We would like to thank the Canadian Institutes of Health Research (CIHR) who have provided funding for this research. Further, we would like to acknowledge Dr. Tim Taha and Dr. Scott Thomas from the University of Toronto for their assistance with the development of our protocol for the collection of resting state heart rate variability data.

El protocolo descrito incluye la evaluación de seguimiento antes de la lesión / pruebas de línea de base y después de la lesión y se completa con tres estaciones. Esta prueba se puede completar de forma individual o en grupos de cuatro sujetos en cada estación a la vez. Los sujetos proceden a través de cada estación en el orden que se indica a continuación. La Tabla 1 ilustra el esquema de administración de pruebas del protocolo. Ética aprobación de esta investigación se obtuvo de la Junta Ética de Investigación Holanda Bloorview en el Hospital de Rehabilitación Bloorview Kids Holanda. Todos los participantes y sus tutores legales proporcionan firmaron el consentimiento informado antes de completar el protocolo y la recopilación de datos relacionados. Previa a la lesión / Pruebas de línea de base 1. Estación 1: Obtención de antes de la lesión Información demográfica, síntomas post-conmoción cerebral Informe y Descansar Estado variabilidad del ritmo cardíaco (HRV) de datos <ol><li> Antes de someter (s) que llegan para la prueba, asegúrese de todos los equipos es la funcióning correctamente y listo para la prueba y que las habitaciones de evaluación están libres de distracciones innecesarias. </li><li> Después de revisar consentimiento de los padres y el sujeto, medir y registrar la altura y el peso del sujeto. Configure correas y relojes monitor de frecuencia cardiaca en cada sujeto correctamente. </li><li> Administrar el formulario de información demográfica y recoger post-concusión informe síntoma usando la versión infantil del Inventario de Síntomas de post-concusión (PCSI-C) mientras que cada sujeto se sienta durante 5 min. </li><li> Haga que cada sujeto yacía boca arriba en el suelo sobre una estera limpia y desinfectada. Encienda los monitores de ritmo cardíaco para registrar los datos del estado de reposo variabilidad de la frecuencia cardiaca (VFC) (con función de intervalo RR ajustado en [On]). Haga que cada sujeto permanece tumbado en decúbito supino en silencio sin hablar durante 10 minutos durante la grabación de HR. </li><li> Después de 10 minutos, haga clic en el botón de vuelta en el reloj para indicar el final de la mentira supina descansando la recopilación de datos de la VFC estado. Pida al sujeto que regresar a una posición sentada, haga clic en los bu vueltatecla se mantendrá en el reloj de nuevo para indicar comienzo de la recolección de datos en reposo HRV sentado estado. </li><li> Haga que cada sujeto permanecerá en la posición de sentado durante 5 minutos sin hablar. Después de 5 minutos, detener la función de grabación de reloj para terminar la sesión y la recopilación de datos de la VFC estado de reposo. Pida al sujeto a quitarse la correa y los relojes de la frecuencia cardíaca. </li></ol> 2. Estación 2: Obtención de datos de rendimiento cognitivo <ol><li> Haga que cada sit sujeto a un cubículo con un ordenador portátil personal creado con un ratón. Asegúrese de probar el medio ambiente es libre de distracciones. </li><li> Administrar la evaluación inmediata post-conmoción cerebral y la prueba cognitiva (IMPACT), una herramienta de evaluación neuropsicológica rápido e informatizado (aproximadamente 25 minutos para completar). </li></ol> 3. Station 3: Obtención de balance estático, fuerza de agarre y agilidad / Motor Skills datos <ol><li> Administrar la valoración del equilibrio estático mediante la Prueba Clínica modificada sensorial Integratiel de Equilibrio (m-CTSIB) en el sistema de balanza portátil. Mientras estaba en la placa de fuerza Sistema de balance, el sujeto complete cuatro condiciones ordenadas que incluyen de pie con los ojos abiertos durante 20 segundos; de pie con los ojos cerrados durante 20 segundos; de pie con los ojos abiertos en la almohadilla de espuma indexada durante 20 segundos; y de pie con los ojos cerrados en la almohadilla de espuma indexada durante 20 segundos. </li><li> Utilizando un dinamómetro, medir y fuerza de agarre récord mano en kg para ambas manos derecha e izquierda. Registre la mano dominante para cada sujeto mientras todavía completar 3 ensayos consecutivos para cada mano comenzando con la mano dominante. De los 3 ensayos tomadas, también se grabará el máximo agarre en la mano en cada mano. Para cada prueba el sujeto se le dice a apretar el puño tan duro como puedan durante 3 segundos manteniendo una posición neutral de la extremidad superior (de pie, brazo recto paralelo al lado del cuerpo, con la palma hacia el cuerpo y neutral de la muñeca). </li><li> En un pasillo o en el gimnasio, al menos, 2,5 m de ancho y 15 m de largo administran la agilidad / motorevaluación de habilidades usando la Evaluación de ABI-Challenge (ABI-CA) - Módulo conmoción cerebral. Coloque la cinta sobre el terreno en una línea recta marcado puntos por cada 1 m. En el siguiente orden administrar estos 6 pruebas siguiendo las directrices y criterios de puntuación establecidos en el módulo de la conmoción cerebral. <ol><li> Salto-jacks (Timed): <ol><li> De pie, con los brazos a los lados y saltar a una posición de &quot;X&quot; con los brazos y las piernas, y luego al instante saltar de nuevo en posición de partida. Cuente cuántos se puede hacer en 15 segundos. </li></ol></li><li> Pilón carrera de obstáculos / cono plazo (temporizado): <ol><li> Ejecutar dentro y fuera de las torres de alta tensión hasta el final (10 m) y de nuevo lo más rápido que puede, pero a una velocidad que te sientas seguro. No toque las torres de alta tensión. Continuar en línea recta a través de la línea de meta. (Torres de alta tensión situados a los 3, 5, 7, 10 m) </li></ol></li><li> Backwards tándem caminar (temporizado): <ol><li> En la pista bordeada, caminar hacia atrás en un patrón tándem para 5 m. Patrón Tandem está tocando su talón a sus Opostoe ite en cada paso. </li></ol></li><li> PCN Modificado (temporizado): <ol><li> Corre a lo largo de la pista de 10 m, recoger una bolsa de frijoles en el final del curso, y volver corriendo a colocar la pelotita en una cesta en el punto de partida. Ellos deben tocar la línea de salida con el pie cada vez que regrese a la cesta. Repita esto tres veces hasta que todas las bolsas de frijoles están en la canasta en el punto de partida. </li></ol></li><li> Entradas y salidas (temporizado): <ol><li> De pie, con los dos pies dentro de dos líneas paralelas (en el camino) que son 40 cm de distancia. Mueva un pie fuera de la línea correspondiente, seguido de la otra pierna se mueve fuera de la otra línea. El primer pie se devuelve a continuación, hacia el interior, seguido por el segundo pie. Ciclos deben ser consecutivos y debe ser realizado de una manera rítmica (tiempo igual entre cada paso), y se repitió 10 veces no se mueve hacia adelante o hacia atrás. </li></ol></li><li> Salto en largo: pasar a la fase de pie con ambos pies como far como pueda y mantenga presionado el aterrizaje durante 3 segundos. Mida y registre la distancia desde la parte delantera del pie más retrasada. Se dan tres ensayos para alcanzar la máxima distancia </li></ol></li></ol> 4. post-lesión / Pruebas de seguimiento <ol><li> La obtención de datos post-conmoción cerebral mientras se encontraba sujeto está experimentando los síntomas post-conmoción cerebral <ol><li> El mismo día, un sujeto sufre una lesión, el personal de investigación se pone en contacto por tema utilizando teléfono o correo electrónico. Personal investigador registra los detalles clínicos y funcionales con respecto a la lesión. </li><li> Inmediatamente después de la conmoción cerebral (post lesiones 24-48 h), recoge: descansando datos de VFC estado (repita los pasos 1.3, 1.5 a 1.10); datos de síntomas post-conmoción cerebral (repita el paso 1.4); y datos de la balanza (repita el paso 3.1). Si se agravan los síntomas durante la prueba, deje de recopilación de datos y permitir que sujetos a descansar. </li><li> Seguir recogiendo datos de la VFC en reposo estado (repita los pasos 1.3, 1.5 a 1.10), datos de síntomas post-conmoción cerebral (repita el paso 1.4), yLa información del balance (repita el paso 3.1) semanalmente hasta que los síntomas post-conmoción cerebral han resuelto. Si se agravan los síntomas durante la prueba, deje de recopilación de datos y permitir que sujetos a descansar. </li><li> El personal de investigación sigue con objeto semanalmente por teléfono para determinar si los síntomas post-conmoción cerebral resolver (usando PCSI-C). </li></ol></li></ol> 5. Obtención de post-concusión datos Mientras Asunto Ya no está experimentando síntomas post-concusión <ol><li> En 1 semana después de los síntomas post-conmoción cerebral han resuelto, recoger: descansando datos de VFC estado (repita los pasos 1.3, 1.5 a 1.10); datos de síntomas post-conmoción cerebral (repita el paso 1.4); datos de rendimiento cognitivo (repita los pasos 2.1-2.2); La información del balance (repita el paso 3.1); datos del asidero (repita el paso 3.2); y, los datos de habilidades agilidad / motor (repita el paso 3.3). Si se agravan los síntomas durante la prueba, deje de recopilación de datos y permitir que sujetos a descansar. </li><li> En 1 mes después de los síntomas post-conmoción cerebral han resuelto, repita el paso 5.1. A los 3 meses después del mensaje-concussion síntomas hayan desaparecido, repita el paso 5.1. A los 6 meses después de la post-conmociones cerebrales síntomas hayan desaparecido, repita el paso 5.1. </li></ol>

<ol>
	<li>McCrory, P., Meeuwisse, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Consensus+statement+on+Concussion+in+Sport+3rd+International+Conference+on+Concussion+in+Sport+held+in+Zurich,+November+2008.">Consensus statement on Concussion in Sport 3rd International Conference on Concussion in Sport held in Zurich, November 2008.</a> Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine. 19 (3), 185-200 (2009).</li><li>Kirkwood, M. W., Yeates, K. O., Wilson, P. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pediatric+sport-related+concussion:+a+review+of+the+clinical+management+of+an+oft-neglected+population.">Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population.</a> Pediatrics. 117 (4), 1359-1371 (2006).</li><li>Khan, F., Baguley, I. J., Cameron, I. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=4:+Rehabilitation+after+traumatic+brain+injury.">4: Rehabilitation after traumatic brain injury.</a> The Medical journal of Australia. 178 (6), 290-295 (2003).</li><li>Langlois, J. A., Rutland-Brown, W., Wald, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+epidemiology+and+impact+of+traumatic+brain+injury:+a+brief+overview.">The epidemiology and impact of traumatic brain injury: a brief overview.</a> The Journal of head trauma rehabilitation. 21 (5), 375-378 (2006).</li><li>Browne, G. J., Lam, L. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concussive+head+injury+in+children+and+adolescents+related+to+sports+and+other+leisure+physical+activities.">Concussive head injury in children and adolescents related to sports and other leisure physical activities.</a> British Journal of Sports Medicine. 40 (2), 163-168 (2006).</li><li>Emery, C. A., Meeuwisse, W. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Injury+rates,+risk+factors,+and+mechanisms+of+injury+in+minor+hockey.">Injury rates, risk factors, and mechanisms of injury in minor hockey.</a> The American journal of sports medicine. 34 (12), 1960-1969 (2006).</li><li>Keightley, M., Reed, N., Green, S., Taha, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Age+and+competition+level+on+injuries+in+female+ice+hockey.">Age and competition level on injuries in female ice hockey.</a> International journal of sports medicine. 34 (8), 756-759 (2013).</li><li>McCrory, P., Meeuwisse, W. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Consensus+statement+on+concussion+in+sport:+the+4th+International+Conference+on+Concussion+in+Sport+held+in+Zurich,+November+2012.">Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.</a> British journal of sports medicine. 47 (5), 250-258 (2013).</li><li>Krol, A. L., Mrazik, M., Naidu, D., Brooks, B. L., Iverson, G. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+symptoms+in+a+concussion+management+programme:+method+influences+outcome.">Assessment of symptoms in a concussion management programme: method influences outcome.</a> Brain injury: [BI. 25 (13-14), 1300-1305 (2011).</li><li>Williamson, I. J. S., Goodman, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Converging+evidence+for+the+under-reporting+of+concussions+in+youth+ice+hockey.">Converging evidence for the under-reporting of concussions in youth ice hockey.</a> British Journal of Sports Medicine. 40 (2), 128-132 (2006).</li><li>Cassidy, J. D., Carroll, L. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence,+risk+factors+and+prevention+of+mild+traumatic+brain+injury:+results+of+the+WHO+Collaborating+Centre+Task+Force+on+Mild+Traumatic+Brain+Injury.">Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.</a> Journal of Rehabilitation Medicine: Official Journal of the UEMS European Board of Physical and Rehabilitation Medicine. (43 Suppl), 28-60 (2004).</li><li>Collins, M. W., Lovell, M. R., Iverson, G. L., Cantu, R. C., Maroon, J. C., Field, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cumulative+effects+of+concussion+in+high+school+athletes.">Cumulative effects of concussion in high school athletes.</a> Neurosurgery. 51 (5), 1175-1179 (2002).</li><li>Lovell, M. R., Collins, M. W., Iverson, G. L., Johnston, K. M., Bradley, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Grade+1+or+&#8220;ding&#8221;+concussions+in+high+school+athletes.">Grade 1 or &#8220;ding&#8221; concussions in high school athletes.</a> The American Journal of Sports Medicine. 32 (1), 47-54 (2004).</li><li>Guskiewicz, K. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Postural+stability+assessment+following+concussion:+one+piece+of+the+puzzle.">Postural stability assessment following concussion: one piece of the puzzle.</a> Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine. 11 (3), 182-189 (2001).</li><li>Guskiewicz, K. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+postural+stability+following+sport-related+concussion.">Assessment of postural stability following sport-related concussion.</a> Current Sports Medicine Reports. 2 (1), 24-30 (2003).</li><li>Reed, N., Taha, T., Tremblay, L., Monette, G., Keightley, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concussion+and+strength+performance+in+youth+hockey+players.">Concussion and strength performance in youth hockey players.</a> Brain Injury. 26 (4-5), 766 (2012).</li><li>Chevignard, M., Toure, H., Brugel, D. G., Poirier, J., Laurent-Vannier, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comprehensive+model+of+care+for+rehabilitation+of+children+with+acquired+brain+injuries.">A comprehensive model of care for rehabilitation of children with acquired brain injuries.</a> Child: care, health and development. 36 (1), 31-43 (2010).</li><li>Goldstein, B., Toweill, D., Lai, S., Sonnenthal, K., Kimberly, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Uncoupling+of+the+autonomic+and+cardiovascular+systems+in+acute+brain+injury.">Uncoupling of the autonomic and cardiovascular systems in acute brain injury.</a> The American journal of physiology. 275 (4 Pt 2), R1287-R1292 (1998).</li><li>Korpelainen, J. T., Huikuri, H. V., Sotaniemi, K. A., Myllyl&#228;, V. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Abnormal+heart+rate+variability+reflecting+autonomic+dysfunction+in+brainstem+infarction.">Abnormal heart rate variability reflecting autonomic dysfunction in brainstem infarction.</a> Acta neurologica Scandinavica. 94 (5), 337-342 (1996).</li><li>Leddy, J. J., Kozlowski, K., Fung, M., Pendergast, D. R., Willer, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regulatory+and+autoregulatory+physiological+dysfunction+as+a+primary+characteristic+of+post+concussion+syndrome:+implications+for+treatment.">Regulatory and autoregulatory physiological dysfunction as a primary characteristic of post concussion syndrome: implications for treatment.</a> NeuroRehabilitation. 22 (3), 199-205 (2007).</li><li>Covassin, T., Weiss, L., Powell, J., Womack, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+a+maximal+exercise+test+on+neurocognitive+function.">Effects of a maximal exercise test on neurocognitive function.</a> British journal of sports medicine. 41 (6), 370-374 (2007).</li><li>McCrory, P., Collie, A., Anderson, V., Davis, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Can+we+manage+sport+related+concussion+in+children+the+same+as+in+adults?.">Can we manage sport related concussion in children the same as in adults?.</a> British Journal of Sports Medicine. 38 (5), 516-519 (2004).</li></ol>

The authors have nothing to disclose.

Este protocolo presenta un enfoque multimodal para medir la recuperación en atletas jóvenes después de una conmoción cerebral. Una característica fundamental de este protocolo es la comparación de los datos post-conmoción cerebral a través de una amplia gama de dominios de desempeño (la cognición, el equilibrio, la fuerza, la agilidad, la variabilidad del ritmo cardíaco en reposo estado, etc) para pre-lesión / línea de base. Estos datos sirven como un medio para indicar la recuperación entre los a...

Conmoción cerebral se puede definir como &quot;un proceso fisiopatológico complejo que afecta el cerebro inducidos por fuerzas biomecánicas traumáticas&quot; 1, y puede dar lugar a síntomas conductuales / cortas y somáticos a largo plazo, cognitivas y / o emocionales 2. Funcionalmente, conmoción cerebral y los síntomas relacionados pueden tener un impacto significativo en la participación de una de las actividades diarias y actividades 3. Se ha estimado que en los Estados Unidos, entre 1,6 y 3,8 millones de conmoción cerebral cada año se producen como resultado de la participación en el deporte 4. Específica a los niños y jóvenes que participan en los deportes, la conmoción cerebral es una de las lesiones más comúnmente reportados 5-7. A pesar de la conmoción cerebral puede tener impacto en las actividades diarias y la prevalencia de la conmoción entre los niños y los jóvenes, sigue habiendo una falta de datos científicos que informaron de cómo el cerebro responde a la juventud conmoción cerebral a través de una variedad de dominios de desempeño. Línea de base tresante, o el uso de las puntuaciones de las pruebas antes de la lesión como un punto de referencia para la comparación con los puntajes de pruebas después de la lesión para informar a la recuperación, es una práctica de la creciente popularidad dentro de la comunidad deportiva juvenil y se ha sugerido internacionalmente 8 para ser &quot;útil añadir útil información &quot;(p.3) durante la gestión de concusión. Para representar mejor la variada naturaleza de los síntomas post-conmoción cerebral (somáticas, cognitivas y emocionales / conductuales), es importante que la evaluación de la recuperación post-conmoción cerebral incluyen una variedad de medidas de resultado. Además, la gestión de conmoción actual se basa en gran medida en el informe subjetivo de los síntomas post-conmoción cerebral. La validez de este informe subjetivo puede ser influenciada por una variedad de factores 9 y puede conducir a ambos sub-registro de los síntomas 10,11 y un índice de menos preciso y fiable de recuperación. Como resultado, hay una necesidad significativa para explorar enfoques para la medición de la recuperación post-conmoción cerebral a través de Performandominios ce que son objetiva y sensible. Se ha demostrado que la cognición, el equilibrio, la fuerza y la agilidad puede ser alterada en la juventud tras la conmoción cerebral y lesión cerebral 12-17. Se eligieron las medidas incluidas dentro de este protocolo de pruebas para dar una idea de la recuperación a través de estos dominios tras la conmoción cerebral y para incorporar el uso de las herramientas de pruebas clínicas validadas que se utilizan comúnmente en todos los entornos clínicos centrados en la gestión de la conmoción cerebral. Además, desde un punto de vista más exploratoria, descansando HRV estado puede ser visto como una medida exacta de equilibrio simpático 18,19. En una población sana, el equilibrio simpático se define como el sistema parasimpático es dominante en reposo, mientras que el sistema simpático está bajo control inhibidor tónico. La hipótesis es que después de la conmoción cerebral, debido al estrés fisiológico, existirá un desequilibrio entre los dos sistemas y descansando estado puede cambiar a la hiperactividad de lasistema simpático y hipoactividad del sistema parasimpático 20. El objetivo del protocolo de este estudio es realizar una evaluación multi-modal de rendimiento antes y después de la conmoción cerebral entre atletas jóvenes (edades 10-18 años) con el fin de obtener una comprensión más integral, objetiva y precisa de la recuperación después de la conmoción cerebral. Este estudio tiene como objetivo proporcionar información sobre el desarrollo y la entrega de protocolos de gestión de la conmoción cerebral y rehabilitación específicas para niños y jóvenes.

<table border="0" cellpadding="0" cellspacing="0" width="584">
	<tbody>
		<tr>
			<td>Name of Reagent/ Equipment</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments/Description</td>
		</tr>
		<tr>
			<td>Scale</td>
			<td>Weight Watchers: Conair&#160;</td>
			<td>WW30WB</td>
			<td></td>
		</tr>
		<tr>
			<td>Measuring Tape</td>
			<td>Hi-Viz Lufkin</td>
			<td>HVC716CME</td>
			<td></td>
		</tr>
		<tr>
			<td>Heart Rate Monitor (Chest Strap and Watch)</td>
			<td>Polar</td>
			<td>RS800CX GPS</td>
			<td></td>
		</tr>
		<tr>
			<td>Exercise/Yoga Mat</td>
			<td>Pur Athletics</td>
			<td>WTE10126</td>
			<td></td>
		</tr>
		<tr>
			<td>Sportline Stopwatch (Model 228)</td>
			<td>EB Sport Group</td>
			<td>#2787</td>
			<td></td>
		</tr>
		<tr>
			<td>Laptop - MacBook Pro</td>
			<td>Apple</td>
			<td>A1278</td>
			<td></td>
		</tr>
		<tr>
			<td>Computerized Cognitive Assessment- Immediate Post-Concussion Assessment and Cognitive Task</td>
			<td>ImPACT Application&#39;s Inc.&#160;</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Hand Grip Dynamometer</td>
			<td>Sammons Preston- Smedley-Type</td>
			<td>5032P</td>
			<td></td>
		</tr>
		<tr>
			<td>BioSway</td>
			<td>Biodex Medical Supplies Inc.&#160;</td>
			<td>950-510</td>
			<td></td>
		</tr>
		<tr>
			<td>Painter&#39;s Mate Green Tape</td>
			<td>ShurTech Brands LLC</td>
			<td>#49462</td>
			<td></td>
		</tr>
		<tr>
			<td>Pylons/Cones (12&#34;)</td>
			<td>Canadian Tire</td>
			<td>84-295-4</td>
			<td></td>
		</tr>
		<tr>
			<td>Basket</td>
			<td>Canadian Tire</td>
			<td>42-9919-2</td>
			<td></td>
		</tr>
		<tr>
			<td>Bean Bags</td>
			<td>Eastpoint/Go Gater</td>
			<td>1-1-16392</td>
			<td></td>
		</tr>
	</tbody>
</table>

a multi-modal approach to assessing recovery in youth athletes following concussion

La conmoción cerebral es una de las lesiones más frecuentemente notificadas entre los niños y jóvenes involucrados en la participación deportiva. A raíz de una conmoción cerebral, los jóvenes pueden experimentar una serie de síntomas neuroconductuales a corto y largo plazo (somático, cognitivo y emocional / conductual) que pueden tener un impacto significativo en la participación de uno en las actividades diarias y actividades de interés (por ejemplo, la escuela, el deporte, el trabajo, familia / vida social, etc). A pesar de ello, sigue habiendo una escasez en la investigación impulsada clínicamente dirigida específicamente a la exploración de la conmoción cerebral en el deporte juvenil de la población, y más concretamente, los enfoques multimodales a la medición de la recuperación. Este artículo proporciona una visión general de un enfoque novedoso y multimodal para la medición de la recuperación entre los atletas juveniles tras la conmoción cerebral. El enfoque que se presenta consiste en el uso de ambos antes de la lesión / pruebas de línea de base y después de la lesión / pruebas de seguimiento para evaluar el desempeño en una amplia variedad de dominios (post-concussíntomas sión, la cognición, el equilibrio, la fuerza, la agilidad habilidades / motor y estado de reposo variabilidad del ritmo cardíaco). El objetivo de esta investigación es obtener una comprensión más objetiva y precisa de la recuperación después de la conmoción cerebral en atletas jóvenes (edades 10-18 años). Los resultados de esta investigación pueden ayudar a informar el desarrollo y uso de enfoques mejorados de concusión tratamiento y la rehabilitación específica para la comunidad deportiva de la juventud.

El protocolo que se presenta es una investigación en curso. Tabla 1 muestra el esquema de administración de pruebas del protocolo. Los resultados representativos se presentan para demostrar la viabilidad de la recogida de datos de referencia / antes de la lesión y después de la conmoción cerebral a través de una variedad de dominios de desempeño se sabe que están afectados por la conmoción cerebral en la juventud. Un solo caso de un joven conmocionado que ha completado todas las etapas del prot...

Watch this Scientific Journal Video about A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion at JoVE.com

A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion

This article provides an overview of a multi-modal approach to assessing recovery following concussion in youth athletes. The described protocol uses pre- and post-concussion assessment of performance across a wide variety of domains and can inform the development of improved concussion rehabilitation protocols specific to the youth sport community.

Un Enfoque Multi-Modal de recuperación Evaluación de Atletas Jóvenes Siguiendo Concusión

Concussion is one of the most commonly reported injuries amongst children and youth involved in sport participation. Following a concussion, youth can ...

a-multi-modal-approach-to-assessing-recovery-youth-athletes-following

Research

JoVE Journal

Medicine

13.3K vistas.  Holland Bloorview Kids Rehabilitation Hospital. This article provides an overview of a multi-modal approach to assessing recovery following concussion in youth athletes. The described protocol uses pre- and post-concussion assessment of performance across a wide variety of domains and can inform the development of improved concussion rehabilitation protocols specific to the youth sport community.

Video: A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion

An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System

One of the most commonly reported injuries in children who participate in sports is concussion or mild traumatic brain injury (mTBI)1. Children and youth involved in organized sports such as competitive hockey are nearly six times more likely to suffer a severe concussion compared to children involved in other leisure physical activities2. While the most common cognitive sequelae of mTBI appear similar for children and adults, the recovery profile and breadth of consequences in children remains largely unknown2, as does the influence of pre-injury characteristics (e.g. gender) and injury details (e.g. magnitude and direction of impact) on long-term outcomes. Competitive sports, such as hockey, allow the rare opportunity to utilize a pre-post design to obtain pre-injury data before concussion occurs on youth characteristics and functioning and to relate this to outcome following injury. Our primary goals are to refine pediatric concussion diagnosis and management based on research evidence that is specific to children and youth. To do this we use new, multi-modal and integrative approaches that will:
 1.Evaluate the immediate effects of head trauma in youth 
2.Monitor the resolution of post-concussion symptoms (PCS) and cognitive performance during recovery 
3.Utilize new methods to verify brain injury and recovery
To achieve our goals, we have implemented the Head Impact Telemetry (HIT) System. (Simbex; Lebanon, NH, USA). This system equips commercially available Easton S9 hockey helmets (Easton-Bell Sports; Van Nuys, CA, USA) with single-axis accelerometers designed to measure real-time head accelerations during contact sport participation 3 - 5. By using telemetric technology, the magnitude of acceleration and location of all head impacts during sport participation can be objectively detected and recorded. We also use functional magnetic resonance imaging (fMRI) to localize and assess changes in neural activity specifically in the medial temporal and frontal lobes during the performance of cognitive tasks, since those are the cerebral regions most sensitive to concussive head injury 6. Finally, we are acquiring structural imaging data sensitive to damage in brain white matter.

This article provides an overview of a multi-modal approach to mild traumatic brain injury diagnosis and recovery in youth. This approach combines neuropsychological testing with functional magnetic resonance imaging and the Head Impact Telemetry System to monitor the relationship between head impacts and brain activity during cognitive testing.

Una investigación de los efectos de la conmoción cerebral relacionado con el deporte en la juventud, recurriendo a imágenes de resonancia magnética y el sistema de impacto de la cabeza de telemetría

One of the most commonly reported injuries in children who participate in sports is concussion or mild traumatic brain injury (mTBI)1. Children and youth ...

Investigación

Medicina

Assessing Teratogenic Changes in a Zebrafish Model of Fetal Alcohol Exposure

Fetal alcohol syndrome (FAS) is a severe manifestation of embryonic exposure to ethanol. It presents with characteristic defects to the face and organs, including mental retardation due to disordered and damaged brain development. Fetal alcohol spectrum disorder (FASD) is a term used to cover a continuum of birth defects that occur due to maternal alcohol consumption, and occurs in approximately 4% of children born in the United States. With 50% of child-bearing age women reporting consumption of alcohol, and half of all pregnancies being unplanned, unintentional exposure is a continuing issue2. In order to best understand the damage produced by ethanol, plus produce a model with which to test potential interventions, we developed a model of developmental ethanol exposure using the zebrafish embryo. Zebrafish are ideal for this kind of teratogen study3-8. Each pair lays hundreds of eggs, which can then be collected without harming the adult fish. The zebrafish embryo is transparent and can be readily imaged with any number of stains. Analysis of these embryos after exposure to ethanol at different doses and times of duration and application shows that the gross developmental defects produced by ethanol are consistent with the human birth defect. Described here are the basic techniques used to study and manipulate the zebrafish FAS model.

In order to understand the molecular mechanisms of the ethanol-induced developmental damage, we have developed a zebrafish model of ethanol exposure and are exploring the physical, cellular, and genetic alterations that occur after ethanol exposure1. We then seek to find potential interventions and rapidly test them in this animal model.

Evaluación de los cambios teratogénicos en un modelo de pez cebra de la exposición fetal al alcohol

Fetal alcohol syndrome (FAS) is a severe manifestation of embryonic exposure to ethanol. It presents with characteristic defects to the face and organs, ...

Multi-modal Imaging of Angiogenesis in a Nude Rat Model of Breast Cancer Bone Metastasis Using Magnetic Resonance Imaging, Volumetric Computed Tomography and Ultrasound

Angiogenesis is an essential feature of cancer growth and metastasis formation. In bone metastasis, angiogenic factors are pivotal for tumor cell proliferation in the bone marrow cavity as well as for interaction of tumor and bone cells resulting in local bone destruction. Our aim was to develop a model of experimental bone metastasis that allows in vivo assessment of angiogenesis in skeletal lesions using non-invasive imaging techniques.
For this purpose, we injected 105 MDA-MB-231 human breast cancer cells into the superficial epigastric artery, which precludes the growth of metastases in body areas other than the respective hind leg1. Following 25-30 days after tumor cell inoculation, site-specific bone metastases develop, restricted to the distal femur, proximal tibia and proximal fibula1. Morphological and functional aspects of angiogenesis can be investigated longitudinally in bone metastases using magnetic resonance imaging (MRI), volumetric computed tomography (VCT) and ultrasound (US).
MRI displays morphologic information on the soft tissue part of bone metastases that is initially confined to the bone marrow cavity and subsequently exceeds cortical bone while progressing. Using dynamic contrast-enhanced MRI (DCE-MRI) functional data including regional blood volume, perfusion and vessel permeability can be obtained and quantified2-4. Bone destruction is captured in high resolution using morphological VCT imaging. Complementary to MRI findings, osteolytic lesions can be located adjacent to sites of intramedullary tumor growth. After contrast agent application, VCT angiography reveals the macrovessel architecture in bone metastases in high resolution, and DCE-VCT enables insight in the microcirculation of these lesions5,6. US is applicable to assess morphological and functional features from skeletal lesions due to local osteolysis of cortical bone. Using B-mode and Doppler techniques, structure and perfusion of the soft tissue metastases can be evaluated, respectively. DCE-US allows for real-time imaging of vascularization in bone metastases after injection of microbubbles7.
In conclusion, in a model of site-specific breast cancer bone metastases multi-modal imaging techniques including MRI, VCT and US offer complementary information on morphology and functional parameters of angiogenesis in these skeletal lesions.

In the pathogenesis of bone metastasis, angiogenesis is a crucial process and therefore represents a target for imaging and therapy. Here, we present a rat model of site-specific breast cancer bone metastasis and describe strategies to non-invasively image angiogenesis in vivo using magnetic resonance imaging, volumetric computed tomography and ultrasound.

Multimodal de imágenes de la angiogénesis en un modelo de rata desnuda de las metástasis óseas del cáncer de pecho utilizando imágenes de resonancia magnética, tomografía computarizada y la ecografía volumétrica

Angiogenesis is an essential feature of cancer growth and metastasis formation. In bone metastasis, angiogenic factors are pivotal for tumor cell ...

A Neuroscientific Approach to the Examination of Concussions in Student-Athletes

Concussions are occurring at alarming rates in the United States and have become a serious public health concern. The CDC estimates that 1.6 to 3.8 million concussions occur in sports and recreational activities annually. Concussion as defined by the 2013 Concussion Consensus Statement &#8220;may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an &#8216;impulsive&#8217; force transmitted to the head.&#8221; Concussions leave the individual with both short- and long-term effects. The short-term effects of sport related concussions may include changes in playing ability, confusion, memory disturbance, the loss of consciousness, slowing of reaction time, loss of coordination, headaches, dizziness, vomiting, changes in sleep patterns and mood changes. These symptoms typically resolve in a matter of days. However, while some individuals recover from a single concussion rather quickly, many experience lingering effects that can last for weeks or months. The factors related to concussion susceptibility and the subsequent recovery times are not well known or understood at this time. Several factors have been suggested and they include the individual&#8217;s concussion history, the severity of the initial injury, history of migraines, history of learning disabilities, history of psychiatric comorbidities, and possibly, genetic factors. Many studies have individually investigated certain factors both the short-term and long-term effects of concussions, recovery time course, susceptibility and recovery. What has not been clearly established is an effective multifaceted approach to concussion evaluation that would yield valuable information related to the etiology, functional changes, and recovery. The purpose of this manuscript is to show one such multifaceted approached which examines concussions using computerized neurocognitive testing, event related potentials, somatosensory perceptual responses, balance assessment, gait assessment and genetic testing.

There is great variability in an individual&#8217;s risk for concussion and their corresponding recovery. A multifaceted approach to concussion evaluation is warranted; including baseline testing of athletes before participation in sport and timely evaluation post injury. The goal of this protocol is to provide an appropriate multifaceted approach to examine concussions.

Un enfoque neurocientífica al Examen de conmociones cerebrales en estudiantes atletas

Concussions are occurring at alarming rates in the United States and have become a serious public health concern. The CDC estimates that 1.6 to 3.8 ...

Non-invasive Assessments of Subjective and Objective Recovery Characteristics Following an Exhaustive Jump Protocol

Fast recovery after strenuous exercise is important in sports and is often studied via cryotherapy applications. Cryotherapy has a significant vasoconstrictive effect, which seems to be the leading factor in its effectiveness. The resulting enhanced recovery can be measured by using both objective and subjective parameters. Two commonly measured subjective characteristics of recovery are delayed-onset muscle soreness (DOMS) and ratings of perceived exertion (RPE). Two important objective recovery characteristics are countermovement jump (CMJ) performance and peak power output (PPO). Here, we provide a detailed protocol to induce muscular exhaustion of the frontal thighs with a self-paced, 3 x 30 countermovement jump protocol (30-s rest between each set). This randomized controlled trial protocol explains how to perform local cryotherapy cuff application (+ 8 &#176;C for 20 min) and thermoneutral cuff application (+ 32 &#176;C for 20 min) on both thighs as two possible post-exercise recovery modalities. Finally, we provide a non-invasive protocol to measure the effects of these two recovery modalities on subjective (i.e., DOMS of both frontal thighs and RPE) and objective recovery (i.e., CMJ and PPO) characteristics 24, 48, and 72 h post-application. The advantage of this method is that it provides a tool for researchers or coaches to induce muscular exhaustion, without using any expensive devices; to implement local cooling strategies; and to measure both subjective and objective recovery, without using invasive methods. Limitations of this protocol are that the 30 s rest period between sets is very short, and the cardiovascular demand is very high. Future studies may find the assessment of maximum voluntary contractions to be a more sensitive assessment of muscular exhaustion compared to CMJs.

This protocol describes the procedure for non-invasive recovery assessments during a 72 h recovery period. This protocol induces muscular exhaustion of the frontal thighs using countermovement jumps and uses either local cold-cuff or thermoneutral-cuff application as a recovery modality.

Evaluaciones no invasivas de las características de recuperación subjetiva y objetiva después de un protocolo de salto exhaustivo

Fast recovery after strenuous exercise is important in sports and is often studied via cryotherapy applications. Cryotherapy has a significant ...

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based three-chamber bags (3CBs) and soybean-oil-based compounded bags (CoBs) in hospitalized adult patients. We designed a multicenter, randomized, prospective, open-label, noninferiority protocol to compare the efficacy, safety, and distribution of olive-oil-based 3CBs and soybean-oil-based CoB formulations in adult Chinese patients requiring PN during surgical intervention. Subjects were randomized to receive either one of the study treatments using an interactive voice or web-based recognition system in accordance with the randomization code. Randomization was further stratified based on the study site and surgical category. Both treatment groups received similar amounts of calories and protein. In addition, the two study treatments contained a similar composition of the amino-acid component. The only difference between the two PN formulations was the lipid constitution. The duration of administration of study treatments was a minimum of 5 days up to a maximum of 14 days after the surgical procedure. The primary efficacy endpoint was serum prealbumin levels on day 5 of the study. Noninferiority was proved if the anti-log of the lower bound of the 95% confidence interval (CI) of the treatment difference was at least 0.80. Other efficacy measures included treatment preparation time; duration to achieve tolerability of oral nutrition; associated infectious complications; length of hospitalization; and laboratory assessment of markers of nutrition, inflammation, metabolism, and oxidative stress. A total of 458 patients were enrolled in the study. The results showed that olive-oil-based 3CBs were non-inferior to soybean-based CoBs, besides being well tolerated. The infection rate was found to be significantly lower in the olive-oil-based 3CB group. Thus, this study may be used as a reference for future research on lipid emulsion and 3CBs.

Here, we present a protocol for a study comparing the efficacy, safety, and delivery of olive-oil-based 3CB and soybean-oil-based CoB formulations in adults requiring parenteral nutrition. The results revealed that olive-oil-based 3CBs is non-inferior and well tolerated compared to soybean formulations.

Un ensayo clínico que evalúa la seguridad, eficacia y entrega de bolsas de tres cámaras basadas en aceite de oliva para la nutrición parenteral

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based ...

Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology

Participation in organized sports makes a significant contribution to youth development, but places youth at a higher risk for sustaining a concussion. To date, return-to-activity decision-making has been anchored in the monitoring of self-reported concussion symptoms and neurocognitive testing. However, multi-modal assessments that corroborate objective physiological measures with traditional subjective symptom reporting are needed and can be valuable. Heart rate variability (HRV) is a non-invasive physiological indicator of the autonomic nervous system, capturing the reciprocal interplay between the sympathetic and parasympathetic nervous systems. There is a dearth of literature exploring the effect of concussion on HRV in youth athletes, and developmental differences preclude the application of adult findings to a pediatric population. Further, the current state of HRV methodology has primarily included short-term (5-15 min) recordings, by using resting state or short-term physical exertion testing to elucidate changes following concussion. The novelty in utilizing a 24 h&#160;recording methodology is that it has the potential to capture natural variation in autonomic function, directly related to the activities a youth athlete performs on a regular basis. Within a prospective, longitudinal research setting, this novel approach to quantifying autonomic function can provide important information regarding the recovery trajectory, alongside traditional self-report symptom measures. Our objectives regarding a 24 h recording methodology were to (1) evaluate the physiological effects of a concussion in youth athletes, and (2) describe the trajectory of physiological change, while considering the resolution of self-reported post-concussion symptoms. To achieve these objectives, non-invasive sensor technology was implemented. The raw beat-to-beat time intervals captured can be transformed to derive time domain and frequency domain measures, which reflect an individual&#39;s ability to adapt and be flexible to their ever-changing environment. By using non-invasive heart rate technology, autonomic function can be quantified outside of a traditional controlled research setting.

We demonstrate a 24 h heart rate recording methodology to evaluate the influence of concussion across the recovery trajectory in youth athletes, within an ecologically valid context.

Función autonómica después de conmoción cerebral en atletas jóvenes: una exploración de la variabilidad del ritmo cardíaco utilizando metodología de grabación de 24 horas

Participation in organized sports makes a significant contribution to youth development, but places youth at a higher risk for sustaining a concussion. To ...

A Novel Approach to Monitoring Graft Neovascularization in the Human Gingiva

Laser speckle contrast imaging (LSCI) is a novel method for measuring superficial blood perfusion over large areas. Since it is non-invasive and avoids direct contact with the measured area, it is suitable for monitoring blood flow changes during wound healing in human patients. Vestibuloplasty is periodontal surgery to the oral vestibule, aiming to restore vestibular depth with simultaneous enlargement of the keratinized gingiva. In this special clinical case, a split thickness flap was elevated at the first upper premolar and a xenogenic collagen matrix was adapted to the resulting recipient bed. LSCI was used to monitor the re- and neovascularization of the graft and the surrounding mucosa for one year. A protocol is introduced for the correct adjustment of microcirculation measurement in the oral mucosa, highlighting difficulties and possible failures.
The clinical case study presented demonstrated that &#8212; following the appropriate protocol &#8212; LSCI is a suitable and reliable method for following up microcirculation in a healing wound in the human oral mucosa and gives useful information on graft integration.

This study introduces a protocol for measuring microcirculation in human oral mucosa by laser speckle contrast imaging. The monitoring of wound healing after vestibuloplasty combined with a xenogenic collagen graft is presented on a clinical case.

Un nuevo enfoque de supervisión Neovascularization del injerto en la encía humana

Laser speckle contrast imaging (LSCI) is a novel method for measuring superficial blood perfusion over large areas. Since it is non-invasive and avoids ...

Multi-Modal Home Sleep Monitoring in Older Adults

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and research participants. Home sleep testing has gained momentum in the field of sleep medicine due to its convenience and lower cost, as well as being more naturalistic. The accuracy and quality of home sleep testing, however, may be variable because studies are not monitored by sleep technologists. There has been some success in improving the accuracy of home sleep studies by having trained sleep technicians assist participants inside their homes with putting on the devices, but this can be intrusive and time-consuming for those involved. In this protocol, participants undergo at-home sleep monitoring with multiple devices: 1) a single-channel EEG device; 2) a home sleep test for sleep-disordered breathing and periodic limb movements; 3) actigraphy; and 4) sleep logs. A major challenge of this study is obtaining high-quality sleep monitoring data on the first attempt in order to minimize participant burden. This protocol describes the implementation of educational manuals with step-by-step instructions and photos. The goal is to improve the quality of home sleep testing.

Here, we present a protocol to improve the quality of data from home sleep testing by providing a method to enhance instructions through a structured participant visit. This protocol includes the implementation of a step-by-step educational manual with photos to ensure proper placement of equipment.

Sueño hogar multimodal en adultos mayores

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and ...

Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion

The evidence-informed standardization of care along disease lines is recommended to improve outcomes and reduce healthcare costs. The aim of this project is to 1) describe the development and implementation of the Concussion Carepath, 2) demonstrate the process of integrating technology in the form of a mobile application to enable the carepath and guide clinical decision-making, and 3) present data on the utility of the C3 app in facilitating decision-making throughout the injury recovery process. A multi-disciplinary team of experts in concussion care was formed to develop an evidence-informed algorithm, outlining best practices for the clinical management of concussion along three phases of recovery &#8211; acute, subacute, and post-concussive. A custom mobile application, the Cleveland Clinic Concussion (C3) app was developed and validated to provide a platform for the systematic collection of objective, biomechanical outcomes and to provide guidance in clinical decision-making in the field and clinical environments. The Cleveland Clinic Concussion app included an electronic incident report, assessment modules to measure important aspects of cognitive and motor function, and a return to play module to systematically document the six phases of post-injury rehabilitation. The assessment modules served as qualifiers within the carepath algorithm, driving referral for specialty services as indicated. Overall, the carepath coupled with the C3 app functioned in unison to facilitate communication among the interdisciplinary team, prevent stagnant care, and drive patients to the right provider at the right time for efficient and effective clinical management.

A multidisciplinary carepath to standardize disparate concussion care was developed and implemented at the Cleveland Clinic. The Cleveland Clinic Concussion (C3) mobile application was used to enable the carepath through biomechanical outcomes characterizing cognitive and motor function. Patient outcomes improved while cost of care was reduced following implementation.

Desarrollo e implementación de una tecnología multidisciplinar mejorado vía de tratamiento para jóvenes y adultos con conmoción cerebral

The evidence-informed standardization of care along disease lines is recommended to improve outcomes and reduce healthcare costs. The aim of this project ...