# Active Injury Management (AIM) after Pediatric Concussion

> **NIH ALLCDC U01** · MEDICAL COLLEGE OF WISCONSIN · 2021 · $549,992

## Abstract

PROJECT SUMMARY
Concussion impacts nearly 2 million children each year. Up to 30% of these patients will experience symptoms
lasting weeks to months after injury. Current practice recommends strict rest for 24-48 hours post-concussion
followed by a symptom-guided return to activity. Emerging evidence shows prolonged rest may be harmful by
contributing to deconditioning, impeding the brain's nascent ability to heal, and/or setting up psychological
barriers to recovery. We recently published results from a randomized controlled trial (RCT) of strict rest following
acute concussion and found patients who were prescribed prolonged rest experienced greater symptoms and
slower recovery. We also found that this negative effect was more pronounced if patients presented with post-
concussive symptoms-only in the absence of more severe signs of injury. Exercise has been reported to aid brain
recovery and improve symptoms in patients with prolonged recovery. Evidence also shows that early activity in
patients is associated with lower rates of persistent post-concussive symptoms at 30 days. The objective of this
proposal is to determine the benefit of prescribed low-intensity physical activity, behavioral management, or both,
versus standard rest in acute concussion patients presenting to the Emergency Department (ED). We propose an
exploratory phase II clinical trial with four treatment groups to determine the impact of an active injury
management strategy and a parallel quality improvement (QI) initiative. This study aims to 1) determine the ideal
discharge recommendations related to activity and behavioral management, and 2) develop and implement
evidence-based decision support for concussion diagnosis, serial symptom assessment, and return to learn
instructions. For the clinical trial, a total of 388 patients age 11-18 y/o presenting to the ED within 48 hours of a
concussion will be recruited from two sites over three years to participate in a RCT of concussion management.
Consented patients will be randomized to one of four treatment groups: 1) REST- prescribed rest for 24-48 hr with
return to school and light physical and cognitive activity as soon as tolerated; 2) ACTIVITY-prescribed activity
“10,000 steps per day by the first week post injury”. 3) mHEALTH APP- use of a free “resilience” app. 4)
ACTIVITY + mHEALTH app. The primary outcomes will be symptoms and recovery at 14 days. The secondary
outcomes will include activity levels (via actigraph), daily symptoms (via app), symptoms at 3 days (via phone),
neurocognitive, vestibular/ocular motor, and balance impairment at 14 day (at follow-up), and pediatric quality of
life measures, time to symptom resolution and return to normal activity at 1 and 2 months (via phone). We will
conduct a QI initiative to improve the effectiveness and patient-centeredness of the care of patients in the ED with
concussion by: 1) improving the quality of ED assessments; 2) improving the discharge process; 3) ensuring
appr...

## Key facts

- **NIH application ID:** 10220814
- **Project number:** 5U01CE002944-04
- **Recipient organization:** MEDICAL COLLEGE OF WISCONSIN
- **Principal Investigator:** Anthony P Kontos
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2021
- **Award amount:** $549,992
- **Award type:** 5
- **Project period:** 2018-09-30 → 2022-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10220814

## Citation

> US National Institutes of Health, RePORTER application 10220814, Active Injury Management (AIM) after Pediatric Concussion (5U01CE002944-04). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10220814. Licensed CC0.

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