Safely Returning Children and Youth to Activity after mTBI/Concussion

The decision regarding return to activity following Mild Traumatic Brain Injury (mTBI)/concussion is one of the most difficult and controversial areas in concussion management for adults and even more complicated for children and youth. Children who sustain a mTBI are being provided with management strategies and return to activity guidelines that have been designed for adult athletes. This population is at high risk for repeat injuries within a short period of time as well as prolonged symptoms affecting their school and leisure participation and success. Experts agree that return to activity (RTA) including Return to School (RTS) decision should be more conservative, cautious, and individualized for children and youth. Our clinical and research team at McMaster Children's Hospital and CanChild have developed, with CIHR funding, new RTA and RTS guidelines as part of a study to educate family physicians about mTBI in children. The current study evaluates these innovative, recently developed, evidenced-based guidelines with children and families. Outcomes include: time to symptom resolution, repeat injuries, length of time to return to play and school and parents' and children's perception of the new guidelines. Electronic activity monitoring devices as well as applications for symptom monitoring will be used to provide both compliance with guidelines and health information. In order to understand how children with different symptom resolution differ biologically, we will incorporate new EEG techniques never used with children with mTBI. We will also trial a method of exertion testing having children pedal an ergometer while in the MRI scanner to look for effects of exercise on the injured brain. The issue of returning to activity after mTBI is very important to the children and families of Canada. Protecting the brains of our children through increased knowledge and decision-making based on sound research is paramount.

Here's what families had to say about our study:

The G. and M. Families would like to extend one last "Thank You" to the whole Back to Play Study group for all the hard work, research, change of dates, and mostly for the dedication it takes to provide day after day research, study and advice on "anything and everything" that can help make life just that much better for many in the future.

J, although a boy of few words sometimes, expressed to me that he was delighted to be of any service, whether or not his participation helped, to be part of something that is so worthwhile. But, although he did mention he was not thrilled at having a concussion, he hopes that you learned from him!!

Thank you again, I know we will refer to all of you affectionately in the years coming.

- C. G., J's Grandmother (Reposted with permission)

Research Team

Principal Investigator

Carol DeMatteo, OT, MSc

Co-Investigators

  • Lucy Giglia, MD FRCP(C), MSc
  • Nicholas Bock, PhD
  • John Connolly, PhD
  • Geoffrey Hall, PhD
  • Colleen Cupido, PT, MSc

  • Sheila Singh, MD FRCS(C), PhD
  • Michael Noseworthy, PhD, PEng
  • Brian Timmons, PhD
  • Michael Mazurek, MD, FRCP(C)
  • Lehana Thabane, PhD

Study Coordinator​

Project Updates

Concussion Guidelines for Children
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Back to Play Study Newsletter

Presentations

  • DeMatteo C & Lin CY. Return to School and Return to Play – Are they Compatible? The 12th World Congress on Brain Injury. New Orleans, LA, USA. March 29-April 1, 2017.
  • Ho R, Hall G, Noseworthy M, & DeMatteo C. Exploring the biological and clinical effect of depressive symptoms in youth following concussion. The 12th World Congress on Brain Injury. New Orleans, LA, USA. March 29-April 1, 2017.
  • Berger I, Obeid J, & DeMatteo C. Exploring accelerometer versus questionnaire assessment of sleep in youth with concussion. The 12th World Congress on Brain Injury. New Orleans, LA, USA. March 29-April 1, 2017.
  • DeMatteo C, Lin CY, & Claridge E. Do children and youth with concussion really follow return to school and return to activity guidelines? [Poster]. The 12th World Congress on Brain Injury. New Orleans, LA, USA. March 29-April 1, 2017.
  • Stazyk K, DeMatteo C, & Lin CY. Developing Symptom Profiles in Depressed Versus Non-depressed Youth Recovering from Concussion. [Poster]. The 12th World Congress on Brain Injury. New Orleans, LA, USA. March 29-April 1, 2017.
  • Berger I, Obeid J, DeMatteo C. Exploring accelerometry-based versus questionnaire assessment of sleep in youth with concussion [Poster]. UHN Traumatic Brain Injury Conference. Toronto, Canada. February 10, 2017.
  • Ho RA, Hall G, Noseworthy M, & DeMatteo C. Emotion-mediated executive function in adolescents with post-concussive depressive symptoms [Poster]. 5th Annual Symposium: Research on the Concussion Spectrum of Disorders. Toronto, Canada. January 21, 2017.
  • Berger I, DeMatteo C, Obeid J, Timmons B. Investigating self-reported versus objectively measured sleep disturbances in youth with concussion. Brain Injury Canada Annual Conference 2016. Toronto, Canada. September 28, 2016.
  • Ruiter KI, Boshra R & Connolly JF. Correlation of ERP and behavioural responses in patients suffering from post-concussion syndrome [Poster]. 18th International Organization of Psychophysiology (IOP) World Congress, Havana, Cuba, August 31-September 4, 2016.
  • Ruiter K, Boshra R, DeMatteo C, Noseworthy M & Connolly J. ERP investigation of attentional and language processes after concussion [Poster]. 10th Annual Canadian Neuroscience Meeting. Toronto, Ontario, Canada. May 29-June 1, 2016.
  • Boshra R, Ruiter K, Reilly J & Connolly J. Machine learning based framework for EEG/ERP analysis [Poster]. 10thAnnual Canadian Neuroscience Meeting. Toronto, Ontario, Canada. May 29-June 1, 2016.
  • DeMatteo C, Bock N, Connolly J, Cupido C, Giglia L, Hall G, Mazurek M, Noseworthy M, Singh S, Thabane L, Timmons B, Lin C-Y, Claridge E, Randall S. Measuring Adherence to Return to Activity and Return to School Guidelines in Children and Youth Post Concussive Injury. The First International Conference on Pediatric Acquired Brain Injury. Liverpool, United Kingdom. Sep 16, 2015.

Articles:

  • Stazyk K, DeMatteo C, Moll S, & Missiuna C. (2017). Depression in youth recovering from concussion: Correlates and predictors. Brain Injury, DOI: 10.1080/02699052.2017.1283533
  • Dona O, Noseworthy M, DeMatteo C, Connolly J. (2017). Fractal Analysis of Brain Blood Oxygenation Level Dependent (BOLD) Signals from Children with mild Traumatic Brain Injury. PLOS ONE, 12(1). doi:10.1371/journal.pone.0169647
  • DeMatteo C, Stazyk K, Giglia L, Mahoney W, Singh S, Hollenberg R, Harper J, Missiuna C, Law M, McCauley D, Randall S. A Balanced Protocol for Return to School for Children and Youth Following Concussive Injury. Clin Pediatr (Phila), 54(8):783-92. Jul 2015. 
  • DeMatteo C, Stazyk K, Singh S, Giglia L, Hollenberg R, Malcolmson C, Mahoney W, Harper J, Missiuna C, Law M, McCauley D. Development of a Conservative Protocol to Return Children and Youth to Activity Following Concussive Injury. Clin Pediatr (Phila), 54(2), 152-163. Feb 2015.
  • DeMatteo C, McCauley D, Stazyk K, Adamich J, Randall S, Missiuna C. Post-concussion Return to Play and Return to School Guidelines for Children and Youth: A Scoping Methodology. Disability & Rehabilitation, 37(12):1107-12. Aug 2014. 

Abstracts:

  • Berger I, Obeid J, & DeMatteo C (2017). Exploring accelerometery versus questionnaire assessment of sleep in youth with concussion [Abstract]. Brain Injury, 31(6-7), 805, DOI: 10.1080/02699052.2017.1312145
  • DeMatteo C, Lin C-Y, & Claridge E (2017). Do children and youth with concussion really follow return to school and return to activity guidelines? [Abstract]. Brain Injury, 31(6-7), 906, DOI: 10.1080/02699052.2017.1312145
  • DeMatteo C & Lin C-Y (2017). Return to school and return-to-play—are they compatible? [Abstract]. Brain Injury, 31(6-7), 952, DOI: 10.1080/02699052.2017.131214
  • Ho R, DeMatteo C, Hall G, & Noseworthy M (2017). Exploring the biological and clinical effect of depressive symptoms in youth following concussion [Abstract]. Brain Injury, 31(6-7), 953, DOI: 10.1080/02699052.2017.1312145
  • Stazky K & DeMatteo C (2017). Developing symptom profiles in depressed versus non-depressed youth recovering from concussion [Abstract]. Brain Injury, 31(6-7), 1016, DOI: 10.1080/02699052.2017.1312145

Funder

CIHR (Canadian Institutes for Health Research Operating Grant MOP #133527) 2014-2017