An Investigation of Return to Play Exertion Protocol in Concussed Adolescents

Written informed parental consent and assent will be obtained for all subjects. The PI or
Co-I will administer ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), the
PCSS (Post Concussion Symptom Scale), and the VOMS (Vestibular Ocular Motor Screening) to
each subject during their first clinical visit. In addition to demographic variables such as
age and gender, groups will be matched based on ImPACT and VOMS performance as well as the
number, type, and severity of symptoms reported on the PCSS. Subjects will be assigned to
receive either the currently accepted standard of care (Heart Rate Exertion group) or the
newly developed exertion protocol (Dynamic Exertion Group). Participants will be matched
according to PCSS total, VOMS symptom report, and by demographic variables including age and
gender. The first participant will be assigned to the dynamic exertion group and the next to
the standard of care group, alternating accordingly as covariates allow. The physical
therapists will be responsible for administering the assigned exertion protocol to each
subject across four time points (one week between each session). Follow-up data regarding
recovery time (i.e., clinical return to normal activity) will also be collected.
Neurocognitive testing will take place on 3-4 week intervals as is consistent with clinical
practice. The current study will include a pre-exertion neurocognitive evaluation and a
post-exertion protocol neurocognitive evaluation.

Inclusion Criteria:

- 14-17 years of age

- Referred to exertion physical therapy within 6 weeks of sport related concussion

Exclusion Criteria:

- Family history of mood or anxiety disorder

- Diagnosis or treatment of migraine

- Diagnosed history of learning disability, ADHD (Attention Deficit Hyperactivity
Disorder)

- Concussion history of 3 or more

- Other factors that would prevent subject from completing exertion protocol