Discipline of Exercise and Sport Science, Faculty of Health Sciences, and Discipline of Emergency Medicine, The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, Australia.
Sydney Children's Hospital Network, Children's Hospital Institute of Sports Medicine, The Royal Alexandra Hospital for Children, Children's Hospital Westmead, Sydney, Australia.
Clin J Sport Med. 2021 Jan;31(1):23-30. doi: 10.1097/JSM.0000000000000683.
To determine whether graded exercise testing can predict recovery trajectory of concussion in children and adolescents.
Prospective study.
Children's Hospital, Westmead, Australia.
One hundred thirty-nine children aged 12 to 16 years at 5 to 7 days after an acute concussive injury.
Graded exercise testing on a treadmill at the subacute phase to assess symptom provocation and determine clinical recovery indicating readiness to commence a return to activity (RTA) protocol. Exercise time to symptom exacerbation and clinical recovery were measured.
Standard concussion assessment and clinical testing (neurocognitive, vestibular/ocular, and balance) were conducted to determine major clinical drivers/indicators.
Participants (mean age 12.4 ± 2.8 years, 73% male) had a confirmed sport-related concussion. The main clinical drivers identified on exercise testing were headache, balance, and vestibular dysfunction. Participants fell into 1 of 2 groups, exercise-tolerant (54%) and exercise-intolerant (46%). Exercise-tolerant patients showed mild clinical indicators, no symptom exacerbation during 10.3 ± 3.3 minutes of exercise, were safely transitioned to a RTA protocol, and recovered within 10 days. Exercise-intolerant patients had high clinical indicators, significant symptom exacerbation at 4.2 ± 1.6 minutes of exercise, and prolonged recovery of 45.6 days. No adverse effects from exercise were reported in either group. Combined use of provocative exercise and clinical testing was 93% predictive of outcome.
Exercise testing during the subacute phase after a concussion can predict longer recovery. Exercise testing can identify a unique window where patients can be safely transitioned to activity, enabling clinicians to better inform patients and families, allocate resources and streamline care.
确定分级运动测试是否可预测儿童和青少年脑震荡的恢复轨迹。
前瞻性研究。
澳大利亚威斯密德儿童医院。
139 名 12 至 16 岁的儿童在急性脑震荡后 5 至 7 天。
亚急性期在跑步机上进行分级运动测试，以评估症状诱发情况并确定临床康复情况，表明可以开始恢复活动（RTA）方案。测量运动时间和症状加重以及临床康复情况。
进行标准脑震荡评估和临床测试（神经认知、前庭/眼动和平衡），以确定主要临床驱动因素/指标。
参与者（平均年龄 12.4 ± 2.8 岁，73%为男性）为确诊的与运动相关的脑震荡。运动测试中确定的主要临床驱动因素是头痛、平衡和前庭功能障碍。参与者分为 2 组，运动耐受组（54%）和运动不耐受组（46%）。运动耐受组患者表现出轻度的临床指标，在 10.3 ± 3.3 分钟的运动中无症状加重，安全过渡到 RTA 方案，并在 10 天内恢复。运动不耐受组患者的临床指标较高，在 4.2 ± 1.6 分钟的运动中出现明显的症状加重，恢复时间延长至 45.6 天。两组均未报告运动引起的不良反应。运动激发试验和临床检查联合使用的预测准确率为 93%。
脑震荡后亚急性期的运动测试可预测更长的恢复时间。运动测试可识别出一个独特的窗口，使患者能够安全过渡到活动，从而使临床医生能够更好地为患者和家属提供信息，分配资源并简化护理。
