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Time to Rehabilitation in Pediatric Concussion Patients Influences Recovery Outcomes

Abel S. Mathew, Alison E. Datoc, Daniel M. Choi, Chris R. Tak, and John P. Abt

Context: Targeted and directed rehabilitation with a healthcare provider can be an effective approach in the treatment of concussion, particularly for patients with protracted recovery, high symptom reporting, cervicogenic dysfunction, musculoskeletal involvement, and/or vestibular/oculomotor dysfunction. While many environmental and intrinsic medical history factors may influence concussion recovery, little is known about whether an individual’s recovery trajectory can be influenced by the amount of time taken to receive rehabilitation. The purpose of this study was to evaluate recovery trajectories of concussion patients requiring targeted multimodal rehabilitation after a specialty concussion clinic visit within ≤3 days, 4 to 7 days, and >7 days. We also sought to evaluate risk factors for protracted recovery. Design and Methods: The study involved a retrospective chart review of 103 patients (mean age = 13.78 [2.89]; 55% female) who, after their initial specialty concussion clinic visit, received rehabilitation in ≤3 days, 4 to 7 days, and >7 days. Patients were evaluated at a pediatric specialty concussion clinic between April 2021 and December 2023, and diagnosed with concussion by a specialist (primary care sports medicine physician, nurse practitioner, and/or neuropsychologist), referred for rehabilitation via physical therapy services, completed more than one rehabilitation session, and received medical clearance to initiate the return-to-sport protocol. Groups were compared based on relevant clinical factors, Vestibular Ocular Motor Screening, neurocognitive testing (Trails B-A), Post-Concussion Symptom Scale, days from injury to concussion evaluation, days from concussion evaluation to rehabilitation, number of rehabilitation sessions, recovery days after rehabilitation, and total recovery days (ie, days from injury to medical clearance to initiate return-to-sport protocol). Data analysis included chi-square, correlations, 1-way analysis of variance, and general linear regression. Adjusted odds ratios for protracted recovery were derived from a logistic regression model. Discussion: Days from injury to concussion evaluation (P < .001), days from concussion evaluation to rehabilitation (P = .006), and Trails B-A (P = .009), were significant predictors of total recovery time among pediatric concussion patients who required multimodal rehabilitation. Risk of protracted recovery increased by 34% each day from injury to concussion evaluation a patient did not receive treatment (Nagelkerke Pseudo R 2 = .45; P < .001). Previous studies have also shown that time to concussion evaluation is an important prognostic indicator of recovery. Correspondingly, prompt referral to concussion care and rehabilitation for patients with a need for multimodal rehabilitation can improve recovery outcomes.

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A Commentary on Latash: “Useful and Useless Misnomers in Motor Control”

Grace Niyo and Francisco J. Valero-Cuevas

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Cross-Disciplinary Communication and Evolving Language: A Comment on Latash

Hannah J. Block, Kess L. Folco, Reshma Babu, Manasi Wali, Bashir S. Isa, and Maner Wang

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An Ecological-Dynamical Perspective on Latash’s Misnomers in Motor Control

Raoul M. Bongers, Vitor L.S. Profeta, and Steven J. Harrison

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Exactness as the Universal Currency of Research in Natural Science

Mark L. Latash

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Motor Control Needs to Build More Bridges Across Levels of Analysis

Rajiv Ranganathan, Mei-Hua Lee, and Chandramouli Krishnan

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Recognizing Context, Embracing Jargon, and Learning From Linguists: A Commentary on “Useful and Useless Misnomers in Motor Control”

Bailey Uitz, Mathew Yarossi, and Eugene Tunik

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Reflecting on Emergent Behaviors, Synergies, Stiffness, and Redundancy From a Biomechanics Perspective

Peter J. Keir and Daanish M. Mulla

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Terms Are Tools in Biological Motor Control

Sasha Reschechtko and J. Andrew Pruszynski

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Multimodal Rehabilitation Including Strengthening Exercise Is Effective in Improving Fear-Avoidance Beliefs in Individuals With Patellofemoral Pain: A Critically Appraised Topic

Sarah Meade, Sungwan Kim, and Neal R. Glaviano

Clinical Scenario: Individuals with patellofemoral pain (PFP) present with a variety of neuromuscular and psychological deficits, with the “gold-standard” for treatment being rehabilitation programs with strengthening-based exercises. While such interventions primarily target pain and function measures, it is unknown whether psychological measures such as fear-avoidance beliefs (FABs) are also affected. Clinical Question: Is rehabilitation including strengthening exercises effective in improving FABs in individuals with PFP? Summary of Key Findings: Three studies met the inclusion criteria and were included in the appraisal. All studies found that rehabilitation including strengthening exercises was effective in improving FABs for physical activity, though such improvements were modest. One study found that supplementing a one-time psychological intervention to rehabilitation including strengthening exercises resulted in greater improvements in FABs than with rehabilitation including strengthening exercises alone. Two studies found associations between changes in FABs and changes in pain and/or function outcomes. Clinical Bottom Line: There is consistent evidence that the incorporation of rehabilitation with strengthening exercises is effective in improving FABs in individuals with PFP, though such improvements are modest. Furthermore, supplementation with psychological interventions to rehabilitation including strengthening exercises may produce larger improvements in FABs, particularly in patients with an elevated FABs phenotype. As a result of improving FABs, patient outcomes of pain and function may be improved, though future research is needed. Therefore, at this time, we recommend that rehabilitation, including strengthening exercises with supplemental psychological interventions be prescribed for the treatment of PFP particularly in subgroups with elevated FABs, to improve patient outcomes. Strength of Recommendation: Collectively, the body of evidence included to answer the clinical question aligns with the strength of recommendation of A based on the Strength of Recommendation Taxonomy.