None listed
Conditions
Brief summary
Concussion is a significant public health concern among Australian children and adolescents. A large population of children who experience a concussion (approximately 30%) will go on to experience persistence post-concussion symptoms for more than 4 weeks following their injury. These symptoms can limit their ability to attend and engage in school, extra-curricular activities and can lead to reduced quality of life. International consensus on Concussion recommends a brief period of physical rest immediately after concussion (24-48 hours) followed by a graduated return to physical activity at a level that does not provoke significant symptom exacerbation . Active rehabilitation involving sub-symptom threshold aerobic activity is a growing area of research with evidence showing reduced symptoms and improvements in recovery following concussion. There is a lack of evidence for an incremental aerobic exercise test that can safely be performed via a telehealth platform. This requires that the participant remain in view of the therapist via a computer, tablet or smart phone camera. One such method is the Modified Shuttle Test (MST). The MST is an incremental aerobic exercise test. Here, the participant to walk/run back and forth between the two markers separated by 10m as many times as possible following incrementally increasing speeds (i.e. incrementally increasing aerobic exercise) indicated by an audio recording. It has been validated in several paediatric populations with chronic health issues (Cystic Fibrosis, bronchiectasis, cerebral palsy, asthma, obesity). We propose to validate the 10m MST in children and adolescents with concussion. In phase 1 of our study, we will validate the 10m MST by comparing it to the gold-standard Buffalo Concussion Treadmill Test. The aim of the study is to validate the Incremental 10m Shuttle test for use in a paediatric population who have sustained a concussion. The objective of this study is to determine if there is a correlation between the Buffalo Concussion Treadmill Test and Modified Shuttle Test exertion test for those children who have sustained a concussion. Permission for the physiotherapist to contact the family will be provided as per QPRS Contact Consent Form. The physiotherapist will supply the participant with a graded exercise program in the next 24 hours via email if the family are interested.
Interventions
Each year, many children present to emergency departments with concussion (or mild head injury). These children are given advice and education on how to assist in their recovery from the injury including a gradual return to exercise and many (n=240) are referred to the Queensland Paediatric Rehabilitation Service (QPRS) Complex Concussion Clinic. We are hoping to provide a more structured approach for returning to exercise using a tele-health physiotherapy led program for those referred to our
Each year, many children present to emergency departments with concussion (or mild head injury). These children are given advice and education on how to assist in their recovery from the injury including a gradual return to exercise and many (n=240) are referred to the Queensland Paediatric Rehabilitation Service (QPRS) Complex Concussion Clinic. We are hoping to provide a more structured approach for returning to exercise using a tele-health physiotherapy led program for those referred to our service (QPRS). Before we can start the telehealth program, we first need to make sure that the exercise test (10 m Shuttle Test) is a good option to be used in children who have experience a concussion. We will test this against a treadmill test (Buffalo Concussion Treadmill Test) that has good evidence for adolescent who have experienced a concussion. The 10m Shuttle Test is a graded exercise test that is usually used as a test to exertion however we will be using this test in a modified fashion to measure the intensity of exercise that elicit participant concussion symptoms. The child will be asked to sit on a chair in a clinic room. They will rest in this position for 2 minutes with Polar OH1 Heart Rate Sensor fitted to their upper arm. During their rest period, the testing process will be explained to the child and attending parent. The child will be fitted with the Heart Rate monitor and this will be worn throughout the tests. They will have the OMNI exertion measure and Visual Analogue Scale (VAS) Symptom Severity Scale explained to them and that they will be asked during the test to use the number and pictorial system to explain how they are feeling in regard to their level of exertion and symptoms. The OMNI and VAS will be printed out and laminated in front of the child. After the rest period, the baseline heart rate (HR) and symptoms will be recorded and the testing will begin as per the Modified Shuttle Test protocol. A YouTube video will be used throughout the test with an auditory metronome to maintain pace of the circuit. After each phase (1 minute), the child will be asked to rate their Rate of Perceived Exertion (OMNI RPE) via a number/picture with how they are feeling. The HR will recorded throughout the test and will be added into the data after download. The test will be stopped if the child experiences · a RPE score of 10 or · if their symptoms increase by more than 2 on the VAS. · if the child is unable to keep up with the required pace of the test by missing the metronome sound more than three (3) times. · If the child or parent requests the test to be ceased, we will stop the test immediately, without the need for any of the above criteria to be met. The participant will be able to sit for at least 2 minutes to rest at the end of the test. After this, the participant will attend their appointment at QPRS with the Complex Concussion Clinic team. At the end of their appointment (approximately 60 minutes later), they will then return to the QPRS gym to finish their exercise testing with the Buffalo Concussion Treadmill Test.
Sponsors
Queensland Children's Hospital
Study design
Allocation
Non-randomised trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
8 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
Inclusion criteria - Any child age 8 to 18 years of age - Mild traumatic brain injury/concussion - Any increase in symptoms compared to pre-injury symptoms score - Overall symptoms of less than 6/10 at rest - Ability to walk independently (eg. Dizziness/imbalance, not a risk factor for falls)
Exclusion criteria
- a significant medical history that would contraindicate exercise on a treadmill or flat ground within a clinic setting - a previous concussion within the last 3 months, - persistent symptoms following a previous concussion - inability to complete questionnaires - parents unable to provide informed consent (diminished understanding or comprehension, or a language other than English spoken and an interpreter unavailable)
Outcome results
None listed