Practical Management: Guidelines to Perform the Pediatric Concussion Treadmill Test

Graded exertion testing has diagnostic utility in the management of athletes with sport-related and recreation-related concussions, the results of which are used to prescribe individualized aerobic exercise treatment that facilitates recovery from sport-related concussion and reduces the incidence of symptoms persisting beyond 1 month. Current exertion protocols, such as the Buffalo Concussion Treadmill Test, however, are recommended for patients aged 13 years and older and are not appropriate for younger children with concussion. This practical management article describes a pediatric exertion test protocol using a standard, commercially available treadmill that is designed for patients aged 5 to 12 years with concussion. The Pediatric Concussion Treadmill Test (PCTT) uses age-appropriate walking speeds and symptom-reporting scales and provides additional guidelines on how to perform the test safely in younger children. The PCTT is intended to identify the presence and severity of concussion-related exercise intolerance and can function as an important component of a comprehensive medical evaluation of concussion in children.