Montreal research shows policy changes in child concussion management improve recovery time

Health care facilities that treat concussions in children should have a policy that encourages early return to physical activity, recommends a study that analyzed hundreds of cases from the Montreal Children’s Hospital.

“The goal of our study was to really look at the effect of this policy change and try to validate scientifically if it did what we hoped it would do,” said Elizabeth Teel, lead author & assistant professor, health, Kinesiology & Applied Physiology at Concordia University.

The Montreal Children’s Hospital’s concussion clinic changed its internal policy in 2017 to include a two-week maximum delay in its protocol before physiotherapy rehabilitation sessions could begin. This was the shortest delay the hospital could implement in its treatment model.

“The benefit of a policy is it’s creating sort of a standard and it’s helping to create those intentions and put them into action,” said Teel. “So by having this plan it’s more likely that you’re providing sort of a positive pressure that you know people will follow this plan.”

The Montreal Children’s Hospital’s concussion clinic study, published in the Journal of Sport Rehabilitation, analyzed patient data from two years before and two years after the policy change. The researchers randomly selected 150 cases from each year between 2015 and 2019.

The results showed that children who started treatment earlier recovered about a week faster than those who started treatment later.

“One week might not feel like a huge amount of time but when you have a headache, when you’re nauseous, when you can’t see your friends, when you’re not doing your sports, when you’re feeling isolated, a week is a lot of time to young children,” said Teel.

Teel points out that just a decade ago, the medical consensus was that people should rest for about a month after an injury before returning to physical activity.

“Our recommendation is basically that everyone who treats children with concussions should have a policy with standards for their facility. And what that policy looks like will change depending on how many resources they have available,” said Teel.

Nowadays, professionals suggest resuming physical exercise after only 24 to 48 hours, provided the patient is able to tolerate it. Physical activities should be low-impact and non-contact. Examples include swimming, cycling, or running.

“The general approach for the for kids with concussion is don’t rest too long, take a couple days to you know get yourself back back together then activate yourself meaning that you know get up, walk around, do chores around the house, get gradually more and more active but the main message I think is don’t hesitate to consult,” said Isabelle Gagnon, senior author & clinical scientist at trauma centre at the Montreal Children’s Hospital.

The time taken for treatment after the injury could therefore vary depending on the type of professionals on site, the number of staff available and the financial resources of the healthcare establishment.

“Everyone who treats these children should come in with a policy that will promote exercise and treatment as early as the clinical context allows, always allowing one to two days of rest,” said Teel. “Having a policy helps ensure that intentions become actions, to ensure that treatment is administered properly. It also helps standardize treatment for all patients.”

However, several factors can delay physical rehabilitation treatment for children with concussion. For example, patients who are seen in the emergency department are often referred to a specialized clinic, but the appointment with the therapist is rarely scheduled within 48 hours.

“The earlier the better, but there are a lot of practical considerations that prevent starting treatment at the ideal time. […] Beyond getting the child to the right facilities, there are issues of having the resources available,” Teel said.

She says some children will do well by recovering at home, including with exercises to practice. Rehabilitation care settings will therefore prioritize patients whose condition is difficult to improve without the support of a therapist.

“What we want to see is that people take the time to have a thoughtful plan in place so that we can get these children the best treatment as early as feasible and help them get better as quick as we can,” said Teel.

—The Canadian Press’ health content is funded through a partnership with the Canadian Medical Association. Editorial choices are solely the responsibility of The Canadian Press.

–This report by La Presse Canadienne was translated by CityNews