recognizedthe need for coordinated care for this clienteleand, particularly, the need for individualizedinterdisciplinary management of the paediatric ath-lete who sustains a concussion [7–10]. More focusedand specific research with children has been recom-mended [11, 12].Agreement statements developed by governmentalorganizations , professional associations [10, 14]and research groups  set forth the recommen-dation that athletes, including children, should beasymptomatic at rest prior to engaging in physicalexertion. Without question, these agreement state-ments are designed to protect the health and welfareof the athlete, reduce the likelihood of the athleteexperiencing a set-back in the recovery process andminimize the chances that the athlete will be
Correspondence: Isabelle Gagnon, Montreal Children’s Hospital-McGill University Health Center, Trauma Programs, C-833, 2300 Tupper, Montreal,Canada, H3H 1P3. Tel: 514-412-4400 x23422. Fax: 514-412-4398. E-mail: email@example.comISSN 0269–9052 print/ISSN 1362–301X online
2009 Informa Healthcare Ltd.DOI: 10.3109/02699050903373477