Treatment of non-sports related concussion in adolescents following an irritability algorithmic approach: a case series.

BACKGROUND

Concussion management evidence supports the efficacy of gradual active rehabilitation for return to sport in adolescents, however there is paucity of evidence for non-sports-related concussion management.

PURPOSE: The purpose of this case series is to describe the feasibility and practicality of an irritability-based step-by-step model to guide rehabilitation.

CASE DESCRIPTIONS: Three adolescent patients diagnosed with concussion during a non-sports related event are described. Each adolescent was classified as high, moderate, or low irritability level based on symptom exacerbation with Vestibular/Ocular-Motor Screening (VOMS), physical exertion based on age-predicted maximum heart rate, and cervicogenic factors. Each Patient's intervention was progressed following the proposed irritability-based algorithm.

OUTCOMES: Patients were assessed using the Brain Injury Functional Status Patient-Reported Outcome Measure, VOMS testing, and a Numeric Pain Rating Scale. Concluding each plan of care, all patients met or exceeded the minimal clinically important difference for age, gender, and risk-adjusted predicted measure on all outcome assessments. All patients returned to school and age-appropriate activities without symptom exacerbation.

CONCLUSION

An irritability-based algorithm model for non-sports-related concussion management may be a practical and feasible treatment approach for adolescents.