title: Management of persistent postconcussion symptoms in youth: a randomised control trial protocol.
abstract: BACKGROUND
  Current management of concussion consists of early education, rest until symptom free, with gradual return to school and physical activity protocols. Although this management strategy is effective for most youth who sustain a concussion, it is not an appropriate strategy for youth with persistent postconcussion symptoms. Prolonged rest and periods of restricted activity may place youth at risk for secondary issues and contribute to the chronicity of postconcussion symptoms. The purpose of this study is to evaluate the efficacy of an active rehabilitation protocol for youth who are slow to recover from concussion. It is hypothesised that an active rehabilitation intervention can reduce persistent postconcussion symptoms, improve function and facilitate return to activity. This article describes the research protocol.
  
  
  METHODS
  This is a randomised clinical trial with blinded outcome measurement. Participants will be recruited and randomly assigned to 1 of 2 treatment groups, an active rehabilitation intervention or a standard care education group. Both groups will receive standard care education. However, the active rehabilitation group will participate in an additional low-intensity exercise programme consisting of aerobic, coordination and visualisation exercises. Both the active rehabilitation and the standard care education interventions will be 6 weeks in duration. The primary outcome measure is postconcussion symptoms. Secondary outcome measures include functional recovery (cognitive, motor, psychosocial and emotional functioning) and return to activity. Outcome measures will be administered preintervention and postintervention. The primary outcome measure will also be repeated 2 weeks into the intervention period.
  
  
  BACKGROUND
  This study has been approved by the Holland Bloorview Kids Rehabilitation Hospital research ethics board (REB # 13-459). The findings from this study will be shared with the general public, sport associations, relevant brain injury organisations and healthcare professionals.
  
  
  BACKGROUND
  NCT02257749.
authors.affiliation: Concussion Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nick
authors.initials: N
authors.lastname: Reed
authors.affiliation: Concussion Research Centre, Centre for Leadership in ABI, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.
authors.forename: Dayna
authors.initials: D
authors.lastname: Greenspoon
authors.affiliation: Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts, USA Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts, USA.
authors.forename: Grant L
authors.initials: GL
authors.lastname: Iverson
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada.
authors.forename: Carol
authors.initials: C
authors.lastname: DeMatteo
authors.affiliation: Department of Human Kinetics Sciences, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Quebec, Canada Research Group on Neuromusculoskeletal Dysfunctions, UQTR, Trois-Rivières, Quebec, Canada Centre de Recherche en Neuropsychologie, Montreal, Quebec, Canada Clinique Cortex Medicine et Readaptation, Quebec City, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Fait
authors.affiliation: School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Gauvin-Lepage
authors.affiliation: Concussion Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Hunt
authors.affiliation: Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada Trauma, Montreal Children's Hospital of the McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Isabelle J
authors.initials: IJ
authors.lastname: Gagnon
mesh_terms: D000293:Adolescent; D001924:Brain Concussion / Q000150:complications; D002648:Child; D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010353:Patient Education as Topic; D038223:Post-Concussion Syndrome / Q000209:etiology / Q000534:rehabilitation*; D011597:Psychomotor Performance / Q000502:physiology; D020127:Recovery of Function; D012107:Research Design; D012648:Self Care; D016037:Single-Blind Method
keywords: Concussion; Education; Exercise; Mild Traumatic Brain Injury; Pediatrics