This ambitious and slender volume brings together many of the issues relevant to the field of concussion management for children and adolescents with contributing chapters from a wide range of fields from neurology to athletic training and sports medicine. The wide range of perspectives allows for the book to be used by students and clinicians alike with each chapter as a stand-alone. As the field of pediatric concussion evaluation and management has grown rapidly in recent years, this text fills a void for students looking for a resource that presents the major issues, controversies and models of evaluation, and treatment of pediatric concussion. For the practicing neuropsychologist new to concussion management, this text will be a useful reference as the reviews presented within each of the chapters are timely with each chapter ending with bulleted key points, making it an easy to reference text, even if one does not read each chapter in its entirety. The book is divided into three parts, focusing on the definitions and causes of concussion (Part I), the assessment and treatment of concussion (Part II), and a variety of issues are presented in Part III that do not fit neatly into the first two parts of the text. The editor's use of the term treatment is an interesting choice, as most of the chapters focus on early initial assessment and recommendations to prevent secondary injury as opposed to what one traditionally thinks of as “treatment.”
Given the rapid spread of concussion-oriented legislation at the State level requiring some type of educational program, evaluation and eventual clearance by a healthcare professional prior to return to play for children participating in school sports; the practicing pediatric neuropsychologist is encouraged to update their knowledge base regarding concussion with the help of this book. It is a curious fact that the text does not focus on the history of legislative issues nor forensic issues that may be unique to pediatric concussion. The multi-disciplinary perspective of the text means that certain chapters (such as the sideline assessment chapter) may be less relevant on a day-to-day basis for most neuropsychologists, although a thorough understanding of the tools available for rapid identification of concussion in the sports arena is critical for neuropsychologists participating in return to play decision-making. The rapidly changing nature of the guidelines and state of the science of concussion management also means that the information contained in this book may quickly become dated with the expected update to the Concussion in Sport guidelines for return to play after concussion expected to be released in May of 2013.
To critique this book objectively is to critique the state of the knowledge base of pediatric concussion in general, which is sorely lagging behind the knowledge base of adults with concussion. Despite the book's title and clear intent within each of the chapters to focus exclusively on pediatric and adolescent issues, the reader finds much of the text proceeding through a familiar pattern of reviewing the known literature of adult concussion, with appropriate pediatric work cited when possible, and the ramifications and implications for work with children discussed. Many of the authors point out when the information that they present is based on clinical experience and when they have a lack of empirical support for their observations and opinions. The astute reader will recognize that this is through no fault of the authors, but rather reflects the state of the current field of pediatric concussion. A critique of the chapters regarding the assessment of concussion is that many of the legitimate issues regarding the reliability and predictive validity of measures commonly used or marketed for use in the assessment of concussion are given little attention and in-depth discussion. This is an unfortunate exclusion, as the opportunity to present these measures with a healthy discussion of the strengths and weaknesses is sorely needed, especially as an introduction for students new to the field of concussion management.
An area notably not discussed within this text includes the evaluation and management of young, pre-school-aged children with concussion. The paucity of research in this area presents a challenge to clinicians and researchers alike as the existing tools developed for the evaluation of concussion are not applicable to the pre-school-aged children, and there is little guidance available in the published literature that the practicing neuropsychologist can assuredly share with their patients and families.
One can look forward to future, updated editions of this text as the field of pediatric concussion management evolves and matures into a field of study with more empirical support for the approaches to evaluation and management currently used within the field. The editors close the text with their thoughtful chapter on post-injury issues in pediatric concussion, and one can hope that Apps and Walter will continue to bring attention and education regarding this injury, management and outcomes to a future edition, and through continued education efforts.