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Mikolic A, Panenka WJ, Iverson GL, Cotton E, Burke MJ, Silverberg ND. Litigation, Performance Validity Testing, and Treatment Outcomes in Adults With Mild Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:E153-E161. [PMID: 37773600 DOI: 10.1097/htr.0000000000000903] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
OBJECTIVE To investigate whether involvement in litigation and performance validity test (PVT) failure predict adherence to treatment and treatment outcomes in adults with persistent symptoms after mild traumatic brain injury (mTBI). SETTING Outpatient concussion clinics in British Columbia, Canada. Participants were assessed at intake (average 12.9 weeks postinjury) and again following 3 to 4 months of rehabilitation. PARTICIPANTS Adults who met the World Health Organization Neurotrauma Task Force definition of mTBI. Litigation status was known for 69 participants ( n = 21 reported litigation), and 62 participants completed a PVT ( n = 13 failed the Test of Memory Malingering) at clinic intake. DESIGN Secondary analysis of a clinical trial (ClinicalTrials.gov #NCT03972579). MAIN MEASURES Outcomes included number of completed sessions, homework adherence, symptoms (Rivermead Post Concussion Symptoms Questionnaire), disability ratings (World Health Organization Disability Assessment Schedule 2.0), and patient-rated global impression of change. RESULTS We did not observe substantial differences in session and homework adherence associated with litigation or PVT failure. Disability and postconcussion symptoms generally improved with treatment. Involvement in litigation was associated with a smaller improvement in outcomes, particularly disability ( B = 2.57, 95% confidence interval [CI] [0.25-4.89], P = .03) and patient-reported global impression of change (odds ratio [OR] = 4.19, 95% CI [1.40-12.57], P = .01). PVT failure was not associated with considerable differences in treatment outcomes. However, participants who failed the PVT had a higher rate of missing outcomes (31% vs 8%) and perceived somewhat less global improvement (OR = 3.47, 95% CI [0.86-14.04]; P = .08). CONCLUSION Adults with mTBI who are in litigation or who failed PVTs tend to adhere to and improve following treatment. However, involvement in litigation may be associated with attenuated improvements, and pretreatment PVT failure may predict lower engagement in the treatment process.
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Affiliation(s)
- Ana Mikolic
- Departments of Psychology (Drs Mikolic and Silverberg) and Psychiatry (Dr Panenka), The University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, Centre for Aging SMART at Vancouver Coastal Health, Vancouver, British Columbia, Canada (Drs Mikolic and Silverberg); British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada (Dr Panenka); BC Neuropsychiatry Program, Vancouver, British Columbia, Canada (Dr Panenka); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Dr Iverson); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts (Dr Iverson); Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts (Dr Iverson); Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown (Dr Iverson); Departments of Psychiatry and Behavioral Sciences (Dr Cotton) and Neurology (Dr Cotton), Northwestern University, Chicago, Illinois; Neuropsychiatry Program, Department of Psychiatry and Division of Neurology and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (Dr Burke); and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada (Dr Burke)
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Moen E, McLean A, Boyd LA, Schmidt J, Zwicker JG. Experiences of Children and Youth With Concussion: A Qualitative Study. Am J Occup Ther 2022; 76:23301. [PMID: 35709001 DOI: 10.5014/ajot.2022.047597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Concussions are common among children and youth. To date, the pediatric concussion literature has focused on quantitative reports of the effects of concussion and return-to-activity guidelines. However, the subjective experiences of children and youth returning to occupations postconcussion have largely been ignored. An understanding of these experiences is critical to inform effective concussion management. OBJECTIVE To investigate the experiences of children and youth returning to occupations after sustaining a concussion and the impacts on their future engagement in occupation. DESIGN Qualitative interpretive description was used for data analysis and interpretation. SETTING Community. PARTICIPANTS Children and youth ages 11 to 18 yr from a cohort study were recruited to be interviewed about their experiences of engaging in occupations postconcussion. OUTCOMES AND MEASURES Interviews were conducted 3 to 24 mo postconcussion, transcribed verbatim, and analyzed using interpretive description to identify themes. RESULTS Eight children and youth (5 male, 3 female) were included. Analyses revealed three themes of the experiences of children and youth returning to occupations after concussion: diverse experiences of concussion, knowledge is key to concussion management, and concussions affect occupational engagement. CONCLUSIONS AND RELEVANCE This study highlights the importance of considering a person's needs to enable effective concussion treatment plans. The results suggest the need for an occupation-based framework to guide interventions in pediatric concussion management. What This Article Adds: Our findings indicate that children and youth report variable recovery patterns, a lack of knowledge about concussion recovery, and a negative effect of concussion on occupational engagement.
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Affiliation(s)
- Emily Moen
- Emily Moen, BSc, MOT, is Occupational Therapist, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison McLean
- Alison McLean, BSc, MOT, is Occupational Therapist, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lara A Boyd
- Lara A. Boyd, PT, PhD, is Professor, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julia Schmidt
- Julia Schmidt, BSc(OT), PhD, is Assistant Professor, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada, and xxx, GF Strong Rehabilitation Research Program, Vancouver, British Columbia, Canada;
| | - Jill G Zwicker
- Jill G. Zwicker, MA, PhD, BSc, BA, OT(C), is Associate Professor, Department of Occupational Science and Occupational Therapy and Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Investigator, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; and Clinician Scientist, Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
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3
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Shore J, Nalder E, Hutchison M, Reed N, Hunt A. Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development. JMIR Pediatr Parent 2022; 5:e34822. [PMID: 35377326 PMCID: PMC9016504 DOI: 10.2196/34822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Active rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions. OBJECTIVE This paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery. METHODS The intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes. RESULTS Tele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion & You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion. CONCLUSIONS The Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach.
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Affiliation(s)
- Josh Shore
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Emily Nalder
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Michael Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Anne Hunt
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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4
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Davies SC, Lundine JP, Justice AF. Care Coordination for Children with Special Health Care Needs: A Scoping Review to Inform Strategies for Students with Traumatic Brain Injuries. THE JOURNAL OF SCHOOL HEALTH 2022; 92:270-281. [PMID: 34907533 DOI: 10.1111/josh.13132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/28/2021] [Accepted: 06/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Chronic and complex medical issues, including traumatic brain injuries (TBIs), have significant educational implications. The purpose of this study was to identify and summarize the literature on care coordination strategies among health care professionals, educators, and caregivers for children with special health care needs (CSHCN). Clarifying factors that influence care coordination for CSHCN can inform future studies on care coordination for students with TBI. Improved understanding of these factors may lead to better communication, reduction of unmet needs, more efficient service access, and improved long-term outcomes for children. METHODS A scoping review was conducted, guided by PRISMA-ScR methodology. Five databases (CINAHL, PSYCINFO, EMBASE, ERIC, PubMed) were searched to identify relevant studies that focused on care coordination and educational settings. RESULTS Twelve articles met inclusion criteria. Care coordination interventions for CSHCN used in educational settings focused on relationship-building strategies, clear procedures and roles, and education of members of the school community. CONCLUSIONS Findings highlight strategies to coordinate care for CSHCN and factors that may moderate effects of these interventions. Key stakeholders should now study these strategies specifically in children with TBI.
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Affiliation(s)
- Susan C Davies
- Department of Counselor Education and Human Services, University of Dayton, 300 College Park, Dayton, OH, 45469
| | - Jennifer P Lundine
- Department of Speech and Hearing Science, The Ohio State University Division of Clinical Therapies and Inpatient Rehabilitation, Nationwide Children's Hospital 101A Pressey Hall, 1070 Carmack RD, Columbus, OH, 43210
| | - Ann F Justice
- Department of Counselor Education and Human Services University of Dayton 300 College Park, Dayton, OH, 45469
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5
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Silverberg ND, Cairncross M, Brasher PMA, Vranceanu AM, Snell DL, Yeates KO, Panenka WJ, Iverson GL, Debert CT, Bayley MT, Hunt C, Baker A, Burke MJ. Feasibility of concussion rehabilitation approaches tailored to psychological coping styles: A randomized controlled trial. Arch Phys Med Rehabil 2021; 103:1565-1573.e2. [PMID: 34971596 DOI: 10.1016/j.apmr.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the feasibility of a clinical trial involving participants with concussion randomized to treatments designed to address fear avoidance or endurance coping, which are risk factors for disability. A secondary objective was to evaluate whether each treatment could effect selective change on targeted coping outcomes. DESIGN Randomized controlled trial. SETTING Outpatient concussion clinics. PARTICIPANTS 73 adults (M=42.5 years old) who had persistent post-concussion symptoms and high avoidance or endurance behavior were enrolled at M=12.9 weeks post injury. 10 participants did not complete treatment. INTERVENTIONS Participants were randomized to an interdisciplinary rehabilitation program delivered via videoconferencing and tailored to avoidance coping (graded exposure therapy; GET) or endurance coping (operant condition-based pacing strategies plus mindfulness training; Pacing+). MAIN OUTCOME MEASURES Feasibility outcomes included screening efficiency, accrual, credibility, treatment fidelity, adherence, and retention. Avoidance was measured with the Fear Avoidance Behavior after Traumatic Brain Injury questionnaire and endurance behavior with the Behavioral Response to Illness Questionnaire. RESULTS Screening efficiency, or the proportion of clinic patients who were assessed for eligibility, was 44.5% (275/618). 65.8% (73/111) of eligible patients were randomized (n=37 to GET and n=36 to Pacing+), meeting accrual targets. 91.7% (55/60) of participants perceived treatment as credible. Therapists covered M=96.8% of essential prescribed elements, indicating excellent fidelity. The majority (71.2%; 47/66) of participants consistently attended treatment sessions and completed between-session homework. Retention was strong, with 65 of 73 (89%) randomized participants completing the outcome assessment. GET was associated with greater post-treatment reductions in avoidance behavior compared to Pacing+ (Cohen's drepeated measures = 0.81), whereas the treatment approach-specific effect of Pacing+ on endurance behavior was less pronounced (Cohen's drepeated measures = 0.39). CONCLUSIONS Findings support a future efficacy-focused clinical trial. GET has the potential to selectively reduce fear avoidance behavior after concussion, and, via this mechanism, to prevent or reduce disability.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, Rehabilitation Research Program, Vancouver Coastal Health Research Institute.
| | - Molly Cairncross
- Department of Psychology, University of British Columbia, Rehabilitation Research Program, Vancouver Coastal Health Research Institute
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School
| | - Deborah L Snell
- Concussion Clinic, Canterbury District Health Board, Department of Orthopedic Surgery and Musculoskeletal Medicine, University of Otago
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Alberta Children's Hospital Research Institute, University of Calgary, Hotchkiss Brain Institute, University of Calgary
| | - William J Panenka
- British Columbia Neuropsychiatry Program, BC Mental Health and Substance Use Research Institute, Department of Psychiatry, University of British Columbia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital and Spaulding Research Institute, MassGeneral Hospital for Children™ Sports Concussion Program, Home Base, A Red Sox Foundation and Massachusetts General Hospital Program
| | - Chantel T Debert
- Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary, Hotchhiss Brain Institute, Alberta Children's Hospital Research Institute
| | - Mark T Bayley
- Toronto Rehabilitation Institute, University Health Network
| | - Cindy Hunt
- Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael's Hospital, Dalla Lana School of Public Health, University of Toronto
| | - Andrew Baker
- Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael's Hospital
| | - Matthew J Burke
- Neuropsychiatry Program, Department of Psychiatry and Division of Neurology, Department of Medicine Sunnybrook Health Sciences Centre, University of Toronto, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School
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Paniccia M, Ippolito C, McFarland S, Murphy J, Reed N. Health-Related Quality of Life in Non-Concussed Children: A Normative Study to Inform Concussion Management. Dev Neurorehabil 2020; 23:534-541. [PMID: 32156189 DOI: 10.1080/17518423.2020.1736683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: There has been a shift to consider pediatric concussion recovery beyond symptom management by considering how health-related quality of life (HRQoL) affects recovery. This study investigated normative ranges of HRQoL in children and explored its relationship with common pediatric concussion variables. Methods: A cross-sectional study of 1,722 non-concussed children 8-12 years old (M = 10.52 ± 1.23 years; 1,335 males, 387 females) was conducted by secondary analysis of clinical baseline concussion data. Demographic information, concussion-like symptoms (PCSI-C), and HRQoL (KIDSCREEN-10 Index) were self-reported. Results: The most reported concussion-like symptoms were common stress symptoms and were significantly negatively correlated with HRQoL. Premorbid histories of attention deficit hyperactivity disorder, mental health challenges, headaches/migraines, and concussion significantly lowered HRQoL. The number of diagnosed concussions and PCSI-C scores were significantly negatively correlated with HRQoL. Conclusions: The normative ranges and model can indicate HRQoL levels to inform clinicians how children may respond to concussion and streamline care beyond traditional assessment models.
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Affiliation(s)
- M Paniccia
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - C Ippolito
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - S McFarland
- Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - J Murphy
- Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - N Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, Canada
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7
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Paniccia M, Ippolito C, McFarland S, Murphy J, Reed N. Self-efficacy in non-concussed youth: a normative study. Brain Inj 2020; 34:1532-1540. [PMID: 32910683 DOI: 10.1080/02699052.2020.1792983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In pediatric concussion, there has been a shift to consider how pre-injury profiles, such as self-efficacy, affect the recovery trajectory. The aim of this study was to investigate normal ranges of self-efficacy (overall, academic, social, emotional) in youth and to explore its relationship with the effects of daily stressors, operationalized as concussion-like symptoms, demographic factors, pre-injury/learning related factors, and concussion history. METHODS A cross-sectional study of 1300 uninjured youth 13-18 years old (1111 males, 189 females) was conducted by secondary analysis of clinical pre-injury/baseline concussion data. Demographic information, concussion-like symptoms (Post-concussion Symptom Inventory), and self-efficacy (Self-efficacy Questionnaire for Children) were self-reported. RESULTS The most reported concussion-like symptoms were common stress symptoms and there was a strong negative relationship with self-efficacy. Males reported higher self-efficacy than females, but no age effects were observed. Pre-injury factors including learning disability, ADHD, special education, IEP, mental health challenges, history of headaches/migraines, and concussion history were associated with significantly lower overall self-efficacy. CONCLUSIONS These normative ranges and predictive model can be used to provide a benchmark of self-efficacy to indicate how youth may respond to a concussion, and to inform clinical care during recovery.
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Affiliation(s)
- M Paniccia
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - C Ippolito
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - S McFarland
- Concussion Centre, Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - J Murphy
- Concussion Centre, Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - N Reed
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Canada
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Hunt AW, Agnihotri S, Sack L, Tint A, Greenspoon D, Gauvin-Lepage J, Gagnon I, Reed N, Scratch S. Mood-related changes in children and adolescents with persistent concussion symptoms following a six-week active rehabilitation program. Brain Inj 2020; 34:1068-1073. [PMID: 32529851 DOI: 10.1080/02699052.2020.1776396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PRIMARY OBJECTIVE The purpose of this study is to explore changes in mood in youth with persistent post-concussion symptoms following participation in a six-week active rehabilitation program. RESEARCH DESIGN A pre-post test design was used. METHODS AND PROCEDURES Participants (N = 40 children and adolescents with concussion symptoms >2 weeks post-injury) were recruited from the concussion services at an urban children's rehabilitation hospital and the community. The program consisted of individualized low-intensity aerobic exercise, sport-specific drills, relaxation exercises and comprehensive education and support. The 6 week program was completed by participants in their home or local community with weekly check-ins with the research team. Data were analyzed using descriptive statistics and linear regressions. MAIN OUTCOMES AND RESULTS Outcome measures included the Beck Youth Inventories (youth), and the Child Behavior Checklist (parents). Results indicated significant improvements in anger and anxiety post-intervention with anger reduction being more pronounced in girls. CONCLUSIONS Active rehabilitation interventions may have positive effects on mood in youth recovering from concussion. Clinicians may wish to consider addressing anxiety and anger management strategies as part of comprehensive concussion management in youth.
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Affiliation(s)
- Anne W Hunt
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto , Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto, ON, Canada
| | - Sabrina Agnihotri
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto, ON, Canada
| | - Leah Sack
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, ON, Canada
| | - Ami Tint
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, ON, Canada.,Centre for Addiction and Mental Health , Toronto, ON, Canada.,Faculty of Medicine, University of Toronto , Toronto, ON, Canada
| | - Dayna Greenspoon
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, ON, Canada
| | - Jerome Gauvin-Lepage
- Faculty of Nursing, Université De Montréal , Montreal, QC, Canada.,Research Center of the Sainte-Justine University Hospital , Montreal, QC, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University , Montreal, QC, Canada.,Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Center , Montreal, QC, Canada
| | - Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto , Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto, ON, Canada
| | - Shannon Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto, ON, Canada
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Kita H, Mallory KD, Hickling A, Wilson KE, Kroshus E, Reed N. Social support during youth concussion recovery. Brain Inj 2020; 34:782-790. [PMID: 32315217 DOI: 10.1080/02699052.2020.1753243] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE We explored the lived experience of high-school aged girls receiving social support during concussion recovery to better understand (1) how they define meaningful social support and barriers/facilitators to receiving it; (2) who provides that support; and (3) the role of peers. METHODS In person, semi-structured interviews were conducted with 10 girls (aged 14-19 years) with a personal history of concussion. RESULTS Close friends, youth with personal history of concussion, and parents were identified as key providers of meaningful social support during concussion recovery. Participants identified specific examples of support provided by each group. Close friends built a sense of social inclusion that mitigated feelings of social isolation. Youth with a personal history of concussion used their lived experiences to communicate empathy and validate the participant's challenges. Parents assisted with practical challenges (e.g. accessing accommodations) by leveraging their "adult power". Participants identified that lack of understanding of their lived experiences was a key barrier to receiving support. They proposed solutions focused on education initiatives highlighting personal accounts from youth with concussion, and specific examples of how peers can help. CONCLUSIONS Fostering social support may require strategies tailored to each group of key providers as they mitigate different challenges in recovery.
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Affiliation(s)
- Helena Kita
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - Kylie D Mallory
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, Canada
| | - Andrea Hickling
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Canada
| | - Katherine E Wilson
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - Emily Kroshus
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute , Seattle, Washington, USA.,Department of Pediatrics, University of Washington , Seattle, Washington, USA
| | - Nick Reed
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Canada
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10
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Sang RC, Vawda Y, Greenspoon D, Reed N, Hunt AW. An innovative approach to measuring youth concussion recovery: Occupational performance. Br J Occup Ther 2019. [DOI: 10.1177/0308022619851415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Concussion is a common injury in youth. Studies report that active rehabilitation interventions reduce symptoms in these youth. There is no literature that addresses its impact on occupational performance. The purpose of this study was to identify: (a) occupational performance issues experienced by these youth; (b) changes in occupational performance and satisfaction following participation in a 6-week active rehabilitation intervention; and (c) the relationship between changes in occupational performance and symptoms. Method As part of a larger prospective repeated measures study, measures of occupational performance (Canadian Occupational Performance Measure) and self-reported symptoms (Post-Concussion Symptom Inventory) were collected pre and post intervention. Paired t-test, Spearman correlation, and descriptive analyses were conducted. Results Youth (9–18 years; n = 52) reported a range of occupational performance issues in self-care, productivity, and leisure domains. The most frequently reported occupational performance issues were sport (32.70%) and school (31.75%) activities. Positive changes were found in both performance and satisfaction of occupational performance issues post intervention ( p<.001). Correlation analysis revealed that as symptoms decreased, occupational performance improved ( rs = –.359, p = .020). Conclusion Using a measure of occupational performance may provide meaningful insight into the functional recovery of concussion, and can help identify targeted functional approaches to paediatric concussion management.
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Affiliation(s)
- Robyn Chen Sang
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Yasira Vawda
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Dayna Greenspoon
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Nick Reed
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Anne W Hunt
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
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Paniccia M, Knafo R, Thomas S, Taha T, Ladha A, Thompson L, Reed N. Mindfulness-Based Yoga for Youth With Persistent Concussion: A Pilot Study. Am J Occup Ther 2019; 73:7301205040p1-7301205040p11. [DOI: 10.5014/ajot.2019.027672] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We explored the potential impact of mindfulness-based yoga (MBY) for youth with persistent concussion by examining occupation-based and neurophysiological outcomes.
METHOD. In this case series design study, 6 youths ages 13–17 yr with concussion symptoms for >4 wk participated in an 8-wk MBY intervention, 1×/wk for 45 min. Participation, self-efficacy, and heart rate variability (24 hr) were collected before, after, and 3 mo after the intervention. Heart rate variability was also measured during each session.
RESULTS. Trends of increased self-efficacy in academic, social, and emotional domains were found after MBY and maintained at 3-mo follow-up. Trends of increasing heart rate variability were also found pre- to postintervention and within the eight MBY sessions.
CONCLUSION. Preliminary results reveal positive trends after a novel, safe intervention for youth with persistent concussion symptoms and the value of exploring both occupation-based and neurophysiological measures. Future research with a larger sample and control group is warranted.
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Affiliation(s)
- Melissa Paniccia
- Melissa Paniccia, PhD, MScOT, OT Reg. (Ont.), is Postdoctoral Fellow, Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada, and Postdoctoral Fellow, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada;
| | - Ruby Knafo
- Ruby Knafo, MScOT, OT Reg. (Ont.), is Occupational Therapist and Yoga Instructor, Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Scott Thomas
- Scott Thomas, PhD, is Professor, Faculty of Physical Education and Kinesiology, and School of Graduate Studies Appointment, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Tim Taha
- Tim Taha, PhD, is Associate Professor, Faculty of Physical Education and Kinesiology, and School of Graduate Studies Appointment, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Alysha Ladha
- Alysha Ladha, MD, is Developmental Pediatrician, Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada, and Division of Developmental Pediatrics, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Laura Thompson
- Laura Thompson, MScOT, OT Reg. (Ont.), is Occupational Therapist, Concussion Centre, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada, and Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Nick Reed
- Nick Reed, MScOT, OT Reg. (Ont.), PhD, is Clinician Scientist and Occupational Therapist, Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada, and School of Graduate Studies Appointment, Rehabilitation Sciences Institute, and Associate Professor, Department of Occupational Science and Occupational Therapy, University of Toronto
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Paniccia M, Taha T, Keightley M, Thomas S, Verweel L, Murphy J, Wilson K, Reed N. Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology. J Vis Exp 2018:58203. [PMID: 30295657 PMCID: PMC6235273 DOI: 10.3791/58203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Participation in organized sports makes a significant contribution to youth development, but places youth at a higher risk for sustaining a concussion. To date, return-to-activity decision-making has been anchored in the monitoring of self-reported concussion symptoms and neurocognitive testing. However, multi-modal assessments that corroborate objective physiological measures with traditional subjective symptom reporting are needed and can be valuable. Heart rate variability (HRV) is a non-invasive physiological indicator of the autonomic nervous system, capturing the reciprocal interplay between the sympathetic and parasympathetic nervous systems. There is a dearth of literature exploring the effect of concussion on HRV in youth athletes, and developmental differences preclude the application of adult findings to a pediatric population. Further, the current state of HRV methodology has primarily included short-term (5-15 min) recordings, by using resting state or short-term physical exertion testing to elucidate changes following concussion. The novelty in utilizing a 24 h recording methodology is that it has the potential to capture natural variation in autonomic function, directly related to the activities a youth athlete performs on a regular basis. Within a prospective, longitudinal research setting, this novel approach to quantifying autonomic function can provide important information regarding the recovery trajectory, alongside traditional self-report symptom measures. Our objectives regarding a 24 h recording methodology were to (1) evaluate the physiological effects of a concussion in youth athletes, and (2) describe the trajectory of physiological change, while considering the resolution of self-reported post-concussion symptoms. To achieve these objectives, non-invasive sensor technology was implemented. The raw beat-to-beat time intervals captured can be transformed to derive time domain and frequency domain measures, which reflect an individual's ability to adapt and be flexible to their ever-changing environment. By using non-invasive heart rate technology, autonomic function can be quantified outside of a traditional controlled research setting.
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Affiliation(s)
- Melissa Paniccia
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital;
| | - Tim Taha
- Faculty of Kinesiology and Physical Education, University of Toronto
| | - Michelle Keightley
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto
| | - Scott Thomas
- Faculty of Kinesiology and Physical Education, University of Toronto
| | - Lee Verweel
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital
| | - James Murphy
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital
| | - Katherine Wilson
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital
| | - Nick Reed
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto; Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto
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