Concussion and mild traumatic brain injury — structured clinical encounter

Task 1 — Recognise the syndrome and frame the problem representation (3 minutes)

From the history and the examination, identify the features that mark this as persistent post-concussion symptoms rather than an ongoing acute concussion, and state the threshold the child has crossed. State your problem representation in one sentence, and explain how the history of migraine and anxiety and the prolonged rest reshape your differential and your management. [7] [8]

Task 2 — Justify the diagnosis and exclude the mimics (4 minutes)

Explain why a normal neurological examination does not exclude the diagnosis, and describe the reassessment you perform to confirm that no red flag or structural cause has been missed. State the role of repeat imaging in a child with persistent symptoms and a normal initial course, and explain why further computed tomography is rarely the answer. [3] [1]

Task 3 — Identify the predictors and frame the prognosis (3 minutes)

List the predictors of a prolonged recovery that are present in this child, drawing on the pre-injury vulnerabilities and the early management. Explain the natural history that Ledoux and colleagues described, and use it to set the family's expectation for the recovery ahead. [9] [8]

Task 4 — Build the active rehabilitation plan and lead the conversation (5 minutes)

Outline the active rehabilitation plan, naming the specific therapies and the role of each: sub-symptom threshold aerobic exercise, vestibular or ocular rehabilitation, cognitive behavioural or psychological support, and the school liaison with graduated accommodations. Explain why further rest is the wrong prescription and how the entrenchment of deconditioning and school disengagement deepens the syndrome. Finally, outline the conversation you would have with the girl and her mother about the shift from rest to activity, the timeline to recovery, and the coordination of the school, the club, and the clinic. [7] [4] [6]