Returning to Activity After a Concussion

Adolescent and Parent Perceptions of the Impact of Concussion/mTBI on Family Functioning and Activity Levels in Recovery

OBJECTIVE

To explore adolescent and parent perceptions of the impact of a concussion/mild traumatic brain injury (mTBI) on family functioning and activity levels in the first 4 weeks of recovery.

SETTING

Outpatient research setting.

PARTICIPANTS

Twenty-seven adolescents (aged of 13-17 years) within 1 week of a concussion/mTBI and a parent/guardian were enrolled in the study.

DESIGN

Prospective ecological study with qualitative, semistructured interviews.

MAIN MEASURES

Adolescents reported symptoms electronically every 2 days for 28 days via the Post-Concussion Symptom Inventory. Semistructured interviews were completed with each adolescent-parent dyad at the end of the 28-day period. Interview questions focused on perceptions of recovery progress and study procedures.

RESULTS

Symptom trajectories were variable across participants. Three main themes emerged from thematic analysis, including: (1) disruption of routines and activities, (2) injury management considerations, and (3) positive and negative influential factors (eg, school and coach support, timing of injury, and recovery expectations). Results highlighted nuances of recovery challenges that families specifically face and help emphasize the potential benefits of shared decision-making and where more guidance would be appreciated such as more specific self-management of symptoms and physical activity reintegration strategies.

CONCLUSIONS

Study findings support a shared decision-making approach with the identified themes as potential topics to help consider social and environmental influences on recovery. The themes presented in the results could be topics emphasized during intake and follow-up visit processes to help guide plans of care and return-to-activity decisions.

Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development

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.

Neuro-Visual and Vestibular Manifestations of Concussion and Mild TBI

PURPOSE OF REVIEW

Mild traumatic brain injury, or concussion, is a major cause of disability. Vestibular and visual dysfunction following concussion is common and can negatively affect patients' well-being and prolong recovery. Etiologies of visual and vestibular symptoms are numerous, including ocular, neuro-ophthalmic, otologic, and neuro-vestibular conditions. Some etiologies are benign and may be treatable, while others are potentially vision or life-threatening, making a focused history and examination essential. This review offers an approach to the evaluation and treatment of the most common neuro-visual and vestibular impairments that may result from concussion.

RECENT FINDINGS

Treatment of concussion including exercise, computerized programs, transcranial magnetic stimulation, gene therapy, stem cell therapy, and nanoparticles has shown promise. Many novel therapies are in the pipework for visual and vestibular recovery after concussion; however, the treatment mainstay remains therapy and evaluation for co-existing diseases.

Therapeutic Effects of Meditation, Yoga, and Mindfulness-Based Interventions for Chronic Symptoms of Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis

BACKGROUND

Chronic symptoms of mild traumatic brain injury (mTBI) vary greatly and are difficult to treat; we investigate the impact of meditation, yoga, and mindfulness-based interventions on this treatment group.

METHOD

Search included four databases, allowing studies of any design containing pre/post outcomes for meditation, yoga, or mindfulness-based interventions in people suffering from brain injury acquired by mechanical force. Analyses used robust variance estimation to assess overall effects and random-effects models for selected outcomes; we evaluated both between- and within-group changes.

RESULTS

Twenty studies (N = 539) were included. Results revealed significant improvement of overall symptoms compared to controls (d = 0.41; 95% CI [0.04, 0.77]; τ²  = 0.06), with significant within-group improvements in mental health (d = 0.39), physical health (d = 0.39), cognitive performance (d = 0.24), quality of life (d = 0.39), and self-related processing (d = 0.38). Symptoms showing greatest improvement were fatigue (d = 0.96) and depression (d = 0.40). Findings were homogeneous across studies. Study quality concerns include lack of randomisation, blinding, and recording of adverse events.

CONCLUSIONS

This first-ever meta-analysis on meditation, yoga, and mindfulness-based interventions for chronic symptoms of mTBI offers hope but highlights the need for rigorous new trials to advance clinical applications and to explore mechanistic pathways.