scholarly journals Outcomes of Multidisciplinary Care for Pediatric Post-Concussive Symptoms

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S18.1-S18
Author(s):  
Jillian O’Neil ◽  
Sean Rose ◽  
Ashley Davidson ◽  
Kathleen Shiplett ◽  
Anthony Castillo ◽  
...  
Keyword(s):  
Aerobic Exercise ◽  
Psychological Intervention ◽  
Multidisciplinary Treatment ◽  
Symptom Burden ◽  
Multidisciplinary Care ◽  
Exercise Session ◽  
Symptom Improvement ◽  
Final Visit ◽  
Post Injury ◽  
History Of

ObjectiveTo evaluate the effectiveness of a multidisciplinary treatment approach for adolescents experiencing prolonged recovery from concussion.BackgroundAlthough most youth recover from a concussion within 2–4 weeks, an estimated 14% of those injured remain symptomatic at 3 months post-injury. For those experiencing protracted recovery, the 2017 Berlin Concussion in Sport Group Consensus Statement recommends multidisciplinary collaborative care. While recent research utilizing progressive aerobic exercise among adolescents with concussion has shown promise for reduction in symptom burden, limited evidence exists for multidisciplinary care.Design/MethodsParticipants included 39 adolescents (77% female, 87% Caucasian) referred to the Nationwide Children’s Hospital Complex Concussion Clinic. All patients included had persistent (≥30 days post-injury) post-concussion symptoms (SCAT-5 symptom score ≥10). The sample ranged in age from 11-20 years (mean = 15.0, SD = 2.0) and median days since injury was 60 (range = 30–161). 31% of participants had a history of one or more previous concussions, 54% had a history of anxiety or depression, and 26% had a history of ADHD or a learning disorder. The multidisciplinary treatment included sessions with Neurology (mean number of sessions = 2.5), Neuropsychology (mean = 2.1), Physical Therapy (mean = 3.6), and Athletic Training sessions involving graded physical exercise (mean = 4.0), with an average treatment duration of 57.4 days. SCAT-5 symptom rating scales were completed at each visit.ResultsSymptom burden among participants significantly decreased between their initial visit (mean = 49.6, SD = 19.2) and final exercise session (mean = 12.8, SD = 14.1); p < 0.001. Gender did not predict symptom ratings at treatment onset, though males (mean = 5.6) had significantly lower symptom scores than females (mean = 15.0) at their final visit (p < 0.05). Demographic factors and premorbid psychological history did not predict rate of symptom improvement.ConclusionsHigh rates of premorbid psychological problems are evident in children referred for treatment of PCS. Multidisciplinary care involving graded aerobic exercise and psychological intervention shows promise, though specific factors associated with treatment response remain to be elucidated.

scholarly journals Flying may not affect symptom recovery after concussion in Athletes

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S23.1-S23
Author(s):  
Tara Sharma ◽  
Julia Kerrigan ◽  
David McArthur ◽  
Thomas McAllister ◽  
Michael McCrea ◽  
...  
Keyword(s):  
College Athletes ◽  
Assessment Tool ◽  
Symptom Burden ◽  
Collegiate Athletes ◽  
Group Differences ◽  
Post Injury ◽  
Significant Group ◽  
Time Zones ◽  
History Of ◽  
Chi Square Analysis

ObjectiveTo determine if there is a relationship between concussion recovery and airplane travel soon after injury in collegiate athletes and military cadets.BackgroundConcussions are a common occurrence in young athletes. Very few studies have examined how flying may influence the clinical progression of a concussive injury.Design/MethodsThis is a prospective cohort study comprised of 3480 college athletes and cadets with concussion obtained from the Concussion Assessment, Research and Education (CARE) Consortium and divided in two groups: those who flew and those who did not fly after concussion. Those with unknown flight status were excluded. Demographics between groups were compared using Chi Square analysis. Symptom burden was calculated by subtracting baseline Sports Concussion Assessment Tool (SCAT3) symptom scores from the post-injury score after flying. Significance between outcome measures and flight status were evaluated using a paired t-test. Analysis of Variance (ANOVA) was used to determine if number of time zones crossed during flight influenced outcomes.Results165 athletes flew 31.8 ± 52.3 [SD] hours after injury, 2235 athletes did not fly, and 1080 had unknown flight status. There were no significant study group differences for age, sex, sport, history of prior concussion, and history of headache. No significant group differences were found in days to return to unrestricted play (p = 0.11), days after injury to start graded exertion (p = 0.50), duration of concussion symptoms (p = 0.23), days until return to normal academic performance (p = 0.75), and symptom burden (p = 0.47). Number of time zones crossed did not affect any outcomes.ConclusionsAirplane travel early after concussion did not significantly affect recovery or severity of concussion symptoms in college athletes and cadets. Further studies need to investigate the possible effects of flying more acutely after injury. These data may help guide future recommendations on flight travel after concussion in athletes.

Increased Active Hamstring Stiffness After Exercise in Women With a History of Low Back Pain

2013 ◽  
Vol 22 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Rebecca J. Bedard ◽  
Kyung-Min Kim ◽  
Terry L. Grindstaff ◽  
Joseph M. Hart
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Aerobic Exercise ◽  
Outcome Measures ◽  
Perceived Exertion ◽  
Exercise Session ◽  
Electromyographic Activity ◽  
Low Back ◽  
Exercise Protocol ◽  
History Of

Objective:To compare active hamstring stiffness in female subjects with and without a history of low back pain (LBP) after a standardized 20-min aerobic-exercise session.Design:Case control.Setting:Laboratory.Participants:12 women with a history of recurrent episodes of LBP (age = 22.4 ± 2.1 y, mass = 67.1 ± 11.8 kg, height = 167.9 ± 8 cm) and 12 matched healthy women (age = 21.7 ± 1.7 y, mass = 61.4 ± 8.8 kg, height = 165.6 ± 7.3 cm). LBP subjects reported an average 6.5 ± 4.7 on the Oswestry Disability Index.Interventions:Participants walked at a self-selected speed (minimum 3.0 miles/h) for 20 min. The treadmill incline was raised 1% grade per minute for the first 15 min. During the last 5 min, participants adjusted the incline of the treadmill so they would maintain a moderate level of perceived exertion through the end of the exercise protocol.Main Outcome Measures:During session 1, active hamstring stiffness, hamstring and quadriceps isometric strength, and concurrently collected electromyographic activity were recorded before and immediately after the exercise protocol. For session 2, subjects returned 48–72 h after exercise for repeat measure of active hamstring stiffness.Results:Hamstring active stiffness (Nm/rad) taken immediately postexercise was not significantly different between groups. However, individuals with a history of recurrent LBP episodes presented significantly increased hamstring stiffness 48–72 h postexercise compared with controls. For other outcomes, there was no group difference.Conclusions:Women with a history of recurrent LBP episodes presented greater active hamstring stiffness 48–72 h after aerobic exercise.

Blood Biomarkers Relate to Cognitive Performance Years after Traumatic Brain Injury in Service Members and Veterans

2020 ◽  
pp. 1-7
Author(s):  
Sara M. Lippa ◽  
Jessica Gill ◽  
Tracey A. Brickell ◽  
Louis M. French ◽  
Rael T. Lange
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Outcome ◽  
Service Members ◽  
Neurocognitive Performance ◽  
Blood Biomarkers ◽  
Post Injury ◽  
Blood Draw ◽  
Neurofilament Light ◽  
History Of

Abstract Objective: This study examines the relationship of serum total tau, neurofilament light (NFL), ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) with neurocognitive performance in service members and veterans with a history of traumatic brain injury (TBI). Method: Service members (n = 488) with a history of uncomplicated mild (n = 172), complicated mild, moderate, severe, or penetrating TBI (sTBI; n = 126), injured controls (n = 116), and non-injured controls (n = 74) prospectively enrolled from Military Treatment Facilities. Participants completed a blood draw and neuropsychological assessment a year or more post-injury. Six neuropsychological composite scores and presence/absence of mild neurocognitive disorder (MNCD) were evaluated. Within each group, stepwise hierarchical regression models were conducted. Results: Within the sTBI group, increased serum UCH-L1 was related to worse immediate memory and delayed memory (R2Δ = .065–.084, ps < .05) performance, while increased GFAP was related to worse perceptual reasoning (R2Δ = .030, p = .036). Unexpectedly, within injured controls, UCH-L1 and GFAP were inversely related to working memory (R2Δ = .052–.071, ps < .05), and NFL was related to executive functioning (R2Δ = .039, p = .021) and MNCD (Exp(B) = 1.119, p = .029). Conclusions: Results suggest GFAP and UCH-L1 could play a role in predicting poor cognitive outcome following complicated mild and more severe TBI. Further investigation of blood biomarkers and cognition is warranted.

scholarly journals Acute Exercise Increases Adiponectin Levels in Abdominally Obese Men

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Travis J. Saunders ◽  
Andrew Palombella ◽  
K. Ashlee McGuire ◽  
Peter M. Janiszewski ◽  
Jean-Pierre Després ◽  
...  
Keyword(s):  
Aerobic Exercise ◽  
Acute Exercise ◽  
Treadmill Exercise ◽  
Aerobic Exercise Training ◽  
Exercise Session ◽  
Short Term ◽  
Acute Bout ◽  
Plasma Adiponectin ◽  
Peak Intensity ◽  
Before And After

Objective. To examine the effect of acute and short-term (~1 week) aerobic exercise training on plasma adiponectin levels in inactive, abdominally obese men.Materials and Methods. Inactive and abdominally obese men (n=38, waist circumference ≥102 cm) recruited from Kingston, Canada were randomly allocated to perform three bouts of aerobic treadmill exercise at either low (50% VO2peak) or high (75% VO2peak) intensity during a 1-week period. Blood samples were taken before and after the first exercise session and 24–72 hours following the completion of the final exercise session.Results. Adiponectin levels were elevated immediately following an acute bout of exercise at both high and low intensities (High:5.79±0.42versus5.05±0.41 ug/mL; Low:5.24±0.44versus4.37±0.44 ug/mL,P<0.05) and remained elevated following 30 minutes of rest. In comparison to baseline, adiponectin levels were also elevated 24–72 hours following the final exercise session (High:5.47±0.48versus4.88±0.48 ug/mL; Low:5.18±0.49versus4.47±0.49 ug/mL,P<0.05).Conclusion. Both acute and short-term aerobic exercise result in a significant increase in plasma adiponectin levels in inactive, abdominally obese men independent of intensity.

Pain relief with elastic therapeutic taping

2021 ◽  
pp. bmjspcare-2021-003381
Author(s):  
Ekta Gupta ◽  
Courtland Lee ◽  
Amy Ng ◽  
Eduardo Bruera
Keyword(s):  
Rating Scale ◽  
Symptom Burden ◽  
Substantial Improvement ◽  
Functional Mobility ◽  
Background Information ◽  
Symptom Improvement ◽  
Plantar Surface ◽  
Pain Rating Scale ◽  
Pain Improvement

Background and purposeChemotherapy-induced peripheral neuropathy (CIPN) occurs in 19%–85% of patients undergoing cancer treatment. Due to the high symptom burden, specifically pain in the soles of feet, we explore the role of elastic therapeutic (ET) taping for treatment of CIPN.Case descriptionWe report two cases of patients with CIPN-induced foot pain while admitted to the hospital. Their background information, including chemotherapy history, treatments trialed and effects of ET on their pain, is discussed. Each patient underwent ET using the epidermis, dermis, fascia technique for CIPN. An occupational therapist applied ET to the plantar surface of both feet to the ankle with 0% stretch on the tape for 24–96 hours. We also showed the effect of symptom improvement in their individualized rehabilitation session following application of ET.OutcomesPain score, verbally documented by 10 point numerical pain rating scale, decreased by >50% in both patients within 24 hours of application. This reflects a substantial improvement in pain with the intervention of ET. This allowed for improved tolerance in engaging in functional mobility, with improvement in distances ambulated.DiscussionET taping of the distal leg and foot showed pain improvement for these two patients. Our findings suggest that a clinical trial aimed at better characterising the role of ET in these patients is justified.

Correlation between Restless Leg Syndrome and Superficial Venous Reflux

2021 ◽  
Author(s):  
Aaron R. Dezube ◽  
Jake Rauh ◽  
Michael Dezube ◽  
Mark Iafrati ◽  
JoAnn Rigo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Family History ◽  
Lower Extremity ◽  
Symptom Improvement ◽  
Venous Disease ◽  
Restless Leg Syndrome ◽  
Venous Reflux ◽  
Common Cause ◽  
History Of ◽  
Prospective Trials

AbstractRestless leg syndrome (RLS) is a common cause of lower extremity discomfort. We hypothesized that patients with RLS symptoms have higher rates of deep and superficial venous reflux (SVR). Retrospective review of patients ≥18 years of age evaluated in a venous center from December 2018 to February 2019. Differences in rates of RLS symptoms, demographics, comorbidities, and clinical and radiologic presence of venous disease were analyzed. Overall, 207 patients were analyzed; 140 (67.6%) reported RLS symptoms (n = 25 with prior RLS diagnosis). RLS symptoms were more common with superficial or combined superficial and deep venous reflux (DVR) compared with those without reflux (p < 0.001). Patients with RLS symptoms as opposed to those without had similar demographics and comorbidities (all p > 0.05) but increased rates of venous pain, phlebitis, family history of venous disease, lower extremity swelling and SVR, and combined SVR and DVR (all p < 0.05). Our multivariable logistic regression found presence of SVR, and family history of venous reflux was associated with RLS symptomatology (all p < 0.001). Ninety-nine patients with RLS underwent ablation; of them, 93 had duplex-proven reflux resolution of which 81 (87%) reported RLS symptom improvement. This included 13 of 16 (81.3%) with prior RLS diagnosis. SVR is associated with increased rates of RLS symptoms in a vein center population. Therefore, RLS symptoms should trigger a targeted venous evaluation. Our results suggest that venous ablation may lead to resolution of RLS symptoms in patients with SVR, but randomized prospective trials with strict RLS definition criteria are warranted to confirm these outcomes.

scholarly journals Essentials for Best Practice: Treatment Approaches for Athletes With Eating Disorders

2018 ◽  
Vol 12 (4) ◽  
pp. 495-507 ◽  
Author(s):  
Jenny H. Conviser ◽  
Amanda Schlitzer Tierney ◽  
Riley Nickols
Keyword(s):  
Eating Disorders ◽  
Emotional Regulation ◽  
Best Practice ◽  
Sport Participation ◽  
Emotional Health ◽  
Multidisciplinary Treatment ◽  
Return To Sport ◽  
Multidisciplinary Care ◽  
Return To Play ◽  
Treatment Team

Eating disorders (EDs) and disordered-eating behaviors (DEBs), pose a high risk of morbidity and mortality, threatening physical health, emotional health, and overall quality of life. Unfortunately, among athletes, prevalence rates continue to increase. This document summarizes the challenges of establishing and navigating the multidisciplinary care needed to effectively treat EDs and DEBs among athletes. The benefits of timely and frequent communication within the multidisciplinary treatment team (MDTT) are emphasized and discussed. Authors advise who should be selected as members of the MDTT and suggest that all personnel, including athletic coaches, athletic trainers, physical therapists, and certified fitness professionals be ED-informed and ED-sensitive. Vital components of care are noted including use of a variety of evidence-based psychotherapeutic modalities, interventions which target emotional regulation, and prioritize values based compassionate care. Authors caution that performance decrements and medical/physiological changes are not always easily observable in individuals with EDs and DEBs and therefore, attuned, consistent, and ongoing monitoring is needed. Consensus regarding previously established parameters for return to play and careful titration of physical activity throughout the ED recovery process are suggested as important for preserving health, preventing re-injury, or relapse and facilitating successful return to sport participation.

scholarly journals Multidisciplinary Treatment Approach in a Patient with History of Nasopharyngeal Carcinoma

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Atacan Yavuz ◽  
Ömer Birkan Ağralı ◽  
Zeynep Lale Çalışkan ◽  
Dilek Türkaydın ◽  
Atilla Sertgöz ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Multidisciplinary Approach ◽  
Dental Treatment ◽  
Treatment Approach ◽  
Multidisciplinary Treatment ◽  
Preventative Care ◽  
Self Confidence ◽  
Dental Hospital ◽  
History Of

Radiotherapy in NPC patients has side effects on the dentition, which affects quality of life dramatically. This case report presents multidisciplinary dental treatment approach in a 17-year-old male patient with a history of nasopharyngeal carcinoma (NPC), which was treated with chemotherapy and radiotherapy. The adolescent patient applied to dental hospital 4 years after the radiotherapy with aesthetic and functional problems on dentition affecting psychological, social, and physical aspects of his life. The dentition of the patient demonstrated the severe destruction as a devastating side effect of radiotherapy. With a successful multidisciplinary approach, our patient’s aesthetics, function, and self-confidence were obtained. Well-established procedures, which include preventative care and maintenance, can reduce the duration and expenses of the treatment and help in challenging the life-long complications of radiotherapy.

scholarly journals Quality of Life and Symptom Burden 1 Month After Concussion in Children and Adolescents

2018 ◽  
Vol 58 (1) ◽  
pp. 42-49 ◽  
Author(s):  
David R. Howell ◽  
Julie C. Wilson ◽  
Michael W. Kirkwood ◽  
Joseph A. Grubenhoff
Keyword(s):  
Quality Of Life ◽  
Physical Health ◽  
Children And Adolescents ◽  
Symptom Burden ◽  
Psychosocial Health ◽  
Post Injury ◽  
Persistent Symptoms ◽  
Patient Reported ◽  
A Prospective Study

We conducted a prospective study of children and adolescents (n = 176; mean age = 13.0 ±2.7 years; 38% female) assessed acutely post-concussion and again 30 days later. We investigated the association between symptom burden and quality of life (QOL) outcomes, as well as the effect of age on QOL. We assessed QOL using patient-reported Pediatric Quality of Life Inventory 4.0, and symptoms using the Health and Behavior Inventory (HBI). Acute (<2 days post-injury) HBI ratings demonstrated a low correlation ( R2 = 0.08) with physical health QOL and a moderate correlation with psychosocial health QOL ( R2 = 0.21) 30 days post-concussion. HBI ratings 30 days post-concussion demonstrated a moderately high correlation with physical health QOL ( R2 = 0.35) and psychosocial health QOL ( R2 = 0.57). Age was not significantly associated with physical or psychosocial QOL ratings. Impairments in QOL following concussion may identify children and adolescents who need additional referral to address persistent symptoms at this time.

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