This article is more than 5 years old. Information may no longer be current.

Treadmill testing safe, valuable in pediatric concussion evaluation

Testing using graded aerobic treadmill activity is safe, tolerable and clinically valuable in the evaluation and management of sports-related concussion in patients aged younger than 20 years, according to data published in the Journal of Neurosurgery: Pediatrics.

“Clinical studies suggest that 21% to 73% of children and adolescents who sustain a concussion will experience persistent symptoms at 1 month after injury or develop post-concussion syndrome (PCS),” Dean Cordingley, MSc, of the Pan Am Concussion Program in Winnipeg, Canada, and colleagues wrote. “Although laboratory model studies suggest that acute concussion is characterized by a global metabolic energy crisis, there are few clinical diagnostic tools that provide a view into the pathophysiology of PCS and few evidence-based treatment options for patients with this condition.”

To determine the safety and clinical use of graded aerobic treadmill testing in pediatric patients with sports-related concussion, as well as to study the clinical outcomes of treatment with a submaximal aerobic exercise program among patients with physiological post-concussion disorder, the researchers conducted a retrospective chart review for all patients aged younger than 20 years evaluated at the Pan Am Concussion Program, part of the Pan Am Clinic, who underwent such testing. Overall, 106 patients aged 11 to 19 years participated in 141 treadmill tests.

Patients included in the review had been diagnosed with sports-related concussion and participated in treadmill testing between Oct. 9, 2014 and Feb. 11, 2016. A single neurosurgeon performed the clinical assessments, which included clinical history, physical examination and recording patient-reported concussion-related symptoms. The treadmills tests included incremental increases in intensity, and was used as a diagnostic tool assessing physiological recovery, as well as to classify PCS subtype and reassess patient treatment. Patients with a symptom-limited threshold on treadmill testing were treated with submaximal exercise.

According to the researchers, 97.9% of the 141 treadmill tests were tolerated and provided valuable clinical information. Of the 65 patients tested for physiological recovery, graded aerobic treadmill activity provided confirmation in 96.9% of cases, allowing a successful return to play in 93.8%. In addition, treadmill testing was used to diagnose physiological post-concussion disorder in 58 patients and cervicogenic post-concussion disorder in 1 patient. Of the 41 patients with physiological post-concussion disorder who completed the follow-up and were treated with a prescription of submaximal exercise, 90.2% were classified as clinically improved, and 80.5% successfully returned to play.

“The results of this study suggest that graded aerobic treadmill testing can provide clinically valuable information that helps confirm physiological recovery in pediatric [sports-related concussion] patients,” Cordingley and colleagues wrote. “Furthermore, graded aerobic treadmill testing is helpful in classifying pediatric PCS into operational [post-concussion disorders] that can be targeted with individualized rehabilitation programs.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.