Autoimmune encephalitis can be defined as central nervous system inflammation, secondary to multi... more Autoimmune encephalitis can be defined as central nervous system inflammation, secondary to multiple causes, where we can possibly identify the formation of auto-antibody against neurotransmitter receptors or neuronal surface proteins. Approximately 50% of patients are seropositive; the auto-antibody against N-methyl-D-aspartate receptor (NMDAR) are the most common. In the pediatric population, the clinical presentation is characterized by movement disorders and seizures, psychiatric manifestations are more commonly found in young adults. An early intervention is associated with a better prognosis in these patients. In contrast to the seropositive group, seronegative autoimmune encephalitis is linked with less movement alterations and is related with a worse cognitive outcome. Much remains to be discovered about possible etiologies, molecular processes, detection, and interaction of yet undescribed antibodies,as well as increasing our knowledge about clinical manifestations in early disease and new diagnostic techniques that could improve the diagnosis of autoimmune encephalitis. The main goal of this document is to review the updates of the molecular field about the antibody against GluK2 and its clinical presentation in pediatric population; COVID-19 as a possible cause of autoimmune encephalitis; recognize the importance of psychiatric manifestation in early disease, especially catatonia as a marker of severity; additionally consider new imaging diagnostic method such as positron emission tomography (PET), which has shown to be more sensible than MRI (goal standard).
Traumatic brain injury (TBI) as well as Attention Deficit Disorder with or without hyperactivity ... more Traumatic brain injury (TBI) as well as Attention Deficit Disorder with or without hyperactivity (ADHD) are very common problems that affect children. It is known that patients who suffer a traumatic brain injury may present symptoms of ADHD, which often go unnoticed in the acute period, especially when there are more serious injuries that hide them and are only evident when the patient returns to their regular cognitive activity after discharge. Symptoms can vary depending on the mechanism of injury, the location in the brain where the trauma or its effects occur, complications, and the severity of the injury. Some symptoms of TBI are identical to those of ADHD, making the diagnosis of these patients more difficult to discern either because the patient or their parents report them together or when the patient already had pre-existing ADHD. We describe some clinical scenarios in this article in which there is an interaction between these two processes that are explained in part beca...
The study purpose was to describe and evaluate the effectiveness of a 6-week, community-based, ad... more The study purpose was to describe and evaluate the effectiveness of a 6-week, community-based, adaptive soccer program for 18 children with autism spectrum disorder (ASD). Pre- and post-soccer skill outcomes and a parent satisfaction survey documented the intervention effectiveness. Program physical intensity was moderate since the children averaged 5546 ( SD = 2817) steps per session. Improvements in kicking accuracy ( p = 0.048) and 15-yard agility time ( p < 0.001) were observed and parents were satisfied with the program. This research supported the feasibility and effectiveness of an adaptive soccer program on improving soccer related skills and physical activity outcomes in children with ASD.
Inherited optic neuropathies (IONs) are neurodegenerative disorders characterized by optic atroph... more Inherited optic neuropathies (IONs) are neurodegenerative disorders characterized by optic atrophy with or without extra-ocular manifestations. Optic atrophy-10 (OPA10) is an autosomal recessive ION recently reported to be caused by mutations in RTN4IP1, which encodes reticulon 4 interacting protein 1 (RTN4IP1), a mitochondrial ubiquinol oxydo-reductase. Here we report novel compound heterozygous mutations in RTN4IP1 in a male proband with developmental delay, epilepsy, optic atrophy, ataxia, and choreoathetosis. Workup was notable for transiently elevated lactate and lactate-to-pyruvate ratio, brain magnetic resonance imaging with optic atrophy and T2 signal abnormalities, and a non-diagnostic initial genetic workup, including chromosomal microarray and mitochondrial panel testing. Exome sequencing identified a paternally inherited missense variant (c.263T>G, p.Val88Gly) predicted to be deleterious and a maternally inherited deletion encompassing RTN4IP1. To our knowledge, this is the first report of a non-single nucleotide pathogenic variant associated with OPA10. This case highlights the expanding phenotypic spectrum of OPA10, the association between "syndromic" cases and severe RTN4IP1 mutations, and the importance of non-biased genetic testing, such as ES, to analyze multiple genes and variants types, in patients suspected of having genetic disease.
Sleep is an active and cyclic physiological process that has a critical impact on health. Its fun... more Sleep is an active and cyclic physiological process that has a critical impact on health. Its functions are numerous: growth, development, learning, memory, synaptic efficiency, regulation of behavior, emotion, immune strengthening and cleaning time of neurotoxic substances. During the first years of life, there are a number of important changes in development, which lead to the expected pattern of sleep and wakefulness in adults. The sleep occupies a third of the adult's life. However, sleeping during the first months of life takes up more than 50% of time. This review of the topic will describe normal sleep patterns in childhood.
Pediatric epilepsy presents with various diagnostic challenges. Recent advances in neuroimaging p... more Pediatric epilepsy presents with various diagnostic challenges. Recent advances in neuroimaging play an important role in the diagnosis, management and in guiding the treatment of pediatric epilepsy. Structural neuroimaging techniques such as CT and MRI can identify underlying structural abnormalities associated with epileptic focus. Functional neuroimaging provides further information and may show abnormalities even in cases where MRI was normal, thus further helping in the localization of the epileptogenic foci and guiding the possible surgical management of intractable/refractory epilepsy when indicated. A multi-modal imaging approach helps in the diagnosis of refractory epilepsy. In this review, we will discuss various imaging techniques, as well as aspects of structural and functional neuroimaging and their application in the management of pediatric epilepsy.
Dr Alcy Torres is a pediatric neurologist who specializes in traumatic brain injury. Much of his ... more Dr Alcy Torres is a pediatric neurologist who specializes in traumatic brain injury. Much of his clinical work takes place around the Pediatric Concussion Program at Boston Medical Center; a multidisciplinary center coordinating care between the Emergency Room, the inpatient and outpatient services but also the common referrals to Physical, Vestibular, Ocular, Speech therapies and Neuropsychology services. His aim is to provide the highest level of care to children and adolescents who have sustained a brain injury by understanding the pathophysiology of the pediatric patient through research and enhancing the health and well-being of patients, minimizing distress, and preventing longer-term difficulties.In order to achieve this goal, he has developed a Standardized Clinical Assessment and Management Plans, now adopted by the Adult Concussion Clinic at Boston University to continuously review individual patient data for areas in our practice that need improvement, thus ensuring that ...
Between 2009 and 2014, all 50 states and the District of Columbia passed legislation to improve t... more Between 2009 and 2014, all 50 states and the District of Columbia passed legislation to improve the recognition and management of youth concussed in sports. These laws can include requirements for concussion training for school athletic personnel, concussion education for children and their parents, return-to-play (RTP) procedures, and medical clearance to for RTP. Concussion can impact academic learning and performance in children and adolescents. Postconcussion academic accommodations during recovery can be an important component of secondary prevention for mitigating the sequalae of head injury. Few state youth concussion laws, however, include provision of postconcussion return-to-learn (RTL) accommodations and most of those that do address RTL apply to student athletes only. Concussions may occur in youth who are not participating in organised sports (eg, falls, traffic crashes) and thus may not be subjected to RTL accommodations, even if the state mandates such procedures for ...
The Journal of school nursing : the official publication of the National Association of School Nurses, 2021
Although all states have legislation pertaining to youth sports concussion, most of these laws fo... more Although all states have legislation pertaining to youth sports concussion, most of these laws focus on return-to-play procedures; only a few address return-to-learn (RTL) accommodations for students who have experienced a concussion. To address this gap in the legislation, some states and nongovernmental organizations have developed RTL guidelines to advise school personnel, parents, and health care providers on best practices for accommodating students' postconcussion reintegration into academic activity. In 2018, the Massachusetts Department of Public Health (MDPH) developed RTL guidelines which were disseminated to school nurses (SNs) at all public and nonpublic middle and high schools in the state. In 2020, the MDPH engaged the Injury Prevention Center at Boston Medical Center to survey Massachusetts SNs to assess the usefulness of the guidelines. The response rate was 63%; 92% found the booklet extremely useful or moderately useful; and 70% endorsed that the booklet foster...
La enfermedad cerebrovascular isquémica en niños tiene una fisiopatología particular: a) embolism... more La enfermedad cerebrovascular isquémica en niños tiene una fisiopatología particular: a) embolismo desde el corazón o aorta; b) enfermedad vascular; y c) hipercoagulabilidad. Al inicio los síntomas son inespecíficos o puede haber signos neurológicos de focalidad. Un inicio agudo de signos neurológicos focales debe considerarse como de origen vascular hasta no demostrar lo contrario. El diagnóstico diferencial se realiza con otras enfermedades neurológicas que pueden presentarse con signos focales y que se llaman “imitadoras”. Presentamos nuestra guía de práctica clínica de diagnóstico y tratamiento de la enfermedad cerebrovascular isquémica en niños.
Recent Patents on Inflammation & Allergy Drug Discovery, 2021
Background:: Infectious encephalitis is a serious and challenging condition to manage. This overv... more Background:: Infectious encephalitis is a serious and challenging condition to manage. This overview summarizes the current literature regarding the etiology, clinical manifestations, diagnosis, management, and recent patents of acute childhood infectious encephalitis. Methods:: We used PubMed Clinical Queries as a search engine and used keywords of “encephalitis” AND “childhood” Patents were searched using the key term “encephalitis” in google.patents.- com and patentsonline.com. Results:: Viral encephalitis is the most common cause of acute infectious encephalitis in children. In young children, the clinical manifestations can be non-specific. Provision of empiric antimicrobial therapy until a specific infectious organism has been identified, which in most cases includes acyclovir, is the cornerstone of therapy. Advanced investigation tools, including nucleic acid-based test panel and metagenomic next-generation sequencing, improve the diagnostic yield of identifying an infectious...
Neonatal seizures are among the most dramatic manifestations of acute central nervous system dysf... more Neonatal seizures are among the most dramatic manifestations of acute central nervous system dysfunction. The incidence is much higher in very low weight neonates than in full term infants (˜ 58 and 3.5 per 100 live births, respectively). Neonatal seizures represent the clinical manifestation of a non-specific cortical cerebral dysfunction which can lead to permanent brain injury. The etiology is multifactorial and requires a judicious assessment for each clinical scenario. The diagnosis is further complicated by the fact that most neonatal seizures are subclinical, that is, may display very subtle or no clinical changes and the diagnosis may just be based on EEG findings. The treatment depends on the etiology, but an early and opportune intervention prevents further brain damage, thus improving prognosis. Although early identification and treatment are critical, the diagnosis of neonatal seizures is complicated by several factors such as different clinical presentations, possible e...
The child psychiatrist is frequently called upon to determine if psychotic-like phenomena in a ch... more The child psychiatrist is frequently called upon to determine if psychotic-like phenomena in a child or developmentally disabled individual are part of normal development or part of a more concerning disorder. While it is true that phenomena such as imaginary friends may be part of normal development, some neurodevelopmental disorders include psychotic phenomenology and must be promptly identified. Certain underlying genetic disorders carry childhood-onset psychosis as hallmark symptoms. This is the case of a young woman with two genetic conditions as well as a complex history of trauma and disrupted attachment. Her difficult psychosocial circumstances resulted in misdiagnosis of her psychotic disorder which delayed appropriate treatment.
PurposeThere is evidence of socioeconomic disparities with respect to the implementation of stude... more PurposeThere is evidence of socioeconomic disparities with respect to the implementation of student-sports concussion laws nationally. The purpose of this study was to examine school sociodemographic characteristics associated with the provision of computerised baseline neurocognitive testing (BNT) in Massachusetts (MA) high schools, and to assess whether the scope of testing is associated with the economic status of student populations in MA.MethodsA cross-sectional secondary analysis of surveys conducted with MA athletic directors (n=270) was employed to investigate school characteristics associated with the provision of BNT. Correlation and regression analyses were used to assess whether the scope of testing is associated with the economic status of student populations in MA.ResultsThe scope of BNT was independently associated with the economic disadvantage rate (EDR) of the student population (β=−0.02, p=0.01); whether or not the school employs an athletic trainer (AT) (β=0.43, ...
Background In 2011 the Massachusetts Department of Public Health issued regulations pursuant to 2... more Background In 2011 the Massachusetts Department of Public Health issued regulations pursuant to 2010 Massachusetts youth sports concussion legislation that provided policies and procedures for persons engaged in the prevention, training, management, and return-to-activity for students who sustain head injury during interscholastic athletics, including Athletic Directors (ADs). Methods A survey instrument was developed with participation from injury prevention experts at the Boston University School of Medicine, the Massachusetts Department of Public Health, and ADs. An electronic survey was sent to all AD members of the Massachusetts Interscholastic Athletic Association to assess their perceptions of implementation of the sports concussion law. Results Response rate was 75% (260/346). The mean rating on a 0–10 scale (10 being “very important”) on importance of the law for student safety was 9.24, and the mean rating of the law’s impact on workload was 5.54. Perceived impact on workl...
Traumatic brain injury (TBI) is common in children. The evaluation and management of children wit... more Traumatic brain injury (TBI) is common in children. The evaluation and management of children with TBI is based on the research performed in adults. There is a relative paucity of research in the literature involving children and many of the practice recommendations for this age are based on expert opinion in the absence of good research studies in both sports and non–sports-related injuries. The pediatric population is heterogeneous and the approach might be specific for infants, preschoolers, school age children, and adolescents. Children may also suffer from neurodevelopmental disabilities, making their evaluation even more challenging. Adult neurologists are often asked to see children due to increasing demands. This review will focus on specific issues related to TBI in children that might be useful to adult neurologists. Science, however, is evolving rapidly and physicians should make sure to remain up to date to offer evidence-based services to their patients.
Autoimmune encephalitis can be defined as central nervous system inflammation, secondary to multi... more Autoimmune encephalitis can be defined as central nervous system inflammation, secondary to multiple causes, where we can possibly identify the formation of auto-antibody against neurotransmitter receptors or neuronal surface proteins. Approximately 50% of patients are seropositive; the auto-antibody against N-methyl-D-aspartate receptor (NMDAR) are the most common. In the pediatric population, the clinical presentation is characterized by movement disorders and seizures, psychiatric manifestations are more commonly found in young adults. An early intervention is associated with a better prognosis in these patients. In contrast to the seropositive group, seronegative autoimmune encephalitis is linked with less movement alterations and is related with a worse cognitive outcome. Much remains to be discovered about possible etiologies, molecular processes, detection, and interaction of yet undescribed antibodies,as well as increasing our knowledge about clinical manifestations in early disease and new diagnostic techniques that could improve the diagnosis of autoimmune encephalitis. The main goal of this document is to review the updates of the molecular field about the antibody against GluK2 and its clinical presentation in pediatric population; COVID-19 as a possible cause of autoimmune encephalitis; recognize the importance of psychiatric manifestation in early disease, especially catatonia as a marker of severity; additionally consider new imaging diagnostic method such as positron emission tomography (PET), which has shown to be more sensible than MRI (goal standard).
Traumatic brain injury (TBI) as well as Attention Deficit Disorder with or without hyperactivity ... more Traumatic brain injury (TBI) as well as Attention Deficit Disorder with or without hyperactivity (ADHD) are very common problems that affect children. It is known that patients who suffer a traumatic brain injury may present symptoms of ADHD, which often go unnoticed in the acute period, especially when there are more serious injuries that hide them and are only evident when the patient returns to their regular cognitive activity after discharge. Symptoms can vary depending on the mechanism of injury, the location in the brain where the trauma or its effects occur, complications, and the severity of the injury. Some symptoms of TBI are identical to those of ADHD, making the diagnosis of these patients more difficult to discern either because the patient or their parents report them together or when the patient already had pre-existing ADHD. We describe some clinical scenarios in this article in which there is an interaction between these two processes that are explained in part beca...
The study purpose was to describe and evaluate the effectiveness of a 6-week, community-based, ad... more The study purpose was to describe and evaluate the effectiveness of a 6-week, community-based, adaptive soccer program for 18 children with autism spectrum disorder (ASD). Pre- and post-soccer skill outcomes and a parent satisfaction survey documented the intervention effectiveness. Program physical intensity was moderate since the children averaged 5546 ( SD = 2817) steps per session. Improvements in kicking accuracy ( p = 0.048) and 15-yard agility time ( p < 0.001) were observed and parents were satisfied with the program. This research supported the feasibility and effectiveness of an adaptive soccer program on improving soccer related skills and physical activity outcomes in children with ASD.
Inherited optic neuropathies (IONs) are neurodegenerative disorders characterized by optic atroph... more Inherited optic neuropathies (IONs) are neurodegenerative disorders characterized by optic atrophy with or without extra-ocular manifestations. Optic atrophy-10 (OPA10) is an autosomal recessive ION recently reported to be caused by mutations in RTN4IP1, which encodes reticulon 4 interacting protein 1 (RTN4IP1), a mitochondrial ubiquinol oxydo-reductase. Here we report novel compound heterozygous mutations in RTN4IP1 in a male proband with developmental delay, epilepsy, optic atrophy, ataxia, and choreoathetosis. Workup was notable for transiently elevated lactate and lactate-to-pyruvate ratio, brain magnetic resonance imaging with optic atrophy and T2 signal abnormalities, and a non-diagnostic initial genetic workup, including chromosomal microarray and mitochondrial panel testing. Exome sequencing identified a paternally inherited missense variant (c.263T>G, p.Val88Gly) predicted to be deleterious and a maternally inherited deletion encompassing RTN4IP1. To our knowledge, this is the first report of a non-single nucleotide pathogenic variant associated with OPA10. This case highlights the expanding phenotypic spectrum of OPA10, the association between "syndromic" cases and severe RTN4IP1 mutations, and the importance of non-biased genetic testing, such as ES, to analyze multiple genes and variants types, in patients suspected of having genetic disease.
Sleep is an active and cyclic physiological process that has a critical impact on health. Its fun... more Sleep is an active and cyclic physiological process that has a critical impact on health. Its functions are numerous: growth, development, learning, memory, synaptic efficiency, regulation of behavior, emotion, immune strengthening and cleaning time of neurotoxic substances. During the first years of life, there are a number of important changes in development, which lead to the expected pattern of sleep and wakefulness in adults. The sleep occupies a third of the adult's life. However, sleeping during the first months of life takes up more than 50% of time. This review of the topic will describe normal sleep patterns in childhood.
Pediatric epilepsy presents with various diagnostic challenges. Recent advances in neuroimaging p... more Pediatric epilepsy presents with various diagnostic challenges. Recent advances in neuroimaging play an important role in the diagnosis, management and in guiding the treatment of pediatric epilepsy. Structural neuroimaging techniques such as CT and MRI can identify underlying structural abnormalities associated with epileptic focus. Functional neuroimaging provides further information and may show abnormalities even in cases where MRI was normal, thus further helping in the localization of the epileptogenic foci and guiding the possible surgical management of intractable/refractory epilepsy when indicated. A multi-modal imaging approach helps in the diagnosis of refractory epilepsy. In this review, we will discuss various imaging techniques, as well as aspects of structural and functional neuroimaging and their application in the management of pediatric epilepsy.
Dr Alcy Torres is a pediatric neurologist who specializes in traumatic brain injury. Much of his ... more Dr Alcy Torres is a pediatric neurologist who specializes in traumatic brain injury. Much of his clinical work takes place around the Pediatric Concussion Program at Boston Medical Center; a multidisciplinary center coordinating care between the Emergency Room, the inpatient and outpatient services but also the common referrals to Physical, Vestibular, Ocular, Speech therapies and Neuropsychology services. His aim is to provide the highest level of care to children and adolescents who have sustained a brain injury by understanding the pathophysiology of the pediatric patient through research and enhancing the health and well-being of patients, minimizing distress, and preventing longer-term difficulties.In order to achieve this goal, he has developed a Standardized Clinical Assessment and Management Plans, now adopted by the Adult Concussion Clinic at Boston University to continuously review individual patient data for areas in our practice that need improvement, thus ensuring that ...
Between 2009 and 2014, all 50 states and the District of Columbia passed legislation to improve t... more Between 2009 and 2014, all 50 states and the District of Columbia passed legislation to improve the recognition and management of youth concussed in sports. These laws can include requirements for concussion training for school athletic personnel, concussion education for children and their parents, return-to-play (RTP) procedures, and medical clearance to for RTP. Concussion can impact academic learning and performance in children and adolescents. Postconcussion academic accommodations during recovery can be an important component of secondary prevention for mitigating the sequalae of head injury. Few state youth concussion laws, however, include provision of postconcussion return-to-learn (RTL) accommodations and most of those that do address RTL apply to student athletes only. Concussions may occur in youth who are not participating in organised sports (eg, falls, traffic crashes) and thus may not be subjected to RTL accommodations, even if the state mandates such procedures for ...
The Journal of school nursing : the official publication of the National Association of School Nurses, 2021
Although all states have legislation pertaining to youth sports concussion, most of these laws fo... more Although all states have legislation pertaining to youth sports concussion, most of these laws focus on return-to-play procedures; only a few address return-to-learn (RTL) accommodations for students who have experienced a concussion. To address this gap in the legislation, some states and nongovernmental organizations have developed RTL guidelines to advise school personnel, parents, and health care providers on best practices for accommodating students' postconcussion reintegration into academic activity. In 2018, the Massachusetts Department of Public Health (MDPH) developed RTL guidelines which were disseminated to school nurses (SNs) at all public and nonpublic middle and high schools in the state. In 2020, the MDPH engaged the Injury Prevention Center at Boston Medical Center to survey Massachusetts SNs to assess the usefulness of the guidelines. The response rate was 63%; 92% found the booklet extremely useful or moderately useful; and 70% endorsed that the booklet foster...
La enfermedad cerebrovascular isquémica en niños tiene una fisiopatología particular: a) embolism... more La enfermedad cerebrovascular isquémica en niños tiene una fisiopatología particular: a) embolismo desde el corazón o aorta; b) enfermedad vascular; y c) hipercoagulabilidad. Al inicio los síntomas son inespecíficos o puede haber signos neurológicos de focalidad. Un inicio agudo de signos neurológicos focales debe considerarse como de origen vascular hasta no demostrar lo contrario. El diagnóstico diferencial se realiza con otras enfermedades neurológicas que pueden presentarse con signos focales y que se llaman “imitadoras”. Presentamos nuestra guía de práctica clínica de diagnóstico y tratamiento de la enfermedad cerebrovascular isquémica en niños.
Recent Patents on Inflammation & Allergy Drug Discovery, 2021
Background:: Infectious encephalitis is a serious and challenging condition to manage. This overv... more Background:: Infectious encephalitis is a serious and challenging condition to manage. This overview summarizes the current literature regarding the etiology, clinical manifestations, diagnosis, management, and recent patents of acute childhood infectious encephalitis. Methods:: We used PubMed Clinical Queries as a search engine and used keywords of “encephalitis” AND “childhood” Patents were searched using the key term “encephalitis” in google.patents.- com and patentsonline.com. Results:: Viral encephalitis is the most common cause of acute infectious encephalitis in children. In young children, the clinical manifestations can be non-specific. Provision of empiric antimicrobial therapy until a specific infectious organism has been identified, which in most cases includes acyclovir, is the cornerstone of therapy. Advanced investigation tools, including nucleic acid-based test panel and metagenomic next-generation sequencing, improve the diagnostic yield of identifying an infectious...
Neonatal seizures are among the most dramatic manifestations of acute central nervous system dysf... more Neonatal seizures are among the most dramatic manifestations of acute central nervous system dysfunction. The incidence is much higher in very low weight neonates than in full term infants (˜ 58 and 3.5 per 100 live births, respectively). Neonatal seizures represent the clinical manifestation of a non-specific cortical cerebral dysfunction which can lead to permanent brain injury. The etiology is multifactorial and requires a judicious assessment for each clinical scenario. The diagnosis is further complicated by the fact that most neonatal seizures are subclinical, that is, may display very subtle or no clinical changes and the diagnosis may just be based on EEG findings. The treatment depends on the etiology, but an early and opportune intervention prevents further brain damage, thus improving prognosis. Although early identification and treatment are critical, the diagnosis of neonatal seizures is complicated by several factors such as different clinical presentations, possible e...
The child psychiatrist is frequently called upon to determine if psychotic-like phenomena in a ch... more The child psychiatrist is frequently called upon to determine if psychotic-like phenomena in a child or developmentally disabled individual are part of normal development or part of a more concerning disorder. While it is true that phenomena such as imaginary friends may be part of normal development, some neurodevelopmental disorders include psychotic phenomenology and must be promptly identified. Certain underlying genetic disorders carry childhood-onset psychosis as hallmark symptoms. This is the case of a young woman with two genetic conditions as well as a complex history of trauma and disrupted attachment. Her difficult psychosocial circumstances resulted in misdiagnosis of her psychotic disorder which delayed appropriate treatment.
PurposeThere is evidence of socioeconomic disparities with respect to the implementation of stude... more PurposeThere is evidence of socioeconomic disparities with respect to the implementation of student-sports concussion laws nationally. The purpose of this study was to examine school sociodemographic characteristics associated with the provision of computerised baseline neurocognitive testing (BNT) in Massachusetts (MA) high schools, and to assess whether the scope of testing is associated with the economic status of student populations in MA.MethodsA cross-sectional secondary analysis of surveys conducted with MA athletic directors (n=270) was employed to investigate school characteristics associated with the provision of BNT. Correlation and regression analyses were used to assess whether the scope of testing is associated with the economic status of student populations in MA.ResultsThe scope of BNT was independently associated with the economic disadvantage rate (EDR) of the student population (β=−0.02, p=0.01); whether or not the school employs an athletic trainer (AT) (β=0.43, ...
Background In 2011 the Massachusetts Department of Public Health issued regulations pursuant to 2... more Background In 2011 the Massachusetts Department of Public Health issued regulations pursuant to 2010 Massachusetts youth sports concussion legislation that provided policies and procedures for persons engaged in the prevention, training, management, and return-to-activity for students who sustain head injury during interscholastic athletics, including Athletic Directors (ADs). Methods A survey instrument was developed with participation from injury prevention experts at the Boston University School of Medicine, the Massachusetts Department of Public Health, and ADs. An electronic survey was sent to all AD members of the Massachusetts Interscholastic Athletic Association to assess their perceptions of implementation of the sports concussion law. Results Response rate was 75% (260/346). The mean rating on a 0–10 scale (10 being “very important”) on importance of the law for student safety was 9.24, and the mean rating of the law’s impact on workload was 5.54. Perceived impact on workl...
Traumatic brain injury (TBI) is common in children. The evaluation and management of children wit... more Traumatic brain injury (TBI) is common in children. The evaluation and management of children with TBI is based on the research performed in adults. There is a relative paucity of research in the literature involving children and many of the practice recommendations for this age are based on expert opinion in the absence of good research studies in both sports and non–sports-related injuries. The pediatric population is heterogeneous and the approach might be specific for infants, preschoolers, school age children, and adolescents. Children may also suffer from neurodevelopmental disabilities, making their evaluation even more challenging. Adult neurologists are often asked to see children due to increasing demands. This review will focus on specific issues related to TBI in children that might be useful to adult neurologists. Science, however, is evolving rapidly and physicians should make sure to remain up to date to offer evidence-based services to their patients.
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