Living Guideline for Pediatric Concussion Care
Reed, N., Zemek, R., et al. (2024).
Toronto (Canada): Ontario Neurotrauma Foundation, 1-58.
This updated guideline from the Ontario Neurotrauma Foundation offers recommendations for healthcare providers who deliver services to children and youth who have sustained or are suspected of having sustained a concussion. Although many recommendations focus on medical management, this summary highlights recommendations within the scope of audiologists and speech-language pathologists.
Ontario Neurotrauma Foundation (Canada)
<div>For children (18 years old or younger) who have sustained a concussion and who screen positive for benign paroxysmal positional vertigo (BPPV) during the Dix-Hallpike Test, a Particle Repositioning Maneuver may be appropriate for treatment. In the case of canalithiasis, the Epley Maneuver should be considered. Other subtypes of BPPV may require further assessment or alternative canalith repositioning maneuvers (Level C).</div>
<div>After clearance of the cervical spine, children (18 years old or younger) who have sustained a concussion and who experience symptoms of dizziness, vertigo, or postural imbalance should undergo a medical assessment 1-2 weeks post-injury. Additional screening by an interdisciplinary team with training in vestibular rehabilitation may include:</div>
<ul>
<li>the Dix-Hallpike Test for benign paroxysmal positional vertigo;</li>
<li>head thrust test and dynamic visual acuity for assessment of the vestibulo-ocular reflex (VOR);</li>
<li>standing balance test, Balance Error Scoring System, or dynamic balance tests for postural stability and balance; and/or</li>
<li>further assessment to rule out alternative peripheral and central vestibular disorders (e.g., superior semi-circular canal dehiscence, vestibular hypofunction) (Level C).</li>
</ul>
<div>Children (18 years old or younger) who have sustained a concussion and who experience symptoms that interfere with daily functioning for more than 4 weeks post-injury should be managed for their cognitive symptoms (Level B). Treatment for specific symptoms or concerns may be initiated earlier while waiting for a referral to a sub-specialist or interdisciplinary concussion team (Level B).</div>
<div>Children (18 years old or younger) who have sustained a concussion should be referred to an interdisciplinary team if post-concussion vestibular symptoms do not gradually resolve by 4 weeks (Level C), or earlier for children who have modifiers that may delay recovery (Level A). If vestibular functioning deficits persist, reassessment is recommended. In the presence of deterioration, refer for immediate medical follow-up (Level C).</div>
<div>Children (18 years old or younger) who have sustained a concussion and who experience symptoms that interfere with daily functioning should be evaluated for cognitive problems. Assessment should include a clinical history with consideration of the child’s pre-existing factors and current cognitive profile and symptoms (Level B).</div>
<div>For children who have sustained a concussion, school-based healthcare professionals should collaborate with the child, caregiver, school staff, and/or employers to manage cognitive difficulties, provide accommodations, and reduce stressors across home, school, and community settings (Level C). Children should engage in low-risk cognitive activities as soon as tolerated while staying below their symptom-exacerbation thresholds (Level B). Return-to-school goals should be prioritized before return to work (Level B).</div>
<div>For children (18 years old or younger) who have sustained a concussion and who experience vestibular symptoms, post-concussion education should be provided that outlines the symptoms of concussion and provides suggestions for activity modification and academic accommodation for managing vestibular symptoms (Level C).</div>
<div>Children (18 years old or younger) who have sustained a concussion should be referred to an interdisciplinary team if post-concussion cognitive symptoms do not gradually resolve by 4 weeks (Level B), or earlier for children who have modifiers that may delay recovery (Level A). Interdisciplinary team members may include educational professionals, neuropsychologists, speech-language pathologists, or occupational therapists (Level B).</div>
