Background: The current guidelines for managing a sport-related concussion include physical and cognitive rest until acute symptoms resolve, followed by a graded program of exertion before medical clearance. However, this consensus does not address children less than 13 years of age. Children are physically, cognitively, and emotionally very different from adults and there is evidence that younger athletes take longer to recover after a concussive injury. Currently, there is no specific timeframe for how long prescribed rest should last if individuals do not recover as expected. The purpose of this systematic review is to address the use of light physical activity as a treatment modality for children and adolescents who are slow to recover from a sport-related concussion.
Methods: An exhaustive literature search using MEDLINE-Ovid, MEDLINE-PubMed, Web of Science, and Google Scholar was conducted using keywords: brain concussion and exercise therapy. Articles were screened with eligibility criteria and the resulting studies were then appraised and assessed for quality with GRADE.
Results: Two pilot studies were included in this systematic review that met the inclusion criteria and were conducted by similar groups of researchers. One studyof 16 children and adolescents who were slow to recover from a sport-related concussion found that involvement in an active rehabilitation program in the post-acute period may promote recovery. The second study of 10 adolescents found that the utilization of graded light-intensity exercise in the post-acute period following concussion is safe, feasible, and appears to be an effective intervention for adolescents who are slow to recover from a sport-related concussion.
Conclusion: In synthesizing the results from these two pilot studies,the consensus was that light physical activity may have utility in providing symptomatic improvement in sport-related pediatric concussions. Future clinical trials with larger populations, randomization, control groups, and varied timeframes for introducing light physical activity post-concussion are recommended. This upcoming research could change the way clinicians evaluate and manage pediatric concussions.
Keywords: Concussion, pediatric, sports, physical activity, rehabilitation, children, adolescents, brain concussion, brain injury, exercise therapy, sports medicine.
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