Article

The objective of this study was to identify and describe management
strategies to ensure safe return to activity (RTA) and return to school (RTS) of
children with mild traumatic brain injury (MTBI) and determine whether they are
evidence-based. METHODS:
A scoping methodology was conducted using research
published between 1990 and 2013, gray literature and clinical expertise. Once the
data had been charted, an expert panel of physicians and clinicians was consulted
to inform and validate study findings. An analytical and thematic framework was
used to examine the study findings. RESULTS: A total of 400 potentially relevant
published articles, 100 websites and 24 iPad Applications were found. Ten
articles and three web-based resources met inclusion criteria and were included
in the final review. Nine articles recommended a more conservative approach to
RTA, as well as identified a step-wise or severity-oriented approach. General
recommendations were also found regarding safe RTS. One study recommended a
stepwise RTS protocol for children. CONCLUSIONS: This scoping methodology
determined that the most comprehensive guidelines for management are focused on
adults. Evidence concerning prolonged recovery patterns in children and the
impact of concussion on the developing brain suggests that pediatric-specific
guidelines are needed for RTA and RTS after MTBI/concussion. IMPLICATIONS FOR
REHABILITATION: Although concussion in children is an increasing concern, it has
been determined that the most comprehensive guidelines for management are focused
on adults. These guidelines are primarily consensus-based and are not proven fact
through quality research. Evidence concerning prolonged recovery patterns in
youth and the impact of concussion on the developing brain suggest that pediatric
guidelines should be more conservative than for adults. Therefore,
pediatric-specific guidelines need to be developed for return to activity and
return to school after MTBI/concussion.

Langue : ANGLAIS