Sport-related concussion (SRC) frequently affects athletes and represents a complex challenge for diagnosis and clinical management due to the heterogeneity of its manifestations and recovery trajectories. The persistence of post-concussion symptoms (PPCS) can lead to significant functional limitations, requiring multidisciplinary and personalized rehabilitation strategies. In this context, the phenotypic classification of symptoms has been proposed as the model of choice to optimize the effectiveness of care. This pilot study aims to identify and stratify the clinical phenotypes of concussion through the application of the standardized Sport Concussion Office Assessment Tool 6 (SCOAT6™) in a cohort of patients attending a clinic for the management of brain concussion, and to observe the clinical course and recovery times of a structured physical exercise program in a subgroup of subjects. This study enrolled patients with brain concussion attending the specific oitpatient clinic at the Sports and Exercise Medicine Division of the University Hospital of Padua. The clinical evaluation followed the SCOAT6™ protocol (and the Child SCOAT6 for the 8–12 age group), integrating physical examinations, assessment of cognitive status, vestibolo-ocular function, dysautonomia, altered emotionality, and sleep quality. Patients were stratified into seven clinical phenotypes: headache, cervicalgia, vestibolo-ocular deficits, dysautonomic, cognitive deficits, altered emotionality, and sleep disturbances. A selected subgroup of subjects (n = 14) was included in a personalized sub-threshold aerobic exercise-therapy program in the Hospital medical gym. The general cohort included N = 139 patients with a median age of 14 years (range: 6–63 years) and a prevalence of the male sex (66.9%). The trauma occurred in a sports setting in 61.9% of cases, with rugby (41%) and soccer (17.3%) being the most represented disciplines. Upon admission to the clinic (median of 10 days for intake), 21% of the subjects presented a clinical picture that was already spontaneously resolving, while 79% showed one or more phenotypes, with the vestibolo-ocular profile and the headache profile being the most widespread. In the subpopulation included in the gym protocol, which presented a more severe initial clinical picture (median PCSS at trauma equal to 44 [27-73]) and a marked intolerance to both physical and cognitive load (50%), sub-threshold aerobic exercise proved to be safe and without adverse effects, furthermore leading to a decrease in symptoms up to symptom remission with different timelines depending on subjective characteristics. Data analysis confirmed the fundamental role of the standardized objective examination (SCOAT6) as an essential diagnostic filter, capable of both intercepting silent clinical phenotypes otherwise underestimated by self-administered questionnaires (PCSS), and downscaling patient overestimations. An important critical issue also emerged regarding the delay in removal from play on the field (33.7% of cases), a known risk factor for the chronification of symptoms. On the therapeutic level, the subpopulation included in the exercise prescription protocol at the gym demonstrated an adequate safety profile and a progressive, total, and stable clinical remission, supporting the effectiveness of structured physical exercise administration compared to the deconditioning risks of traditional cocoon therapy. Future perspectives aim at expanding the sample size, reducing intake times, and systematically applying phenotype-guided decision matrices to optimize Return-to-Learn and Return-to-Play pathways.
La concussione cerebrale sport-correlata (SRC), colpisce frequentemente gli atleti e rappresenta una sfida complessa per la diagnosi e la gestione clinica a causa dell’eterogeneità delle sue manifestazioni e delle traiettorie di recupero. La persistenza dei sintomi post-commotivi (PPCS) può determinare limitazioni funzionali significative, richiedendo strategie riabilitative multidisciplinari e personalizzate. In questo contesto, la classificazione fenotipica dei sintomi è stata proposta come modello d'elezione per ottimizzare l'efficacia delle cure. Questo studio pilota si propone di identificare e stratificare i fenotipi clinici della concussione attraverso l'applicazione dello strumento standardizzato Sport Concussion Office Assessment Tool 6 (SCOAT6™) in una coorte di pazienti afferenti ad un ambulatorio per la gestione della concussione cerebrale e di osservare l'andamento clinico e i tempi di recupero di un programma di esercizio fisico strutturato in un sottogruppo di soggetti. Questo studio ha arruolato i pazienti con concussione cerebrale afferenti allo specifico ambulatorio attivato presso l'U.O.C. Medicina dello Sport e dell'Esercizio Fisico dell'Azienda Ospedale Università di Padova. La valutazione clinica ha seguito il protocollo dello SCOAT6™ (e del Child SCOAT6 per la fascia 8-12 anni), integrando esami fisici, valutazione dello stato cognitivo, vestibolo-oculomotoria, della disautonomia , dell’alterata emotività e della qualità del sonno. I pazienti sono stati stratificati in sette fenotipi clinici: cefalea, cervicalgia, deficit vestibolo-oculari, disautonomico, deficit cognitivi, alterata emotività e disturbi del sonno. Un sottogruppo selezionato di soggetti (n = 14) è stato inserito in un programma di esercizio-terapia aerobica personalizzato “sottosoglia” svolto presso la palestra medica ospedaliera. La coorte generale ha compreso N = 139 pazienti con un'età mediana di 14 anni (range: 6–63 anni) e una prevalenza del sesso maschile (66,9%). Il trauma è avvenuto in ambito sportivo nel 61,9% dei casi, con rugby (41%) e calcio (17,3%) come discipline maggiormente rappresentate. All'accesso in ambulatorio (mediana di 10 giorni per la presa in carico), il 21% dei soggetti presentava un quadro clinico già in risoluzione spontanea, mentre il 79% mostrava uno o più fenotipi, con il profilo vestibolo-oculare e quello con cefalea come i più diffusi. Nella sottopopolazione inserita nel percorso in palestra, che presentava un quadro clinico iniziale più severo (PCSS mediana al trauma pari a 44 [27-73]) e una spiccata intolleranza sia al carico fisico che cognitivo (50%), l'esercizio aerobico sottosoglia si è rivelato sicuro e senza effetti avversi, determinando inoltre un decremento sintomatologico fino a remissione dei sintomi con tempistiche diverse a seconda delle caratteristiche soggettive. L'analisi dei dati ha confermato il ruolo fondamentale dell'esame obiettivo standardizzato (SCOAT6) come filtro diagnostico essenziale, capace sia di intercettare fenotipi clinici silenti altrimenti sottostimati dai questionari autosomministrati (PCSS), sia di ridimensionare la sovrastima dei sintomi da parte del paziente. È emersa inoltre un'importante criticità legata al ritardo nella rimozione dal gioco sul campo (33,7% dei casi), fattore di rischio noto per favorire una cronicizzazione dei sintomi. Sul piano terapeutico, la sottopopolazione inserita nel protocollo di prescrizione di esercizio in palestra ha dimostrato un profilo di sicurezza adeguato e una progressiva, totale e stabile remissione clinica, supportando l'efficacia della somministrazione di esercizio fisico strutturato rispetto ai rischi di decondizionamento della tradizionale “cocoon therapy”. Le prospettive future mirano all'ampliamento del campione, all'abbattimento dei tempi di presa in carico e all'applicazione sistematica di matrici decisionali fenotipo-guidate per ottimizza
Prescrizione dell'esercizio fisico e outcome clinici nella commozione cerebrale sport-correlata: Risultati preliminari di uno studio pilota.
CENEDESE, ISMAELE
2025/2026
Abstract
Sport-related concussion (SRC) frequently affects athletes and represents a complex challenge for diagnosis and clinical management due to the heterogeneity of its manifestations and recovery trajectories. The persistence of post-concussion symptoms (PPCS) can lead to significant functional limitations, requiring multidisciplinary and personalized rehabilitation strategies. In this context, the phenotypic classification of symptoms has been proposed as the model of choice to optimize the effectiveness of care. This pilot study aims to identify and stratify the clinical phenotypes of concussion through the application of the standardized Sport Concussion Office Assessment Tool 6 (SCOAT6™) in a cohort of patients attending a clinic for the management of brain concussion, and to observe the clinical course and recovery times of a structured physical exercise program in a subgroup of subjects. This study enrolled patients with brain concussion attending the specific oitpatient clinic at the Sports and Exercise Medicine Division of the University Hospital of Padua. The clinical evaluation followed the SCOAT6™ protocol (and the Child SCOAT6 for the 8–12 age group), integrating physical examinations, assessment of cognitive status, vestibolo-ocular function, dysautonomia, altered emotionality, and sleep quality. Patients were stratified into seven clinical phenotypes: headache, cervicalgia, vestibolo-ocular deficits, dysautonomic, cognitive deficits, altered emotionality, and sleep disturbances. A selected subgroup of subjects (n = 14) was included in a personalized sub-threshold aerobic exercise-therapy program in the Hospital medical gym. The general cohort included N = 139 patients with a median age of 14 years (range: 6–63 years) and a prevalence of the male sex (66.9%). The trauma occurred in a sports setting in 61.9% of cases, with rugby (41%) and soccer (17.3%) being the most represented disciplines. Upon admission to the clinic (median of 10 days for intake), 21% of the subjects presented a clinical picture that was already spontaneously resolving, while 79% showed one or more phenotypes, with the vestibolo-ocular profile and the headache profile being the most widespread. In the subpopulation included in the gym protocol, which presented a more severe initial clinical picture (median PCSS at trauma equal to 44 [27-73]) and a marked intolerance to both physical and cognitive load (50%), sub-threshold aerobic exercise proved to be safe and without adverse effects, furthermore leading to a decrease in symptoms up to symptom remission with different timelines depending on subjective characteristics. Data analysis confirmed the fundamental role of the standardized objective examination (SCOAT6) as an essential diagnostic filter, capable of both intercepting silent clinical phenotypes otherwise underestimated by self-administered questionnaires (PCSS), and downscaling patient overestimations. An important critical issue also emerged regarding the delay in removal from play on the field (33.7% of cases), a known risk factor for the chronification of symptoms. On the therapeutic level, the subpopulation included in the exercise prescription protocol at the gym demonstrated an adequate safety profile and a progressive, total, and stable clinical remission, supporting the effectiveness of structured physical exercise administration compared to the deconditioning risks of traditional cocoon therapy. Future perspectives aim at expanding the sample size, reducing intake times, and systematically applying phenotype-guided decision matrices to optimize Return-to-Learn and Return-to-Play pathways.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/109197