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Updated: May 5, 2026
A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
Early Resumption of Physical Activity and Cognitive Outcomes at 4 Weeks Following Pediatric Concussion
Veronik Sicard1, Roger Zemek, Vid Bijelic
1Author Affiliations: Children's Hospital of Eastern Ontario Research Institute (Drs Sicard, Dr Zemek, Mr Bijelic, Dr Barrowman, and Dr Ledoux), Ottawa, ON, Canada; Department of Pediatrics (Dr Zemek), Department of Emergency Medicine (Dr Zemek), University of Ottawa, Ottawa, Ontario, Canada; Department of Psychology (Drs Yeates and Brooks), Hotchkiss Brain Institute (Dr Yeates), Department of Pediatrics (Dr Brooks), University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute (Dr Yeates), Calgary, Alberta, Canada; Ste-Justine Hospital Research Center (Dr Beauchamp), Montreal, Quebec, Canada; Department of Psychology (Dr Beauchamp), University of Montreal, Montreal, Quebec, Canada; Neurosciences Program, Alberta Children's Hospital (Dr Brooks), Calgary, Alberta; Behavioral Neurosciences and Consultation-Liaison Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital (Drs Anderson and Keightley), Toronto, Ontario, Canada; Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute (Dr Keightley), University of Toronto, Toronto, Ontario, Canada; Department of Psychology (Dr Desire), The Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Cellular and Molecular Medicine (Dr Ledoux), University of Medicine, Ottawa, Ontario, Canada.
Insights
Early physical activity (PA) after concussion showed no overall link to cognitive issues in children. However, PA's impact varied by sex and age, affecting verbal flexibility and attention differently.
Area of Science:
- Pediatric neurology
- Sports medicine
- Neuropsychology
Background:
- Early physical activity (PA) may improve concussion recovery, but its cognitive effects are less understood.
- This study explores the relationship between early PA and cognitive outcomes in children post-concussion.
Purpose of the Study:
- To examine the association between early PA (within 7 days) and cognitive inefficiency/impairment at 4 weeks post-pediatric concussion.
- To investigate early PA's link to specific cognitive functions including memory, executive function, processing speed, attention, visual-motor skills, and vocabulary.
Main Methods:
- A secondary analysis of a prospective multicenter cohort study involving children (8-18 years) diagnosed with concussion.
- Early PA was self-reported at 1 week post-injury; cognitive function was assessed via comprehensive neuropsychological testing at 4 weeks.
- Cognitive inefficiency and impairment were primary outcomes, with detailed neuropsychological task scores analyzed as secondary outcomes.
Main Results:
- No significant association was found between early PA and overall cognitive inefficiency or impairment (P ≥ .38).
- An interaction between early PA and sex revealed females engaging in early PA had better verbal cognitive flexibility (P = .02).
- An interaction between early PA and age indicated younger children engaging in early PA performed worse on attention tasks (P = .03).
Conclusions:
- Early PA does not appear to be associated with general cognitive inefficiency or impairment following pediatric concussion.
- The impact of early PA on cognitive outcomes may be moderated by age and sex, suggesting tailored approaches.
- Further research is needed to understand these differential effects and optimize recovery strategies.
Background:
Early physical activity (PA) after concussion may aid in symptom recovery, though its impact on other recovery domains, such as cognitive functioning, remains less explored.
Objectives:
(1) Examine the association between early PA (within 7 days post-injury) and cognitive inefficiency and impairment 4 weeks after pediatric concussion; (2) investigate the association between early PA and cognitive outcomes (memory and executive functioning, information processing speed, attention, visual-motor processing, and vocabulary) 4-week post-concussion.
Setting:
Emergency departments (EDs) of four Canadian pediatric hospitals within the Pediatric Emergency Research Canada (PERC) Network.
Participants:
Children aged 8-18 years presenting to the ED within 48 hours of a head injury and diagnosed with a concussion.
Design:
Planned secondary analysis of data from a prospective multicenter cohort study.
Main Measures:
Participants' PA level was assessed at 1-week post-concussion through a self-report questionnaire in which they had to indicate their current level of recovery in terms of return to physical activities and sports. Early PA participation was defined as any level of PA other than "no activity" at the 1-week follow-up. Participants underwent comprehensive neuropsychological testing at 4-week post-concussion. Primary outcome measures included cognitive inefficiency and impairment (≥2 outcomes with z < -1.0 SD or <-1.5 SD below the normative mean, respectively). Secondary and tertiary outcome measures include t-scores and scaled scores from the 10 neuropsychological tasks, transformed to z-scores.
Results:
Early PA was not significantly associated with the likelihood of cognitive inefficiency or impairment ( P s ≥ .38). The early PA*sex interaction was related to verbal cognitive flexibility ( P = .02), with females engaging in early PA having better scores. Moreover, the early PA*age interaction was associated with attention ( P = .03), with younger children engaged in early PA performing worse.
Conclusions:
Early PA has no overall association with cognitive inefficiency or impairment but may be differentially associated with certain cognitive outcomes by age and sex.
