tag:blogger.com,1999:blog-2186593343917545414.post4332306646442333047..comments2024-03-10T12:29:30.004-07:00Comments on pediatric neurology: Concussion management 2Galen Breningstall, MDhttp://www.blogger.com/profile/07170864203251456228noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-2186593343917545414.post-47368411089858415372016-08-29T09:27:17.723-07:002016-08-29T09:27:17.723-07:00The U.S. Food and Drug Administration today permit...The U.S. Food and Drug Administration today permitted marketing of two new devices to assess a patient’s cognitive function immediately after a suspected brain injury or concussion. The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and ImPACT Pediatric are the first medical devices permitted for marketing that are intended to assess cognitive function following a possible concussion. They are intended as part of the medical evaluation that doctors perform to assess signs and symptoms of a head injury.<br /><br />ImPACT and ImPACT Pediatric are not intended to diagnose concussions or determine appropriate treatments. Instead the devices are meant to test cognitive skills such as word memory, reaction time and word recognition, all of which could be affected by a head injury. The results are compared to an age-matched control database or to a patient’s pre-injury baseline scores, if available.<br /><br />“These devices provide a useful new tool to aid in the evaluation of patients experiencing possible signs of a concussion, but clinicians should not rely on these tests alone to rule out a concussion or determine whether an injured player should return to a game,” said Carlos Peña, Ph.D., M.S., director of the division of neurological and physical medicine devices at the FDA’s Center for Devices and Radiological Health.<br /><br />ImPACT software runs on a desktop or laptop and is intended for those ages 12 to 59, while the ImPACT Pediatric runs on an iPad and is designed for children ages 5 to 11. Only licensed health care professionals should perform the test analysis and interpret the results…<br /><br />The manufacturer submitted over 250 peer-reviewed articles, of which half were independently conducted clinical research studies. The research publications analyzed the scientific value of the ImPACT devices including the devices’ validity, reliability and ability to detect evidence of cognitive dysfunction that might be associated with a concussive head injury. The FDA concluded that these studies provide valid scientific evidence to support the safety and effectiveness of the ImPACT and ImPACT Pediatric devices.<br /><br />The FDA reviewed the ImPACT device through its de novo classification process, a regulatory pathway for novel, low- to-moderate-risk medical devices that are first-of-a-kind, for which special controls can be developed, in addition to general controls, to provide a reasonable assurance of safety and effectiveness of the devices. The device is manufactured by ImPACT Applications, located in Pittsburgh, Pennsylvania.<br /><br />http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm517526.htm<br /><br />Courtesy of Doximity<br />Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.comtag:blogger.com,1999:blog-2186593343917545414.post-17846426680791655662016-08-17T09:02:14.346-07:002016-08-17T09:02:14.346-07:00May KH, Marshall DL, Burns TG, Popoli DM, Polikand...May KH, Marshall DL, Burns TG, Popoli DM, Polikandriotis JA. Pediatric sports specific return to play guidelines following concussion. Int J Sports Phys Ther. 2014 Apr;9(2):242-55.<br /><br />Abstract<br />PURPOSE/BACKGROUND:<br />In 2010, the American Academy of Pediatrics officially adopted the recommended return to play guidelines proposed by the International Conference on Concussion in Sport. The guidelines include a six-step process that provides structure to guide an athlete who is recovering from a concussion in a gradual return to play (RTP) by allowing participation in increasingly difficult physical activities. Unfortunately, the guidelines fail to take into account the variability that occurs within different sports and the resulting challenges medical professionals face in making sure each athlete is able to withstand the rigors of their specific sport, without return of symptoms. Therefore, the purpose of this clinical commentary is to expand upon the current general consensus guidelines for treatment of concussed pediatric athletes and provide sport specific RTP guidelines.<br />DESCRIPTION OF TOPIC:<br />The intention of the sport specific guidelines is to maintain the integrity of the current six-step model, add a moderate activity phase highlighted by resistance training, and to provide contact and limited contact drills specific to the athlete's sport and/or position. The drills and activities in the proposed seven-step programs are designed to simulate sport specific movements; the sports include: football, gymnastics, cheerleading, wrestling, soccer, basketball, lacrosse, baseball, softball, and ice hockey. These activities will provide sports specific challenges to each athlete while simultaneously accomplishing the objectives of each stage of the RTP progression. The final RTP determination should occur with documented medical clearance from a licensed healthcare provider who has been trained in the evaluation and management of concussions.<br />DISCUSSION/RELATION TO CLINICAL PRACTICE:<br />There have been significant strides in the management and care of concussed athletes. However, there continues to be a lot of confusion among, athletes, parents, and coaches regarding the proper management of an athlete with a concussion, particularly in the pediatric population. In an effort to eliminate ambiguity and help further promote adherence to the RTP guidelines, the authors developed several sports-specific RTP guidelines.Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.comtag:blogger.com,1999:blog-2186593343917545414.post-20601352808919597802016-08-17T08:59:16.547-07:002016-08-17T08:59:16.547-07:00Graduated return-to-play protocol in athletes with...Graduated return-to-play protocol in athletes with concussions<br /><br />Baseline: no symptoms<br /> The first step in the return-to-play progression requires that the athlete complete physical and cognitive tests and be symptom free for a minimum of 24 hours. For younger athletes more conservative restrictions can be used.<br />Step 1: light aerobic activity<br /> 5–10 minutes of light aerobic activity, such as walking, light jogging, or riding an exercise bike, with the goal of increasing the heart rate.<br />Step 2: moderate activity<br /> Moderate jogging, brief running, or moderate-intensity weightlifting that is reduced from the typical routine, with a goal of limited body and head movement.<br />Step 3: heavy, non-contact activity<br /> Intense activity that is close to the typical routine but non-contact. There may be some added cognitive component to practice during this step.<br />Step 4: practice and full contact<br /> Reintegrate the athlete into full-contact practice.<br />Step 5: competition<br /> Return to competition.<br /><br />McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvořák J, Echemendia RJ, et al: Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. J Am Coll Surg 216:e55–e71, 2013Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.com