Outcomes of Multidisciplinary Care for Pediatric Post-Concussive Symptoms
Bibliographic record
Abstract
Objective To evaluate the effectiveness of a multidisciplinary treatment approach for adolescents experiencing prolonged recovery from concussion. Background Although 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/Methods Participants 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. Results Symptom 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. Conclusions High 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".