Article Text

Management of persistent postconcussion symptoms in youth: a randomised control trial protocol
  1. Nick Reed1,2,
  2. Dayna Greenspoon3,
  3. Grant L Iverson4,5,6,7,
  4. Carol DeMatteo8,9,
  5. Philippe Fait10,11,12,13,
  6. Jérôme Gauvin-Lepage14,
  7. Anne Hunt1,
  8. Isabelle J Gagnon15,16
  1. 1Concussion Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
  2. 2Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
  3. 3Concussion Research Centre, Centre for Leadership in ABI, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
  4. 4Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
  5. 5Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
  6. 6MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts, USA
  7. 7Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts, USA
  8. 8School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
  9. 9CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada
  10. 10Department of Human Kinetics Sciences, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Quebec, Canada
  11. 11Research Group on Neuromusculoskeletal Dysfunctions, UQTR, Trois-Rivières, Quebec, Canada
  12. 12Centre de Recherche en Neuropsychologie, Montreal, Quebec, Canada
  13. 13Clinique Cortex Medicine et Readaptation, Quebec City, Quebec, Canada
  14. 14School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
  15. 15Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
  16. 16Trauma, Montreal Children's Hospital of the McGill University Health Center, Montreal, Quebec, Canada
  1. Correspondence to Dr Nick Reed; nreed{at}


Introduction Current management of concussion consists of early education, rest until symptom free, with gradual return to school and physical activity protocols. Although this management strategy is effective for most youth who sustain a concussion, it is not an appropriate strategy for youth with persistent postconcussion symptoms. Prolonged rest and periods of restricted activity may place youth at risk for secondary issues and contribute to the chronicity of postconcussion symptoms. The purpose of this study is to evaluate the efficacy of an active rehabilitation protocol for youth who are slow to recover from concussion. It is hypothesised that an active rehabilitation intervention can reduce persistent postconcussion symptoms, improve function and facilitate return to activity. This article describes the research protocol.

Methods and analysis This is a randomised clinical trial with blinded outcome measurement. Participants will be recruited and randomly assigned to 1 of 2 treatment groups, an active rehabilitation intervention or a standard care education group. Both groups will receive standard care education. However, the active rehabilitation group will participate in an additional low-intensity exercise programme consisting of aerobic, coordination and visualisation exercises. Both the active rehabilitation and the standard care education interventions will be 6 weeks in duration. The primary outcome measure is postconcussion symptoms. Secondary outcome measures include functional recovery (cognitive, motor, psychosocial and emotional functioning) and return to activity. Outcome measures will be administered preintervention and postintervention. The primary outcome measure will also be repeated 2 weeks into the intervention period.

Ethics and dissemination This study has been approved by the Holland Bloorview Kids Rehabilitation Hospital research ethics board (REB # 13-459). The findings from this study will be shared with the general public, sport associations, relevant brain injury organisations and healthcare professionals.

Trial registration number NCT02257749.

  • Concussion
  • Mild Traumatic Brain Injury
  • Pediatrics
  • Exercise
  • Education

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.