Measuring Dynamic Symptom Response in Concussion: Children's Exertional Effects Rating Scale
Maegan D Sady1, Christopher G Vaughan, Gerard A Gioia
1Division of Pediatric Neuropsychology, Children's National Health System, and Departments of Pediatrics & Psychiatry and Behavioral Sciences, George Washington University School of Medicine, Washington, District of Columbia.
The Journal of Head Trauma Rehabilitation
|September 1, 2018
Summary
A new scale effectively measures concussion symptom changes after cognitive tasks. The Children's Exertional Effects Rating Scale helps identify concussion recovery status in youth.
Area of Science:
- Pediatric neurology
- Neuropsychology
- Rehabilitation medicine
Background:
- Concussion is a common brain injury in children and adolescents.
- Assessing symptom response to cognitive activity is crucial for concussion management.
- Existing measures may not adequately capture momentary symptom fluctuations.
Purpose of the Study:
- To introduce and validate the Children's Exertional Effects Rating Scale (CEERS).
- To evaluate the scale's ability to measure momentary symptom response to cognitive activity in youth.
- To differentiate between recovered, not recovered, and uninjured individuals based on symptom response.
Main Methods:
- The CEERS was developed, including four symptom domains: Headache, Fatigue, Concentration Problems, and Irritability.
- Participants (aged 5-18) included uninjured (n=590), recovered concussed (n=160), and not-yet-recovered concussed (n=570) groups.
- An exertional effects index was calculated by subtracting pre-activity from post-activity symptom ratings.
Main Results:
- The CEERS demonstrated adequate reliability and validity.
- Negligible differences in pretest and exertional effects ratings were found between uninjured and recovered groups.
- Not-yet-recovered individuals reported significantly higher pretest and exertional effects ratings.
Conclusions:
- The CEERS is a psychometrically sound tool for assessing symptom exacerbation after cognitive exertion in pediatric concussion.
- The scale can aid clinicians in concussion assessment and treatment planning.
- An exertional effects index of 4 or more is a potential indicator of active concussion in youth.
