Improved Care and Prevention Improving childhood concussion care

Roger Zemek, Children’s Hospital of Eastern Ontario
Roger Zemek, Children’s Hospital of Eastern Ontario

Pediatric Concussion Assessment of Rest and Exertion (PedCARE); a Randomized Controlled Trial


  • Concussion is an injury to the brain from a blow or shaking of the head. Concussion rates in children have quadrupled since 2003, representing approximately 30,000 doctor visits/year in Ontario. Research has shown that children are at higher risk of sustaining a concussion than adults and take longer to recover.
  • Physical symptoms (headache, nausea, dizziness), memory and concentration problems, and emotional/behaviour changes are common after a concussion. Disturbingly, one-third of children who sustain a concussion experience these symptoms for months, and some even for years. When symptoms last at least one month, it is known as Persistent post-Concussion Symptoms (PCS). PCS has tremendous negative effects on quality of life and can affect school attendance and performance, and reduce social contact with friends and peers due to removal from sports and recreational activities. In teens, Persistent post-Concussion Symptoms may increase the risk for drug and alcohol abuse, the risk for long-term mental health problems and suicide.
  • In the hope of preventing this condition, current concussion management calls for both physical and mental rest. However, recent research suggests that too much rest may delay the brain’s recovery. Restarting physical activity early has proven physical and mental benefits in many other conditions such as stroke (a severe brain injury). Although this may also be true for concussion, it has not yet been studied.


  • Research is urgently needed to determine the ideal balance of physical rest and exertion. This project will examine whether restarting exercise (beginning with a walking program) at three days following a concussion is associated with better recovery compared to current protocols. It is believed that earlier physical activity in children after concussion may reduce the risk of PCS, result in better quality of life, and a successful return to school and sports performance.