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Updated: Jul 7, 2026
A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
Optimal Recovery Following Pediatric Concussion
Miriam H Beauchamp1,2, Ken Tang3, Andrée-Anne Ledoux4,5,6
1Department of Psychology, University of Montreal, Montreal, Quebec, Canada.
Insights
Pediatric concussion recovery to optimal functioning across multiple domains takes at least 3 months for children, with girls experiencing longer recovery times. Understanding these factors is key to promoting full recovery for all children after concussion.
Area of Science:
- Pediatric neurology
- Sports medicine
- Developmental psychology
Background:
- Pediatric concussion is a common injury with varied recovery patterns.
- Understanding factors influencing positive outcomes is crucial for comprehensive recovery in children.
Purpose of the Study:
- To determine the timeframe for achieving optimal functioning in children (ages 8-16) after concussion.
- To comprehensively assess recovery across motor-physical, cognitive, socioemotional, and resilience domains.
Main Methods:
- Prospective cohort study involving children with concussion or orthopedic injury (OI).
- Assessments conducted at 10 days, 3 months, and 6 months post-injury.
- Utilized self-report and direct assessments measuring symptoms, function, cognition, quality of life, resilience, and social support.
Main Results:
- Optimal functioning scores were lower in the concussion group compared to the OI group at 10 days and 3 months, particularly for females.
- Time was the strongest predictor of optimal functioning, followed by injury group and sex.
- Full recovery, defined as optimal functioning across all domains, took 3 months or more for most children, especially girls.
Conclusions:
- Achieving optimal functioning after pediatric concussion requires a minimum of 3 months, with girls facing longer recovery periods.
- Recovery assessment must consider multiple domains, including physical, cognitive, socioemotional, and resilience factors.
- These findings highlight the need for tailored interventions to support full recovery in pediatric concussion.
Importance:
Pediatric concussion affects millions and results in heterogeneous outcomes and recovery trajectories. Given favorable outcome for most children, it is useful to understand characteristics of positive outcome to promote full recovery in all children.
Objective:
To document the timeframe of recovery to optimal functioning, defined comprehensively across motor-physical, cognitive, socioemotional, and resilience-support domains, after concussion among children ages 8 to 16 years.
Design, Setting, And Participants:
For this prospective cohort study, children ages 8 to 16.99 years with a concussion or orthopedic injury (OI) were recruited between September 2016 and July 2019 from 5 Pediatric Emergency Research Canada emergency departments and assessed approximately 10 days, 3 months, and 6 months after their injury. Data were analyzed from January 29, 2024, to January 11, 2025.
Exposure:
Concussion.
Main Outcomes And Measures:
Participants completed self-report and direct assessment measures of postconcussive symptoms, physical activity and function, balance, cognitive function, quality of life, resilience, and social support. The main outcome was optimal functioning, which was derived from 11 variables and criteria indicative of absence of impairment and average or above functioning in each domain (overall score, 0-11; higher score indicates better function). A longitudinal, multivariable, cumulative probability ordinal regression model was fitted to examine factors associated with optimal functioning.
Results:
A total of 967 children (median [IQR] age, 12.3 [10.5-14.3] years; 562 [58.1%] male) were enrolled, including 633 children with a concussion and 334 children with an OI. The median (IQR) optimal functioning scores for the OI group were 6.0 (4.0-8.0) at 10 days, 7.0 (5.0-9.0) at 3 months, and 7 (5.0-9.0) at 6 months, compared with 4.0 (2.0-6.0) at 10 days, 6.0 (4.0-9.0) at 3 months, and 7.0 (4.0-9.0) at 6 months in the concussion group. The 3 main variables (time, sex, and group) were significantly associated with optimal functioning, as were all 2-way interactions. Time was the strongest factor associated with optimal functioning (Wald χ258 = 485.11; P < .001), followed by group (Wald χ26 = 95.10; P < .001), and sex (Wald χ26 = 23.19; P < .001). At the 10-day follow-up, concussion was associated with lower optimal functioning than OI among females (odds ratio [OR], 0.24 [95% CI, 0.16-0.36]) and males (OR, 0.37 [95% CI, 0.26-0.53]). This difference persisted for females at 3 months (OR, 0.57 [95% CI, 0.35-0.93]) but not for males. Optimal functioning was comparable at 6 months.
Conclusions And Relevance:
In this prospective cohort study of children with concussion, achieving optimal functioning levels across physical, cognitive, socioemotional, and resilience domains took 3 months or more, especially for girls with concussion. Multiple domains of outcome need to be taken into account when considering full recovery and optimal function after pediatric concussion.
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