title: Impact of Exercise on Clinical Symptom Report and Neurocognition after Concussion in Children and Adolescents.
abstract: Recovery from concussion in childhood is poorly understood, despite its importance in decisions regarding return to normal activity. Resolution of post-concussive symptoms (PCS) is widely employed as a marker of recovery in clinical practice; however, it is unclear whether subtle impairments persist only to re-emerge in the context of increased physical or cognitive demands. This study aimed to examine the effect of strenuous exercise on clinical symptom report and neurocognition in children and adolescents after PCS resolution after concussion. We recruited children and adolescents with concussion (n = 30) on presentation to an Emergency Department (ED). At Day 2 and Day 10 post-self-reported symptom resolution, participants completed a strenuous exercise protocol, and pre- and post-exercise assessment of PCS and neurocognition. Results demonstrated an overall reduction in PCS from Day 2 to Day 10 post-symptom resolution, with no evidence of symptom increase after strenuous exercise at either time point. Neurocognitive performance was linked to task complexity: on less cognitively demanding tasks, processing speed was slower post-exercise and, unexpectedly, slower on Day 10 than Day 2, while for more demanding tasks (new learning), Day 2 exercise resulted in faster responses, but Day 10 processing speed post-exercise was slower. In summary, we found the expected recovery pattern for PCS, regardless of exercise, while for neurocognition, recovery was dependent on the degree of cognitive demand, and there was an unexpected reduction in performance from Day 2 to Day 10. Findings provide some suggestion that premature return to normal activities (e.g., school) may slow neurocognitive recovery.
authors.affiliation: 1 Department of Child Neuropsychology, Murdoch Childrens Research Institute , Melbourne, Australia .|3 Department of Paediatrics, University of Melbourne , Melbourne, Australia .
authors.forename: Vicky
authors.initials: V
authors.lastname: Manikas
authors.affiliation: 2 Department of Emergency Research, Murdoch Childrens Research Institute , Melbourne, Australia .|3 Department of Paediatrics, University of Melbourne , Melbourne, Australia .|5 Emergency Medicine, Royal Children's Hospital , Melbourne, Australia .
authors.forename: Franz E
authors.initials: FE
authors.lastname: Babl
authors.affiliation: 1 Department of Child Neuropsychology, Murdoch Childrens Research Institute , Melbourne, Australia .
authors.forename: Stephen
authors.initials: S
authors.lastname: Hearps
authors.affiliation: 1 Department of Child Neuropsychology, Murdoch Childrens Research Institute , Melbourne, Australia .|6 Cuyahoga County Court Psychiatric Clinic , Cleveland, Ohio.
authors.forename: Julian
authors.initials: J
authors.lastname: Dooley
authors.affiliation: 1 Department of Child Neuropsychology, Murdoch Childrens Research Institute , Melbourne, Australia .|3 Department of Paediatrics, University of Melbourne , Melbourne, Australia .|4 Department of Psychological Sciences, University of Melbourne , Melbourne, Australia .
authors.forename: Vicki
authors.initials: V
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D001924:Brain Concussion / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D002648:Child; D003071:Cognition / Q000502:physiology*; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D003936:Diagnosis, Computer-Assisted / Q000379:methods / Q000523:psychology; D015444:Exercise / Q000502:physiology* / Q000523:psychology; D005080:Exercise Test / Q000379:methods / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D011930:Reaction Time / Q000502:physiology
keywords: cognitive function; head trauma; outcome measures; pediatric brain injury; recovery