Holland Bloorview Concussion Centre


Our team has been investigating a multimodal approach for the assessment of concussion in youth and exploring potential objective measures that are novel to pediatric concussion. We have explored symptom report, postural stability, strength, and neurocognitive testing as a testing battery to assess and manage concussion in youth. Further, we are investigating the role of heart rate variability and brain activation as potential objective measures.

Gaps exist in the literature on youth athletes when it comes to grip strength and postural stability. We collected normative data to provide a foundation for post-concussion comparisons. Normative grip strength values (N=695) were generated specific to youth ice hockey players. Regression analyses revealed significantly higher strength with age, higher BMI, males after age 12, and significantly lower strength with self-reports of headache, fatigue and difficulty concentrating. Further, normative postural stability values in children and youth athletes (N=889) were created. Performance significantly increased with age and females under 12, while performance significantly decreased with more self-reported symptoms.

In addition, we explored the test-retest reliability of Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) in the context of our clinical use. Youth athletes (N=58) completed two baseline assessments within variable time intervals (0-24 months). Visual speed and reaction time showed stability between 0-6 and 6-12 months but verbal and visual memory did not reach adequate levels across all time intervals. Grip strength, postural stability, ImPACT and standing long jump were used in a prospective longitudinal case-control design to examine the sensitivity and specificity of a multimodal approach. Youth athletes (N=945) completed baseline assessments, 42 were retested post-concussion along with 42 matched control participants. Combining postural stability and grip strength assessments (while symptomatic) and standing long jump and grip strength (once symptoms resolved) showed the greatest combined sensitivity and specificity.

Heart rate variability (HRV) has emerged as a potential objective measure to provide neurophysiological information across the recovery trajectory. We explored the effect of concussion and symptom report on HRV post-injury in youth athletes. Youth athletes (N=945) completed baseline assessments including a 24-hour heart rate recording, 29 were re-tested post-concussion along with 15 matched control participants. Results indicate increases in HRV across the recovery trajectory, uniquely different from changes in symptoms. Further, we studied changes in HRV in relation to an 8-week intervention (mindfulness-based yoga) addressing persistent concussion symptoms in youth (N=6). Trends towards increasing HRV, increasing self-efficacy, and decreasing symptoms were found following the intervention and maintained after 3 months.

Further, the use of functional connectivity between brain regions has shown potential as an objective measure of injury. We are studying executive function connectivity patterns using a functional near-infrared spectroscopy system, during single (Stroop, postural stability) and dual tasks in healthy youth (N=13) in order to create a comparison for youth post-concussion. Inter- and intra-hemispheric connectivity values are altered in specific brain regions during different cognitive or physically demanding tasks. Functional connectivity during dual-task was not significantly different from rest. By establishing connectivity patterns in healthy youth, a framework for assessing youth who have sustained a concussion may be valuable.

The Concussion Centre at Holland Bloorview Kids Rehabilitation Hospital strives to explore new approaches to assessment, intervention and education for children, youth and families impacted by concussion. Our goal is to help children and youth get back to the things they need, want and love to do.

Also see:- "Maas AIR, Menon DK, Adelson PD, Andelic N, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research, In The Lancet Neurology, 2017 Dec;16(12):987-1048. doi: 10.1016/S1474-4422(17)30371-X. Epub 2017 Nov 6."


All the information provided on this website is provided on an “as is” and “as available” basis and you agree that you use such information entirely at your own risk. [Read More] 

Contact Details

Email: hello@ipbis.org
Website: www.ipbis.org