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4 Treatment and Management of Prolonged Symptoms and Post-Concussion Syndrome
Pages 181-202

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From page 181...
... The chapter addresses those areas described in the statement of task that pertain to risk factors for PCS; the cognitive, affective, and behavioral changes that may occur during the subacute and chronic posttraumatic phases; and the treatment and management of PCS. The committee's charge did not include the development or recommendation of specific clinical practice guidelines.
From page 182...
... no longer contains a specific entry for "postconcussional disorder." Instead, the fifth edition of the DSM captures persistent concussive symptoms under "neurocognitive disorder due to traumatic brain injury" (APA, 2013, pp.
From page 183...
... Neither the symptom clusters nor the cognitive test scores alone provided adequate discriminating power. There was a net 24.41 increase in sensitivity when using neurocognitive testing and symptom clusters together compared with using total symptoms on PCSS alone.
From page 184...
... . The most comprehensive prospective study of sports concussion in youth found that prolonged symptoms were predicted by loss of consciousness, posttraumatic amnesia, and high initial levels of symptomatology (McCrea et al., 2013)
From page 185...
... , postural stability using the BESS, and cognitive function using the SAC and paper-and-pencil neuropsychological testing. Symptom, cognitive, and postural recovery were assessed at baseline, the time of injury, 2 to 3 hours post injury, several times during the first week following injury, and at 45 or 90 days post injury.3 Neuropsychological testing was done at baseline, 1 to 2 days and 1 week post injury, and at day 45 or 90 post injury.
From page 186...
... in children ages 8 to 15 years with mTBI, found that children experiencing prolonged recovery consistently self-reported the presence of symptoms in the somatic and cognitive categories, while parents reported the observation of emotional as well as somatic and cognitive symptoms in their children (Ayr et al., 2009)
From page 187...
... , prolonged recovery (solid line) , and normal control (dotted line)
From page 188...
... , prolonged recovery (solid line) , and normal control (dotted line)
From page 189...
... , prolonged recovery (solid line) , and normal control (dotted line)
From page 190...
... Depressive symptoms following concussions may be associated with structural and functional brain changes, which may inform the treatment of depression and improve outcomes following brain injury. Recently much attention has been paid to the long-term relationships between sports-related concussions and suicide, but there has been almost no focus on the risk for depression and suicidal behavior during the immediate (e.g., first week)
From page 191...
... Role of Exercise in Management of Persistent Symptoms There is some evidence that noncontact aerobic exercise may play a role in the rehabilitation of individuals experiencing a prolonged recovery or PCS. As long as the individual avoids additional impacts during the window of vulnerability for repeat injury (see Chapters 2, 3, and 5)
From page 192...
... a quasi-experimental study targeting cognitive symptoms in concussed adolescents with amantadine (Reddy et al., 2013) and open trials in adults with posttraumatic headache following either sports concussion or mTBI (Makdissi et al., 2013; McBeath and Nanda, 1994; Packard, 2000; Weiss et al., 1991)
From page 193...
... randomized youth with mTBI (but with more severe injuries than most sports concussions, because their Glasgow Coma Scale scores were 13 to 15) to either receiving an educational booklet describing expectable course and coping procedures or treatment as usual.
From page 194...
... Individuals experiencing a prolonged recovery may have a particular need for knowledgeable and coordinated management of their symptoms. During the past several years, there has been a proliferation of clinics around the United States specializing in the management of youth with sports-related concussion (Pennington, 2013)
From page 195...
... • There are no randomized clinical trials testing the efficacy of psychosocial or psychopharmacological treatments for children and adolescents with post-concussive symptoms and prolonged recovery. • There currently are no data to evaluate the relationship between concussion history and risk of suicide in young athletes because ex isting post-concussion symptoms inventories do not assess suicidal ideation.
From page 196...
... 2013. Risk factors for concussive symptoms 1 week or longer in high school athletes.
From page 197...
... 2012. Interventions with a sleep outcome for children with cerebral palsy or a post-traumatic brain injury: A systematic review.
From page 198...
... 2013. Incidence, clinical course, and pre dictors of prolonged recovery time following sport-related concussion in high school and college athletes.
From page 199...
... 2013. Late exercise reduces neuroinflammation and cognitive dysfunction after traumatic brain injury.
From page 200...
... 2006a. An online family intervention to reduce parental distress following pediatric brain injury.
From page 201...
... 2013. Prognosticators of per sistent symptoms following pediatric concussion: A systematic review.


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