Cervical Spine Dysfunction and Concussion: Exploring Assessment Methods, Prevalence, and Screening Protocols in Children with Persistent Post Concussion Symptoms

Although there have been studies that suggest a link between cervical spine injury and persistent post concussion symptoms in adults, the role of the cervical spine has not been thoroughly investigated in children suffering from persistent post concussion symptoms. The force required to the head or body, that can cause a concussion, can also cause a whiplash like injury due to the mechanism of injury. The head will move due to the external force, causing a concussion, and potentially causing injury to the cervical spine at the same time. The first study uses a systematic review to determine the psychometric properties of patient reported outcome measures for cervical spine dysfunction. This review found that no patient reported outcome measure was psychometrically sound in assessing cervical spine dysfunction in children with persistent post concussion symptoms. The second study used the Neck Disability Index to explore the prevalence of cervical spine dysfunction in children with symptoms post concussion; the majority of children reported mild to moderate dysfunction in their neck. The third study surveyed Ontario primary care physicians to explore if they screen for cervical spine dysfunction in children with concussion. The results from this study showed the majority did not screen for cervical spine dysfunction in children with concussion symptoms. Taken together, this doctoral work identified the need for further investigation into the assessment and management of the cervical spine in children with persistent post concussion symptoms. This thesis provides a foundation for further studies of cervical spine assessment and management in children with persistent post concussion symptoms.Ph.D