Tag Archive for: Gerard Gioia

boy being assessed for concussion

Concussion treatments for children need more priority

boy being assessed for concussion

Concussion treatments for children have continued to evolve but ultimately, need more priority.

The Sport Concussion Assessment Tool (SCAT) tools are used worldwide for children, adolescents and adults to assist in the evaluation and management of sport-related concussions (SRC). The SCAT tools have evolved over time based on clinical findings, clinician input, scientific investigations and systematic reviews of the literature, as recently noted in a paper published by the British Journal of Sports Medicine. It is critically important to identify and diagnose a concussion as early as possible and track its recovery with reliable and valid tools across the full age span from young child to adult.

This systematic review occurs only every four years to summarize the current literature on concussions. A team of leading researchers including Gerard Gioia, Ph.D., director of Safe Concussion Outcome, Recovery and Education (SCORE) Program at Children’s National Hospital and co-author of the paper, found that the SCAT measure has been used mostly with adult and adolescent SRCs but not with children ages 5-12 years.

The tools are helpful to diagnose and track recovery in children, adolescents and adults only up to three days post-injury.  Their lack of sensitivity after this time resulted in the recommendation for a new complementary tool, the Sport Concussion Office Assessment Tool (SCOAT), which Dr. Gioia assisted in developing. One of the SCOAT measures – known as SCOAT6 – is the PACE-Self Efficacy Scale, developed by Dr. Gioia, Christopher Vaughan, Psy.D., neuropsychologist, and other colleagues at Children’s National. This measure assesses and tracks the confidence of children and adolescents in managing their recovery, an important component that underlies successful recovery.

We spoke more with Dr. Gioia about the recent advancements in concussion recommendations.

Q: What’s been the hold-up in the field with respect to children and adolescents?

A: A specific hold-up is that the venues where a sport-related concussion can occur do not have the athletic health professionals or researchers available to identify the injuries early or conduct specific research on their manifestations. Pre-adolescent children are typically seen in emergency rooms or their primary care physicians’ offices and are, therefore, not available to be studied and monitored. The venues for older athletes include high schools, colleges and professional sports stadiums with designated athletic health professionals. We need to find better ways to identify pre-adolescent athletes to understand their diagnostic and recovery needs.

Q: Why is it important to update the literature?

A: The periodic work of the Concussion in Sport Group helps to provide an updated understanding of the injury and improve the tools used to diagnose and treat SRC early in the process and to develop the necessary tools beyond this initial period. Its results have made recommendations for improvement given that some measures are not as sensitive to the injury and need to be modified. For example, tools that need further study and revision include the balance exam, word-list learning and memory measures. It calls for improvements in these assessment tools, which will better define and diagnose the injury.

Q: How will this work benefit patients?

A: Improved sensitivity of the acute measure and a new follow-up assessment measure will result in improved treatment recommendations for patients. Recognition of the dearth of data on SRC in children ages 5-12 will hopefully stimulate efforts to generate this research. The team at Children’s National plans to address this need through our research.

Q: What are some of the new updates that excite you about the future of concussion care?

A: Being able to define the current state of the literature and identify the needs, particularly with children, is exciting. It also stimulates our work at Children’s National to continue to improve our understanding and clinical care of children and adolescents with sport-related concussions.

I have been an active member of the Concussion in Sport Group since 2008 as one of the few pediatric concussion specialists involved for this long. We continue to lead in our clinical research that builds better measures and tools to identify, diagnose and treat these injuries in children.

doctor looking at brain MRIs

NINDS awards $10 million for pediatric concussion research

doctor looking at brain MRIs

Researchers will use advanced brain imaging and blood tests to explore biological markers—changes in blood pressure, heart rate and pupil reactivity—that could predict which children will develop persistent symptoms after concussion.

The National Institute of Neurological Disorders and Stroke has awarded a $10-million grant to the Four Corners Youth Consortium, a group of academic medical centers studying concussions in school-aged children. Led in part by the Safe Concussion Outcome Recovery and Education (SCORE) program at Children’s National Hospital, the project is named Concussion Assessment, Research and Education for Kids, or CARE4Kids.

Researchers will use advanced brain imaging and blood tests to explore biological markers—changes in blood pressure, heart rate and pupil reactivity—that could predict which children will develop persistent symptoms after concussion. The five-year CARE4Kids study will enroll more than 1,300 children ages 11-18 nationwide.

The five-year study will be led by Gerard Gioia, Ph.D., division chief of Neuropsychology at Children’s National Hospital, Frederick Rivara, M.D., M.P.H., at Seattle Children’s Center for Child Health, Behavior and Development and University of Washington’s Medicine’s Department of Pediatrics, and Dr. Chris Giza at University of California, Los Angeles (UCLA).

“We will be gathering innovative data to help answer the critical question asked by every patient: ‘When can I expect to recover from this concussion?’” said Dr. Gioia. “We have a great team and are excited to have been selected to study this important issue.”

Christopher G. Vaughan, Psy.D., neuropsychologist, and Raquel Langdon, M.D., neurologist, both at Children’s National, will join Dr. Gioia as principal investigators of the study at this site.

Every year, more than 3 million Americans are diagnosed with concussions. Symptoms continue to plague 30 percent of patients three months after injury—adolescents face an even higher risk of delayed recovery. Chronic migraine headaches, learning and memory problems, exercise intolerance, sleep disturbances, anxiety and depressed mood are common.

“Providing individualized symptom-specific treatments for youth with a concussion has been a longstanding aim of the SCORE program,”Dr. Vaughan said. “This project will lead to a better understanding of the specific markers for which children may have a longer recovery. With this knowledge, we can start individualized treatments earlier in the process and ultimately help to reduce the number of children who experienced prolonged effects after concussion.”

The grant was announced on September 9, 2021.

In Washington, D.C., an estimated 240 children ages 11 to 18, will participate in the study.

The study will unfold in two phases. The first part will evaluate children with concussion to identify a set of biomarkers predictive of persistent post-concussion symptoms. To validate the findings, the next stage will confirm that these biomarkers accurately predict prolonged symptoms in a second group of children who have been diagnosed with concussion. The goal is to develop a practical algorithm for use in general clinical practice for doctors and other health professionals caring for pediatric patients.

Institutions currently recruiting patients for the study include Children’s National Hospital, UCLA Mattel Children’s Hospital, Seattle Children’s, the University of Washington, University of Rochester, University of Texas Southwestern Medical Center and Wake Forest School of Medicine. Indiana University, the National Institute of Nursing Research, University of Arkansas, University of Southern California and the data coordinating center at the University of Utah are also involved in the project.

Earlier research conducted by the Four Corners Youth Consortium that led to this project was funded by private donations from Stan and Patti Silver, the UCLA Steve Tisch BrainSPORT Program and the UCLA Easton Clinic for Brain Health; Children’s National Research Institute; as well as from the Satterberg Foundation to Seattle Children’s Research Institute; and an investment from the Sports Institute at UW Medicine.

doctor showing girl with concussion three fingers

Post-traumatic headache phenotype and recovery time after concussion

doctor showing girl with concussion three fingers

In a recent study published by JAMA Network Open, Gerard Gioia, Ph.D., division chief of Neuropsychology and director of Safe Concussion Outcome, Recovery and Education (SCORE) Program at Children’s National Hospital, along with other leading researchers, described the characteristics of youth with post-traumatic headache (PTH) and determine whether the PTH phenotype is associated with outcome.

Concussions and mild traumatic brain injuries (mTBI) are common among children and adolescents and constitute a major public health challenge. While symptoms from a concussion typically resolve days to weeks after injury, 10% to 30% of patients have symptoms that last longer than four weeks, and a smaller proportion have symptoms that persist for much longer.

PTH is defined as significantly worsened head pain attributed to a blow or force to the head. Although adolescents have a higher risk for sustaining concussions and developing persistent symptoms than younger children or adults, there is little data regarding PTH recovery and treatment in youth.

Dr. Gioia founded the multicenter Four Corners Youth Consortium to fill the gap in our understanding of youth concussion and recovery. This study is the first analysis of PTH phenotype and prognosis in this cohort of concussed youth.

The researchers analyzed headache-related symptoms from a validated questionnaire developed by Dr. Gioia and his Children’s National concussion research team. The primary outcomes were time to recovery and concussion-attributable headache three months after injury while the secondary outcome was headache six months after injury. Recovery was defined as resolution of symptoms related to a concussion.

Future large studies validating the classification of posttraumatic headache phenotypes in youth and studying outcomes are essential. PTH phenotyping will improve prognostication of concussion recovery and will enhance the treatment for PTH with more appropriate and targeted therapies to treat and prevent persistent and disabling headaches in youth with a concussion.