Reconceptualizing Recovery After Concussion: A Phenomenological Exploration of College Student Experiences

A Mixed Methods Evaluation of Implementation Outcomes of a Self-Regulation Strategy for Health Education: Perspectives of Clinicians and Older Adults With and Without Traumatic Brain Injury

PURPOSE

Effective self-management is key for older adults with and without traumatic brain injury (TBI) to maintain their health, safety, and independence. Self-regulation is one method of promoting self-management. However, it is essential to examine effective methods of self-regulation interventions to maximize the use of such health promotion.

METHOD

Forty-one older adults (19 with TBI; 22 without TBI) participated in an in-person or telepractice health education intervention for fall prevention with 15 speech-language pathology student clinicians. The intervention was a self-regulation strategy, mental contrasting with implementation intentions (MCII), for promoting fall prevention. This mixed methods study explored treatment adherence and evaluated implementation outcomes through acceptability, appropriateness, feasibility, modifications to treatment, and therapist adherence and client participation.

RESULTS

All participants demonstrated some behavior change. Participants without TBI evaluated the MCII protocol as more acceptable, F(1, 39) = 5.88, p = .018; appropriate, F(1, 39) = 5.34, p = .023; and feasible, F(1, 39) = 9.56, p = .003, than participants with TBI, although all ratings were perceived as neutral or positive. From clinician data, protocol adherence, F(1, 39) = 1.57, p = .22, and client participation, F(1, 39) = 0.10, p = .92, were similar across injury groups, but participants with TBI required more fidelity-consistent modifications to treatment, F(1, 39) = 6.88, p = .012. There were no differences between settings except that those in telepractice had more client participation, F(1, 39) = 21.02, p < .001. Clinicians felt MCII was equally appropriate for both groups in all settings, acceptability: F(1, 48) = 0.082, p = .78; appropriateness: F(1, 48) = 0.554, p = .46; feasibility: F(1, 48) = 0.197, p = .66.

CONCLUSION

MCII may be a feasible tool to provide health education as it offers enough structure and individualization to be considered appropriate and relevant for older adults, and for novice clinicians to administer and modify as needed based on client needs.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28074443.

Sports-Related Concussion in Collegiate Athletes: The Potential Benefits of Using Graded Neuropsychological Tests With High Ceilings

OBJECTIVE

Sports-related concussion management in collegiate athletes has been focused on return-to-play. However, resuming schoolwork without a gradual stepwise reintroduction contributes to symptom exacerbation, delayed recovery, and adverse academic performance. Return-to-learn guidelines are limited by a lack of sensitivity in methods monitoring cognitive function. This study evaluated 2 neuropsychological tests, the Sternberg test and the Paced Auditory Serial Addition Test (PASAT), with high ceilings for sensitivity to deficits in speed of information processing, cognitive efficiency, and complex attention.

SETTING

Academic center research laboratory.

PARTICIPANTS

We recruited 56 male and female collegiate contact and noncontact sports athletes. They were categorized into as follows: (1) nonconcussed ( n = 23; 7F, 16M); (2) chronic ( n = 21; 4F, 17M), at least 1 year from their last concussion; and (3) acute ( n = 12; 1F, 11M), within 2 weeks from concussion.

DESIGN

Observational cohort study.

MAIN MEASURES

The PASAT assesses complex attention. The Sternberg test examines processing speed and cognitive efficiency. Cognitive difficulty increases with progression through the tasks for both the PASAT and the Sternberg test. The mean outcome differences of the 3 groups (nonconcussed, acute, and chronic) across the 3 or 4 conditions (difficulty level) were measured with repeated-measures analysis of variance and subsequent pairwise comparison.

RESULTS

For processing speed (Sternberg reaction time), the acute group responded slower than the chronic group on the medium ( P = .021, Bonferroni corrected) and hard difficulty tasks ( P = .030, Bonferroni corrected). For cognitive efficiency (Sternberg reaction time variability), the acute group had increased reaction time variability compared with the chronic group on the medium difficulty task ( P = .04, Bonferroni corrected). For complex attention (PASAT omissions), there was a difference between the acute and nonconcussed groups on the moderate-hard difficulty trial ( P = .023, least significant difference [LSD] corrected) and between the acute and chronic groups for hard difficulty trial ( P = .020, LSD corrected). The acute group performed worse, with progressively shorter interstimulus intervals.

CONCLUSION

Neuropsychological testing without ceiling effects can capture higher-level cognitive dysfunction and and use of such tests can contribute to the understanding of how collegiate athletes are affected by SRC. Future studies can investigate optimal testing batteries that include neuropsychological testing with high ceilings and whether the pattern of performance has implications for the return-to-learn process after SRC in the college setting.

Pilot testing the SUCCESS peer mentoring program for students with concussion: the role of personas in mobile technology development

PURPOSE

College students with concussion experience academic, cognitive and psychosocial challenges, yet frequently lack supports necessary for successful reintegration into school. Success in College after Concussion with Effective Student Supports (SUCCESS) is a virtual peer mentoring program designed to provide education, support and connection through a mobile application. The purpose of this study was to describe use of personas as components of mobile app development and conduct preliminary testing of SUCCESS using personas.

METHODS

Personas were developed from case studies and portrayed by college students trained as fictitious mentees. Mentors were blinded to use of personas. Eleven mentors completed measures pre and post a 4-week mentoring cycle. Mentors and personas interacted in the app via chat, video calls and sharing of educational materials. Measures included the Post-Concussion Symptom Scale (PCSS); PROMIS Self-Efficacy; Depression, Anxiety and Stress Scale (DASS); and a series of focus groups.

RESULTS

Mentors suggested improvements to resolve instability of video calls, expand educational materials to address psychosocial functioning, and add structure to the mentoring relationship. Some preferences around communication, like groups chats and emoji keyboards, were not able to be addressed. As expected, PCSS scores were stable. DASS score (p = .04), especially depression (p = .03), decreased. PROMIS scores showed a trend towards growth (p = .057), although were not statistically significant.

CONCLUSIONS

Use of personas allowed technical challenges and program refinements to be addressed before including students with subacute concussion in testing. Although continued development will address enhancement of communication modalities preferred by students, future efficacy testing of SUCCESS is warranted.

Use of Social Media Data Mining to Examine Needs, Concerns, and Experiences of People With Traumatic Brain Injury

PURPOSE

Given the limited availability of topic-specific resources, many people turn to anonymous social media platforms such as Reddit to seek information and connect to others with similar experiences and needs. Mining of such data can therefore identify unmet needs within the community and allow speech-language pathologists to incorporate clients' real-life insights into clinical practices.

METHOD

A mixed-method analysis was performed on 3,648 traumatic brain injury (TBI) subreddit posts created between 2013 and 2021. Sentiment analysis was used to determine the sentiment expressed in each post; topic modeling and qualitative content analysis were used to uncover the main topics discussed across posts. Subgroup analyses were conducted based on injury severity, chronicity, and whether the post was authored by a person with TBI or a close other.

RESULTS

There was no significant difference between the number of posts with positive sentiment and the number of posts with negative sentiment. Comparisons between subgroups showed significantly higher positive sentiment in posts by or about people with moderate-to-severe TBI (compared to mild TBI) and who were more than 1 month postinjury (compared to less than 1 month). Posts by close others had significantly higher positive sentiment than posts by people with TBI. Topic modeling identified three meta-themes: Recovery, Symptoms, and Medical Care. Qualitative content analysis further revealed that returning to productivity and life as well as sharing recovery tips were the primary focus under the Recovery theme. Symptom-related posts often discussed symptom management and validation of experiences. The Medical Care theme encompassed concerns regarding diagnosis, medication, and treatment.

CONCLUSIONS

Concerns and needs shift over time following TBI, and they extend beyond health and functioning to participation in meaningful daily activities. The findings can inform the development of tailored educational resources and rehabilitative approaches, facilitating recovery and community building for individuals with TBI.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24881340.

The SUCCESS Peer Mentoring Program for College Students with Concussion: Preliminary Results of a Mobile Technology Delivered Intervention

Concussions are caused by a hit or blow to the head that alters normal brain functioning. The Success in College after Concussion with Effective Student Supports (SUCCESS) program was developed to provide students with psychosocial support and resources-both key components of concussion management-to assist in recovery and return-to-learn following concussion. In this preliminary evaluation of intervention efficacy, SUCCESS was delivered through a mobile application connecting mentors (students who have recovered from concussion and successfully returned to school) with mentees who were currently recovering. Mentor-mentee pairs met virtually through the app, using chat and videoconferencing features to share support, resources, and program-specific educational materials. Results from 16 mentoring pairs showed that mentee symptoms (V = 119, p = 0.009) and academic problems decreased (V = 114.5, p = 0.002), while academic self-efficacy increased (V = 13.5, p = 0.009) following mentoring. As expected, mentor measures were stable, indicating that providing mentoring did not exacerbate previously resolved concussion complaints. Virtual peer mentoring provided through a mobile application may be a feasible intervention to support academic success and psychosocial processing during recovery for college students with concussion.