Related Experiment Video
Updated: Mar 17, 2026
A Neuroscientific Approach to the Examination of Concussions in Student-Athletes
Published on: December 8, 2014
Activity-Related Symptom Exacerbations After Pediatric Concussion
Noah D Silverberg1, Grant L Iverson2, Michael McCrea3
1Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada2Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts3Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts.
Insights
In children with concussion, symptom spikes occurred in one-third of patients and often resolved within 24 hours. These symptom spikes may not hinder recovery, supporting gradual return to activities.
Area of Science:
- Pediatric neurology
- Sports medicine
- Neuroscience
Background:
- Concussion recovery typically involves gradual improvement, but symptoms can worsen with exertion.
- The phenomenon of symptom exacerbations (spikes) after concussion is not well understood.
- Understanding symptom spikes is crucial for guiding recovery and return-to-activity protocols in adolescents.
Purpose of the Study:
- To investigate the incidence, course, and clinical significance of symptom spikes in children following a concussion.
- To characterize the factors associated with symptom spikes.
- To determine if symptom spikes impact cognitive and balance outcomes.
Main Methods:
- Secondary analysis of clinical trial data from 63 children (aged 11-18) with concussion.
- Participants completed daily symptom scales and activity logs for 10 days post-injury.
- Standardized assessments of symptoms, cognition, and balance were performed 10 days post-injury.
Main Results:
- Symptom spikes occurred in 31.7% of participants and typically resolved within 24 hours.
- Increased mental activity was associated with a higher risk of symptom spikes, though most spikes were not preceded by increased activity.
- Patients with symptom spikes were initially more symptomatic but showed no significant differences in cognition or balance at 10 days post-injury.
Conclusions:
- Symptom spikes in children after concussion may not be detrimental to overall recovery.
- Certain individuals may be prone to reporting variable symptoms.
- Findings support gradual return-to-school and activity guidelines for adolescents post-concussion.
Importance:
Recovery from concussion generally follows a trajectory of gradual improvement, but symptoms can abruptly worsen with exertion. This phenomenon is poorly understood.
Objectives:
To characterize the incidence, course, and clinical significance of symptom exacerbations (spikes) in children after concussion.
Design, Setting, And Participants:
This secondary analysis of clinical trial data analyzes 63 eligible participants prospectively recruited from an emergency department who were asked to complete a postconcussion symptom scale and record their activities in a structured diary for the next 10 days. They completed standardized assessments of symptoms (postconcussion symptom scale), cognition (Immediate Post-Concussion Assessment and Cognitive Testing), and balance (Balance Error Scoring System) 10 days following the injury. Eligible participants were aged 11 to 18 years and sustained a concussion (according to the Centers for Disease Control and Prevention criteria) that did not result in an abnormal computed tomography scan or require hospital admission. The trial was conducted from May 2010 to December 2012, and the analysis was conducted from November 2015 to February 2016.
Main Outcome And Measure:
The occurrence of symptom spikes, defined as an increase of 10 or more points on the postconcussion symptom scale over consecutive days.
Results:
Of the 63 participants, there were 41 boys (65.1%) and 22 girls (34.9%), and the mean (SD) age was 13.8 (1.8) years. Symptom spikes occurred in one-third of the sample (20 participants [31.7%]). Symptom spikes tended to partially resolve within 24 hours. An abrupt increase in mental activity (ie, returning to school and extracurricular activities) from one day to the next increased the risk of a symptom spike (relative risk, 0.81; 95% CI, 0.21-3.21), but most symptom spikes were not preceded by a documented increase in physical or mental activity. Patients with symptom spikes were initially more symptomatic in the emergency department and throughout the observation period but did not differ from the group without symptom spikes on cognition or balance 10 days following injury.
Conclusions And Relevance:
Certain patients appeared susceptible to high and variable symptom reporting. Symptom spikes may not themselves be detrimental to recovery. The present findings support clinical guidelines for adolescents to return to school and activities gradually after concussion.
Trial Registration:
clinicaltrials.gov Identifier: NCT01101724.
More Related Videos
07:02An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System
Published on: January 12, 2011
05:48Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology
Published on: September 21, 2018
Related Concept Videos
01:24Asthma-III: Symptoms and Complications
Classification of Asthma
01:27Post-traumatic Stress Disorder
Symptoms and Behavioral Manifestations
A spectrum of distressing symptoms characterizes PTSD. Recurrent flashbacks, where individuals involuntarily relive traumatic events,...
01:17Pulmonary Cycle: Exhalation