Young Pediatric Buffalo Concussion Exam Identified Physiological Dysfunction in an Adolescent after Repetitive Concussions

Wednesday, November 9, 2022

9:45 AM – 9:50 AM

Location: Station 8

Presenting Author(s)

Ghazala T. Saleem, EdD, OTR/L (she/her/hers)

Assistant Professor
State University of New York at Buffalo
BUFFALO, New York, United States

Non-presenting author(s)

Jacob R. Braun

Student Researcher
Jacobs School of Medicine and Biomedical Sciences
Buffalo, New York, United States

Non-presenting Author(s)

Mohammad N. Haider, MD, PhD

Research Assistant Professor
Department of Orthopedics, State University of New York at Buffalo, Buffalo
Buffalo, New York, United States
John J. Leddy, MD, FACSM, FACP, FAMSSM (he/him/his)

Professor of Rehabilitation Sciences
Department of Orthopaedics, Jacobs School of Medicine & Biomedical Sciences
BUFFALO, New York, United States
Barry S. Willer, PhD

Professor Psychiatry
Department of Psychiatry, Jacobs School of Medicine & Biomedical Sciences
Buffalo, New York, United States
OF

Osman Farooq

Clinical Associate Professor
Department of Neurology, Jacobs School of Medicine & Biomedical Sciences, United States

Research Objectives: To describe the utility of a brief pediatric physical exam, the Young Pediatric Buffalo Concussion Physical Exam (YPBCPE), in an adolescent after hockey-related concussions.

Design: Case Report

Setting: Academically-affiliated research laboratory

Participants: A 16–year old male with a history of two concussions sustained within the past 12 months while playing hockey at the school/travel level was examined 10-weeks post-injury. One 15-minute, in-person visit was completed.

Interventions: Not applicable

Main Outcome Measures: The Post-Concussion Symptom Scale (PCSS) was used to examine the perceived severity (0 being no symptoms and 6 being the highest severity) of concussion-related symptoms. The YPBCPE was used to identify the presence of persistent post-concussive signs and symptoms (PPCS).

Results: The patient reported no (0) balance symptoms and mild (2) visual problems on the PCSS. On the YPBCPE, the patient experienced lightheadedness when standing up from a supine position during the 2-minute supine to 1-minute stand test. Optic nerve exam revealed a reduction in visual fields. Dizziness and sustained nystagmus were observed when horizontal smooth pursuits were tested. Testing near point convergence revealed a prolonged break and recovery at 9 cm and 16 cm, respectively. The patient maintained his balance for < 10 seconds during the single-leg (eyes closed) stance.

Conclusions: While self-report questionnaires provide meaningful information regarding symptoms, field-expedient physical exams help to more objectively establish ongoing physiological dysfunction in youth with PPCS, which may guide treatment. Resolution of abnormal findings also assists in more reliably clearing youth to return to activities. Currently, no markers exist to quantify PPCS in children. The YPBCPE could be valuable in identifying therapies to aid youth with PPCS who report few symptoms on self-report measures.

Author(s) Disclosures: The authors declare no conflict of interest.

Learning Objectives:

Demonstrate an understanding for the value of examining PPCS in pediatric concussion patients.
Explain the current best option to evaluate PPCS in pediatric concussion patients.
Recognize the clinical and research usefulness of precise evaluation of pediatric concussion patients, including the utility of YPBCPE.