Carol DeMatteo has a dual background as an occupational therapist and physiotherapist and is a Professor in the School of Rehabilitation Science at McMaster University. Professor DeMatteo specializes in childhood neurotrauma, specifically acquired brain injury including concussion. Recently, Professor DeMatteo secured several grants including Canadian Institutes of Health Research Catalyst Grant for the Concussion Centre of Excellence (Canadian Concussion Network: Co-Investigator) and Ontario Brain Institute Event Grant (Principle Investigator). Of note, Professor DeMatteo and her team received funding from Canadian Institutes of Health Research (CIHR) and Natural Sciences and Engineering Research Council (NSERC) for their Collaborative Health Research Projects Grant for the development of a concussion management platform (the Back2Play App) for children and youth with concussion. This project builds on Professor DeMatteo’s years of research in pediatric concussion and development of evidenced-based CanChild Return to Activity (RTA) and Return to School (RTS) protocols. In addition to the on-going development of the Back2Play App, Professor DeMatteo has published various peer-reviewed articles and is currently supervising MSc students. Professor DeMatteo is not accepting any additional students at this time.

Development of Concussion Management Platform for Children and Youth: Bridging the Gap Between Research and Practice—The Back2Play App Study

The decision to return to activity (RTA) and return to school (RTS) following concussion is one of the most difficult areas in concussion management for children and youth. Prof. DeMatteo and her research team have developed and evaluated evidence based RTS and RTA guidelines to help children through their concussion recovery. In evaluating these protocols, Prof. DeMatteo found that children and youth had difficulties following the guidelines due to lack of feedback and guidance. To address these issues, Prof. DeMatteo was awarded a Canadian Institutes of Health Research (CIHR) and Natural Sciences and Engineering Research Council (NSERC) grant to develop the Back2Play App. The Back2Play App will help guide children and youth through the CanChild RTA and RTS protocols by incorporating biological feedback, movement data and cognitive assessments. This project consists of 3 phases, Phase 1: App Development, Phase 2: Pilot Study and Phase 3: A Randomized Controlled Trial. The RCT will evaluate whether the Back2Play App shortens the duration and intensity of concussion symptoms and prevents repeat injury in children and youth. Prof. DeMatteo and her team are currently in Phase 1 (App Development) and are working with the mHealth and eHealth Development and Innovation Centre (MEDIC) at Mohawk to develop the Back2Play App. Phase 2, pilot testing of the Back2Play App with 30 children and youth aged 10-18, will begin January 2021.  

Safely Returning Children and Youth to Activity after Concussion – The Back to Play Study

The Back to Play study aimed to evaluate if adherence to the RTA and RTS guidelines improves outcomes, such as duration of symptoms and prevention of repeat injury, in children and youth with concussion. The Back to Play study, funded by CIHR, examined 139 children aged 5-18 years with concussion up to 6 months post injury. The study was led by Prof DeMatteo with support from a team of McMaster investigators from Health, Psychology and Engineering. Participants were assessed for repeat injuries, depression levels, quality of life, length of time to return to play and school as well as parent’s and children’s perception of the new guidelines. Participants also wore accelerometers to assess physical activity levels and adherence to the guidelines. Data from this study is available here, and the final manuscript for the Back to Play study is in preparation. Essentially, it was data obtained from this longitudinal study which provided the evidence required for the 2019 update to the CanChild RTA and RTS guidelines.

Quality Standards Committee on Concussion Standards – Health Quality Ontario: Co-Chair

Prof. DeMatteo was invited to act as co-chair for the Quality Standards Committee on Concussion Standards for Health Quality Ontario. This quality standard addresses care in emergency departments, outpatient care, rehabilitation, and concussion clinics for children age 5 years and older, adolescents, and adults with a concussion. This quality standard includes all causes of concussion (sports and non-sports) and applies to all health care providers. This quality standard addresses the assessment, diagnosis, and management of acute concussion and persistent or prolonged post-concussion symptoms.

Effectiveness of Return to Activity and Return to School protocols for children post-concussion: A systematic review

Prof. DeMatteo and her team performed a systematic review, published in BMJ Open Sport & Exercise, to assess the effects of following RTA and RTS protocols on clinical outcomes in children with concussion. The 12 sub-questions of this review focused on the effectiveness of RTA and RTS protocol guidelines and the evidence supporting the content of the RTA and RTS protocols including rest, exercise and school accommodations. The authors observed that despite the widespread adoption of RTS and RTA protocols for concussed children and youth there is little evidence to determine their efficacy. The authors also observed that the available data supports the recommendation that children in the acute stage post-concussion should undergo 1-2 days of physical and cognitive rest as they initiate graduated RTA and RTS protocols.

Evaluating Adherence to Return to School and Activity Protocols in Children After Concussion

The need for pediatric-specific concussion management protocols on Return to School (RTS) and Return to Activity (RTA) after concussion is recognized internationally. To evaluate the effectiveness of these protocols, it must be established whether children and youth adhere to these recommendations. The objective of this study, published in the Clinical Journal of Sports Medicine, was to explore the prevalence and predictors of adherence to the RTS and RTA protocols in 139 children and youth (5-18 y/o) with concussion. Adherence was assessed using multiple sources including, the child’s and parent’s knowledge of the guidelines, research personnel evaluations, self-report of RTA and RTS Stages as well as the validated post-concussion symptom scale. Prof. DeMatteo and her team observed that 53% and 56% of children and youth adhered to the RTS and RTA protocols, respectively. In addition, the authors observed that the child’s knowledge of the protocols and total post-concussion symptom scale score significantly predicted adherence to the RTS and RTA protocols and may be the most important factor in predicting adherence during recovery from concussion.

Integration of Return to Activity and Return to School

This study, published in Frontiers in Neurology, investigates the recovery trajectories of children and youth following the RTA and RTS protocols simultaneously. Prof. DeMatteo and her team compared the rates of progression through both RTA and RTS protocols as well as the symptom trajectories to determine if integration of RTS and RTA protocols can occur without affecting recovery from concussion. This 3-year study included 139 children and youth aged 5 to 18 years old with concussion. Prof. DeMatteo and her team found that children and youth return to school quicker than they return to activity. The authors also observed that as children progress through the guidelines they experience less symptoms. Prof. DeMatteo and her team observed that 64% of youth reported experiencing school problems during recovery and 30% at symptom resolution with 31% reporting a drop in their grades. Prof. DeMatteo and her team concluded that youth can progress simultaneously through the RTS and RTA protocols during stage 1-3 without affecting their overall progress. Considering that many children experience school difficulties post-concussion, full contact sport of RTA Stage 6 should be delayed until full and successful reintegration back to school.

Concussion Management for Children has Changed

Return to Activity and Return to School are important issues in pediatric concussion management. This study, published in, Clinical Pediatrics, aimed to update the CanChild 2015 RTA and RTS protocols on the basis of empirical data, feedback collected from a prospective cohort study and a systematic review. The new protocols highlight differences from the 2015 version including: 1) Modified symptom strata (A, B or C) to accommodate those who recover more quickly, 2) A shortened rest period in Stage 1 (24 to 48 hours) accompanied by symptom-guided activity, 3) The recommendation that children progress through the stages before they are symptom free, 4) Specific activity suggestions and recommended time spend in each stage, and 5) Integration of RTS and RTA. To review the 2019 CanChild RTA and RTS guidelines in English and French click here.