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Sharma B, Obeid J, DeMatteo C, Noseworthy MD, Timmons BW. New Insights Into Accelerometer-Measured Habitual Physical Activity and Sedentary Time During Early Recovery in Pediatric Concussion. Pediatr Exerc Sci 2024; 36:58-65. [PMID: 37591503 DOI: 10.1123/pes.2023-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/26/2023] [Accepted: 05/25/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Concussion management is shifting away from a rest-is-best approach, as data now suggest that exercise-is-medicine for this mild brain injury. Despite this, we have limited data on habitual physical activity following concussion. Therefore, our objective was to quantify accelerometer-measured physical activity and sedentary time in children with concussion (within the first month of injury) and healthy controls. We hypothesized that children with concussion would be less active than their healthy peers. METHODS We performed a secondary analysis of prospectively collected accelerometer data. Our sample included children with concussion (n = 60, 31 females) and historical controls (n = 60) matched for age, sex, and season of accelerometer wear. RESULTS Children with concussion were significantly more sedentary than controls (mean difference [MD], 38.3 min/d, P = .006), and spent less time performing light physical activity (MD, -19.5 min/d, P = .008), moderate physical activity (MD, -9.8 min/d, P < .001), and vigorous physical activity (MD, -12.0 min/d, P < .001); these differences were observed from 8:00 AM to 9:00 PM. Sex-specific analyses identified that girls with concussion were less active and more sedentary than both boys with concussion (P = .010) and healthy girls (P < .010). CONCLUSION There is an activity deficit observed within the first month of pediatric concussion. Physical activity guidelines should address this while considering sex effects.
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Affiliation(s)
- Bhanu Sharma
- Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, ON,Canada
| | - Joyce Obeid
- Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, ON,Canada
| | - Carol DeMatteo
- School of Rehabilitation Science, McMaster University, Hamilton, ON,Canada
- CanChild Center for Childhood Disability Research, McMaster University, Hamilton, ON,Canada
| | - Michael D Noseworthy
- Imaging Research Center, St. Joseph's Healthcare, Hamilton, ON,Canada
- Department of Electrical & Computer Engineering, McMaster University, Hamilton, ON,Canada
- McMaster School of Biomedical Engineering, McMaster University, Hamilton, ON,Canada
- Department of Radiology, McMaster University, Hamilton, ON,Canada
| | - Brian W Timmons
- Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, ON,Canada
- CanChild Center for Childhood Disability Research, McMaster University, Hamilton, ON,Canada
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Wallace TD, Knollman-Porter K, Brown J, Schwartz A, Hodge A, Brown G, Beardslee J, Gore RK. mTBI evaluation, management, and referral to allied healthcare: practices of first-line healthcare professionals. Brain Inj 2024; 38:32-44. [PMID: 38333958 DOI: 10.1080/02699052.2024.2309245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/19/2024] [Indexed: 02/10/2024]
Abstract
PRIMARY OBJECTIVE To gain an understanding of current evaluation practices, post-injury recommendations, and referrals to allied healthcare professions (AHP) by first-line healthcare professionals (FHPs) providing care for people with mild traumatic brain injury (mTBI). RESEARCH DESIGN Survey study. METHODS AND PROCEDURES Physicians, physician assistants, nurse practitioners, nurses, and athletic trainers (n = 126) completed an online survey, including Likert scale and free response question relating to mTBI evaluation, management, and referral practices. MAIN OUTCOMES AND RESULTS FHPs surveyed reported being confident in their ability to evaluate patients with suspected mTBI, relying most heavily on patient-reported symptoms and physical signs as methods of evaluation. Most FHPs reported making recommendations to compensate for the symptoms experienced following mTBI diagnosis. In contrast, FHPs expressed challenges in the evaluation and management of symptoms associated with mTBI along with limited knowledge of and referrals to AHPs. CONCLUSIONS Overall, FHPs feel confident in the diagnosis of mTBI but experience assessment and management challenges. AHPs are underutilized on mTBI management teams calling for a need for multidisciplinary collaboration on research, education, and rehabilitation efforts to optimally care for people experiencing mTBI symptoms.
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Affiliation(s)
- Tracey D Wallace
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA
- SHARE Military Initiative, Shepherd Center, Atlanta, Georgia, USA
| | | | | | - Amber Schwartz
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA
- SHARE Military Initiative, Shepherd Center, Atlanta, Georgia, USA
| | - April Hodge
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA
| | - Gregory Brown
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA
- SHARE Military Initiative, Shepherd Center, Atlanta, Georgia, USA
| | | | - Russell K Gore
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA
- SHARE Military Initiative, Shepherd Center, Atlanta, Georgia, USA
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Schmidt JD, Anderson M, Weber Rawlins M, Foster CA, Johnson BR, D'Lauro C. Number of prior concussions predict poorer concussion care seeking in military cadets. Brain Inj 2021; 35:1598-1606. [PMID: 34546810 DOI: 10.1080/02699052.2021.1976418] [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] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVE To determine whether concussion history predicts concussion care seeking, self-management practices, or confidence to recognize/report. RESEARCH DESIGN Cross-sectional. METHODS & PROCEDURES 706 United States Air Force Academy (USAFA) cadets completed survey items regarding concussion history (0,1,2,3+), likelihood of reporting a concussion, self-management, and confidence to recognize/report. We used multivariate ordinal and binary logistic regression models to predict responses using concussion history, sex, and race.Main outcomes & results: cadets with 1 (OR = 0.59, 95%CI:0.43-0.82), 2 (OR = 0.55, 95%CI:0.31-0.98), or 3+ (OR = 0.36, 95%CI:0.17-0.78) concussions while at USAFA had respective 41%, 45%, and 64% lower likelihood to report the concussion scenario (ref = no history, p < .001). USAFA cadets with more extensive concussion histories had higher prevalence of not seeking care for a concussion (p < .001); more strongly endorsed self-management (p = .001-0.010); and had greater confidence in their ability to recognize a concussion (p = .005), but not to report (p = .198-0.413). CONCLUSIONS Prior concussion experiences may deter cadets from seeking medical care for future concussions. Interventions should address concussion history and clinicians should consider how the post-concussion management process might deter care seeking.
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Affiliation(s)
- Julianne D Schmidt
- UGAConcussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, USA
| | - Melissa Anderson
- UGAConcussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, USA
| | - Michelle Weber Rawlins
- Department of Interdisciplinary Health Sciences, At Still University, Mesa, Arizona, USA
| | - Craig A Foster
- Department of Behavioral Sciences and Leadership, USAF Academy, Colorado, USA
| | - Brian R Johnson
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Christopher D'Lauro
- Department of Behavioral Sciences and Leadership, USAF Academy, Colorado, USA
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Psychoeducation as Precision Health in Military-Related Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2021; 103:1222-1232. [PMID: 34516996 DOI: 10.1016/j.apmr.2021.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/13/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022]
Abstract
A significant proportion of Service Members and Veterans (SMVs) experience at least 1 mild traumatic brain injury during military activities (mil-mTBI), which can result in enduring cognitive symptoms. Although multiple cognitive rehabilitation (CR) interventions have been developed for this population, patient psychoeducation focusing on biopsychosocial relationships and health behaviors is often cited as the first line of defense for mil-mTBI sequelae. However, theoretical and conceptual foundations of these psychoeducational techniques are not well articulated. This raises questions about the potency of attempts to boost health literacy in affected SMVs, who represent a highly heterogeneous patient population within a special cultural milieu. To elucidate the significance of this problem and identify opportunities for improvement, we view the psychoeducation of SMVs through the lens of educational principles described in serious mental illness, where "psychoeducation" was first formally defined, as well as contextual and phenomenological aspects of mil-mTBI that may complicate treatment efforts. To advance psychoeducation research and practice in mil-mTBI, we discuss how treatment theory, which seeks to link active treatment ingredients with specific therapeutic targets, and an associated conceptual framework for medical rehabilitation-the Rehabilitation Treatment Specification System-can be leveraged to personalize educational content, integrate it into multicomponent CR interventions, and evaluate its effectiveness.
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Ettenhofer ML, Remigio-Baker RA, Bailie JM, Cole WR, Gregory E. Best Practices for Progressive Return to Activity after Concussion: Lessons Learned from a Prospective Study of U.S. Military Service Members. Neurotrauma Rep 2020; 1:137-145. [PMID: 33274343 PMCID: PMC7703689 DOI: 10.1089/neur.2020.0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary care providers can play a crucial role in the clinical management of concussion. However, many providers lack up-to-date information about best practices for rest and return to activity after these injuries. Most research on this topic has been conducted in athletes, and so less is known about how to assist patients with returning to activity in other settings and populations. This article provides a review of best practices for management of progressive return to activity after concussion, with an emphasis on "lessons learned" from the Defense and Veterans Brain Injury Center (DVBIC) Progressive Return to Activity (PRA) study, a multi-site longitudinal research project conducted to evaluate concussion management practices and the effectiveness of provider training on DVBIC clinical recommendations (CRs). Provider clinical practices and patient outcomes were examined at three U.S. military treatment facilities before and after providers completed a standardized training on DVBIC PRA CRs. In summary, research findings provide additional support that concussion recovery can be influenced by patients' activity levels after injury. Patients with concussion may experience poorer outcomes if they return to pre-injury levels of activity too rapidly, but they may also be at risk for prolonged symptoms if they fail to increase activity levels over time after an initial period of rest. Additionally, training primary care providers in return to activity guidelines can result in more effective patient education and better clinical outcomes. This knowledge can be used to inform best practices for progressive return to activity in both civilian and military settings.
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Affiliation(s)
- Mark L. Ettenhofer
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
- Naval Medical Center San Diego, San Diego, California, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
- University of California, San Diego, La Jolla, California, USA
| | - Rosemay A. Remigio-Baker
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, California, USA
- Henry M. Jackson Foundation, Bethesda, Maryland, USA
| | - Jason M. Bailie
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, California, USA
| | - Wesley R. Cole
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
- Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - Emma Gregory
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
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