Traumatic brain injury (TBI) is the most common injury in children and adolescents, and the vast majority of these (71-90%) are categorized as a mild TBI, also known as a “concussion.”

In fact, approximately 144,000 pediatric patients present to emergency departments across the U.S. each year with a concussion, and more than one-third are discharged without an outpatient provider for further treatment.

Critically, follow-up care for patients in rural areas, such as Appalachia, is far less common. To meet these needs, WVU Behavioral Health and Psychiatry and the WVU Rockefeller Neuroscience Institute’s (RNI) NeuroPerformance Innovation Center built a multidisciplinary clinic for outpatient follow-up care for children and adolescents (5-17 years old) who have recently suffered a mild traumatic brain injury (i.e., concussion).

Diagnosing and treating concussions

A concussion is typically diagnosed when there is some sort of impact to the head that causes immediate symptoms such as dizziness, confusion/disorientation, vision disturbance, or problems walking and/or speaking. There may or may not be a brief loss of consciousness (less than 30 minutes), amnesia (less than 24 hours), and/or difficulty following commands for a brief time (less than 30 minutes).

Although such symptoms are thought to be a result of disruptions of blood flow, metabolism, and inflammation in the brain, there are no injuries to the brain structure. This is different from traumatic brain injuries which involve bleeding or structural damage within the brain.

The treatment, recovery, and overall severity of impairment is far different for severe traumatic brain injuries compared to concussion. Indeed, symptoms of concussion typically resolve within a few days; however, some may linger up to 2-3 months. Symptoms that persist longer than two months are most often associated with complex interactions among pre-injury risk factors (e.g., history of migraines/headaches, anxiety, depression) and social/behavioral changes following concussion (e.g., sleep disruption, acute stress related to traumatic event, reluctance to return to daily activities).

How do concussions occur?

Mechanisms for concussion vary widely. In young children (5-9 years old), the most common occurrences come from falls.

For older adolescents (15-19), the most common occurrences are sports-related or motor vehicle-associated. Approximately 15 percent of high school students reported at least one concussion in the past year, and it’s estimated that approximately half of all concussions are unreported.

In West Virginia, there is an over-representation of head injuries due to ATV crashes. Although young adults only make up about 14 percent of ATV ridership, they represent more than 40 percent of head injuries while riding ATVs.

How to treat a concussion

There is a common misconception that the way to deal with concussion is to rest in a dark room until the symptoms resolve. We now know this is not the best way to treat concussion. Instead, these are some tips following a concussion:

• Monitor the child closely for worsening symptoms in the first 12 hours (vomiting, increasing confusion/disorientation, seizure). If symptoms worsen, immediately take the child to the emergency room.
• If symptoms improve sequentially as they should, have the child rest for 1-2 days, but then return them to light physical activity.
• Keep the child hydrated and pace their return to normal daily activities (school, sports, etc.).
• Consult with a professional (RNI Concussion Clinic) about when to return the child to higher impact physical and cognitively demanding activities. There is heightened risk for re-injury during recovery from a concussion if a child returns to certain activities too quickly.

The WVU Medicine Children’s Pediatric Concussion Clinic provides follow-up concussion care (1-8 weeks after injury) in a multidisciplinary setting with pediatric specialists, including Stephanie Ferimer, MD, Physical Medicine and Rehabilitation; Sam Eckrich, PhD, Pediatric Neuropsychology; and Melissa Eckert, OTR/L, Occupational Therapy.

The goal of the clinic is to provide early intervention and psychoeducation to patients and their families and conduct brief cognitive/psychological, medical, and occupational therapy evaluations that can be used to track symptom resolution over time. As research suggests, early intervention and appropriate psychoeducation about concussion will help reduce the prevalence of persistent post-concussion symptoms and return children and adolescents to their daily activities in a healthy way. The evaluations will also help determine whether patients need more comprehensive cognitive assessments, school interventions, and psychological or other physical/occupational therapies.

For more information, visit the WVU Rockefeller Neuroscience Institute Concussion & Brain Injury Center or call the main Neuropsychology phone number at 304-598-4740. For specific information concerning occupational therapy, call 304-598-6127 or email melissa.eckert@wvumedicine.org.