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Concussion research

Program leader: Professor Vicki Anderson

By the age of 10, 1 in 5 children (~51,000 in Australia alone) will sustain a concussion and present with acute Post-Concussion Symptoms (PCS). These symptoms vary from child to child, with the most common being headache, irritability and fatigue, and cognitive disruptions. At The Royal Children’s Hospital Emergency Department this equates to 1000+ concussions yearly, costing >$10M. These PCS resolve spontaneously within 4 weeks in 60% of children and youth, who then safely return to pre-injury activities, leaving ~40% suffering ‘persisting PCS’ (> 2 PCS lasting 4 weeks or more). Persisting PCS cause low tolerance for academic and sport/leisure activities, as well as secondary disruptions to education, fitness and mental health. The family impact of child concussion is significant: medical costs (e.g., radiology, allied health), lost work and school days and parent and child-related stress. Despite their debilitating impact, there is minimal understanding as to which children are at risk for developing persistent PCS, PCS management is inconsistent, and clinical trials investigating treatment methods for persisting PCS are lacking.

The goal of our team is to improve our understanding of how concussion symptoms develop and what the risk factors are for developing persisting PCS in children and adolescents. Additionally, we are focused on tailoring and administering interventions for young children who experience PCS.

Research

The research activities of our team are motivated by a desire to improve understanding of paediatric concussion and to develop effective treatment methods. Current projects include:

Project 1:  Take CARe Biomarkers

The Take CARe Biomarkers study is a single-centre, prospective longitudinal observational study that began in 2014. The aims of the study are: 1) To evaluate the contribution of acute biomarkers to delayed recovery post-concussion, with a focus on the key aspects of the post-injury metabolic cascade and associated brain pathology to better understand the mechanisms underlying delayed symptom recovery; 2) To plot and contrast recovery pathways for children with concussion compared with orthopaedic injury (OI) from time of injury to 3 months post-injury in four domains: post-concussion symptoms, cognition, physical function and mental health and quality of life; and 3). To estimate financial costs of child concussion to patients attending the ED of a tertiary children’s hospital and factors predicting high cost.

Data analysis is ongoing for Take CARe Biomarkers and we have published several papers examining factors that may predict those who are vulnerable to developing persisting PCS. We have identified psychological and family risk factors for developing persisting PCS and we have developed a clinical cut-off score for a widely used concussion symptom inventory. Importantly, our neuroimaging work has not identified neurobiological correlates of persisting PCS, while our blood biomarker analysis has highlighted a number of cytokines that are increased post-concussion, and one (TNFα) that is only increased in children who experience symptoms at 2 weeks post-injury This supports the notion that persistent PCS reflects a functional disturbance rather than a structural neurobiological injury and ongoing symptoms are better explained by other factors (e.g., mental health, family stress).  

Project 2: SCAT5 Validation Study

The SCAT5 Validation Study is a prospective observational study in which children both with and without concussion were recruited from the Emergency Department at Royal Children’s Hospital and administered the Sports Concussion Assessment Tool (SCAT5). There is both a child and adult version of the SCAT. Children below the age of 13 were administered the Child-SCAT5 and children 13 or over were administered the standard adult version. A concussion and control group (made up of upper limb injured and well children) were both recruited to determine if the SCAT5 is an effective diagnostic tool for concussion in an emergency setting. 

Project 3: HeadCheck

HeadCheck is an interactive digital smartphone application designed using the latest scientific knowledge of child concussion. It aims to provide families, young people and sporting officials with ready access to current clinical best practice. The app includes a sideline assessment tool to assist parents, coaches, and first aiders recognize the signs of concussion and provides individually tailored guidance to help parents manage their child’s safe return to normal activities (school, exercise and sport). HeadCheck has been developed by a multidisciplinary team of pediatric concussion researchers, including Emergency Department physicians and allied health professionals, in conjunction with Curve Tomorrow (a health technology company). It was developed in collaboration with the Australian Football League (AFL). The phone application’s content is consistent with the 5th Concussion in Sports Group consensus guidelines, and incorporates validated tools such as the Sports Concussion Assessment Tool 5th Edition (SCAT5 and Child SCAT5), the Pocket Concussion Recognition Tool 5th Edition (CRT5), and the Post Concussion Symptom Inventory (PCSI). Our team have conducted two studies using the HeadCheck app. As part of the development process, we recruited parents of children with a concussion who presented to the Emergency Department of the RCH and sought their feedback on the use of the app. Our team are currently comparing the use of the app to usual care (standard concussion management guidelines) amongst parents recruited in the Emergency Department.

Project 4: Concussion Essentials

We are currently conducting a randomised control trial (RCT) of multimodal treatment for children who are suffering persisting post-concussion symptoms. The design of the trial is based off findings from our team’s earlier Take Care Biomarkers study and a successful pilot of the Concussion Essentials Intervention. The aim of the Concussion Essentials RCT is to determine if our multimodal method of psychological and physiotherapeutic intervention has a higher success rate in alleviating persisting PCS than usual care. This study is expected to run through 2021, recruiting upwards of 200 participants. 

Relevant publications:

  1. Takagi M, Hearps SJC, Babl FE, Anderson N, Bressan S, Clarke C, Davis GA, Doyle M, Dunne K, Lanyon        C, Rausa V, Thompson E, and Anderson V (In Press). Does a computerized neuropsychological test predict prolonged recovery in concussed children presenting to the ED? Child Neuropsychology.
  2. Gornall A., Takagi M., Clarke C., Babl F. E., Davis G. A., Dunne K., Anderson N., Hearps S., Demaneuf T.,Rausa V., Anderson V. (In Press). Behavioral and emotional difficulties following pediatric concussion. Journal of Neurotrauma.
  3. Parkin G, Clarke C, Takagi M, Hearps S, Babl F, Davis G, Anderson V, and Ignjatovic, V. (2019). Plasma          TNF alpha is a predictor of persisting symptoms post-concussion in children. Journal of Neurotrauma, 36(11), 1768-1775.    
  4. Takagi M, Babl FE, Anderson N, Bressan S, Clarke C, Crichton A, Dalziel K, Davis GA, Doyle M, Dunne K, Godfrey C, Hearps SJC, Ignjatovic V, Parkin G, Rausa V, Seal M, Thompson EJ, Truss K, and Anderson V. (2019). Protocol for a prospective, longitudinal, cohort study of recovery pathways, acute biomarkers, and cost for children with persistent post-concussion symptoms: the Take CARe Biomarkers study. BMJ Open, 9(2), e022098.
  5. Rausa V, Anderson V, Babl F, and Takagi M (2018). Predicting concussion recovery in children and adolescents in the emergency room. Current Neurology and Neuroscience Reports, 18(11). 
  6. Lugones M, Parkin G, Bjelosevic S, Takagi M, Clarke C, Anderson V, Ignjatovic V (2018). Blood biomarkers in paediatric mild traumatic brain injury: a systematic review. Neuroscience and Behavioural Reviews, 87, 206-217.  
  7. Truss K, Godfrey C, Takagi M, Babl FE, Bressan S, Hearps S, Clarke C, Dunne K, Anderson V. (2017)Trajectories and Risk Factors for Posttraumatic Stress Symptoms Following Pediatric Concussion. Journal of Neurotrauma, 34(14), 2272-2279.  
  8. Davis G, Anderson V, Babl FE, Gioa GA, Giza, CC, Meehan W, Moser, RS, Purcell L, Schatz P, Schneider K, Takagi M, Yeates KO, Zemek R. (2017). What is the difference in concussion management in children as compared to adults? A systematic review. British Journal of Sports Medicine, 51(12), 949-957.   
  9. Hearps S, Takagi M, Babl F, Bressan S, Truss K, Davis G, Godfrey C, Clarke C, Doyle M, Rausa V, Dunne K, and Anderson V (2017). Validation of a score to determine time to post-concussive recovery. Pediatrics 139 (2), 1-10.  
  10. Bressan S, Takagi M*, Babl F, Davis G, Oakley E, Dunne K, Clarke C, Doyle M, Hearps S, Ignjatovic V, Seal M, Anderson V (2016). Protocol for a prospective, longitudinal, cohort study of post-concussivesymptoms in children: the Take C.A.Re (Concussion Assessment and Recovery Research) study.BMJ Open, 6, e009427. *Co-First Authors.  
  11. Takagi M, Thompson E, Anderson V (2018). Mental health considerations in the diagnosis and Treatment of children and adolescents post-concussion. In Isabelle Gagnon and Alain Ptito (Eds.) Sport Concussion: A Complete Guide to Recovery and Management.

Grant Funders

The work of this team is supported by the Royal Children’s Hospital Foundation and the National Health and Medical Research Council. 

Positions available

We are currently recruiting high quality students with a background in psychology or neuroscience who wish to undertake postgraduate research into paediatric concussion and/or intervention. Interested applicants should email: vicki.anderson@rch.org.au

Contact

Professor Vicki Anderson: Theme Director, Clinical Sciences, MCRI; Head of Psychology, RCH; Professorial Fellow, Melbourne School of Psychological Sciences and the Department of Paediatrics, University of Melbourne; NHMRC Senior Practitioner Fellow. 

Email: vicki.anderson@rch.org.au

Murdoch Children’s Research Institute, 50 Flemington Road, Parkville

Team Members

  • Professor Franz Babl: Professor of Paediatric Emergency Medicine, University of Melbourne; Paediatric Emergency Physician, RCH; Group Leader Emergency Research, MCRI; Vice-Chair, PREDICT Network; NHMRC Practitioner Fellow.    
  • Dr Michael Takagi: Research Fellow and Clinical Neuropsychologist, MCRI; Honorary Psychologist, RCH; Honorary Research Fellow, Melbourne School of Psychological Science, University of Melbourne.  
  • Vanessa Rausa: Project Coordinator and Clinical Neuropsychologist, MCRI
  • Nicholas Anderson: Project Coordinator
  • Cathriona Clarke: Project Coordinator
  • Dr Georgia Parkin: Project Coordinator
  • Fabian Fabiano: Research Assistant

PhD students: Jesse Shapiro, Alice Gornall, Sonia Singh

Masters students: Jessica Beamish, Blair Keys, Carla Wardlaw