Concussion knowledge among rehabilitation staff

Improving Cognitive Empathy Through Traumatic Brain Injury Experiential Learning: A Novel Mixed Methods Approach for Speech-Language Pathology Graduate Education

PURPOSE

The aim of this study was to gauge the impacts of cognitive empathy training experiential learning on traumatic brain injury (TBI) knowledge, awareness, confidence, and empathy in a pilot study of speech-language pathology graduate students.

METHOD

A descriptive quasi-experimental convergent parallel mixed methods design intervention pilot study (QUAL + QUANT) was conducted with a diverse convenience sample of 19 first- and second-year speech-language pathology graduate students who engaged in a half-day TBI point-of-view simulation. The simulation was co-constructed through a participatory design with those living with TBI based on Kolb's experiential learning model and followed the recommendations for point-of-view simulation ethics. After setting goals, participants engaged in four station activities completing cognitive communication activities of daily living, while experiencing manipulations to their sensory systems. Activities included reading while wearing goggles with blurred or double vision, listening with tinnitus and auditory processing disorder, and taking notes during a manipulated college lecture. Participants also interacted with an individual living with TBI and responded to targeted prompts throughout the day. Quantitative outcomes were measured using published TBI knowledge and empathy scales and analyzed with descriptive, parametric and nonparametric statistics, while qualitative data were analyzed through thematic analysis. Data were then triangulated through mixed methods. Mixed methods design quality was ensured by following the Mixed Methods Appraisal Tool (Hong et al., 2018).

RESULTS

After experiential learning, significant increases in speech-language pathologist (SLP) TBI knowledge, empathy, and awareness of TBI symptom and symptom impacts were found. Many, but not all, participants also reported changes in clinical confidence.

CONCLUSIONS

Cognitive empathy training using experiential learning appears to be a viable method to increase SLP knowledge, empathy, and symptom awareness for TBI clinical care. Future research should replicate the study with different types and locations of speech-language pathology graduate programs to consider TBI empathy training as a standard training method to improve both individual and provider outcomes.

PLAIN LANGUAGE SUMMARY

Individuals and families living with traumatic brain injury (TBI) say their providers lack necessary knowledge; do not seem to understand what living with TBI is like; and can be dismissive, uncaring, and lacking empathy. Health care providers do not automatically imagine the world from the patient's perspectives, to "walk in another's shoes"; it takes intentional effort and training. This project attempted to train those specific empathy skills for speech-language pathology graduate students through experiential learning. Experiential learning is a process where people engage in meaningful activities and spend lots of time reflecting on their experiences. Working with people living with TBI, we built a half-day workshop where 19 graduate students completed normal daily activities (such as texting, reading) through different stations that provided insights into what it may be like to have a TBI, such as wearing goggles to induce blurred or double vision, having ringing in their ears (tinnitus), and watching an overwhelming manipulated college video lecture. Afterward, participants listened to a person living with TBI and asked questions. This was important because engaging in activities without interacting with someone living with TBI misses a key idea about listening to and learning from individuals and families. We measured TBI knowledge, empathy, and confidence by looking at surveys pre- and posttraining and reading students' written reflections. Participants reported significant changes in how they think about brain injury and how they will provide clinical care for people living with TBI in the future.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28098254.

Interventions to Improve the Occupational Performance of Youth With Persistent Postconcussion Symptoms: A Systematic Review

IMPORTANCE

Persistent postconcussion symptoms (PPCS) may negatively affect youth's occupational performance in activities of daily living, education, play and leisure, social participation, and rest and sleep.

OBJECTIVE

This review provides occupational therapists with evidence related to interventions for youth with PPCS.

DATA SOURCES

Searches were performed in Embase, PubMed, SportDiscus, CINAHL, and Web of Science.

STUDY SELECTION AND DATA COLLECTION

Inclusion criteria were as follows: studies published in English from January 1, 2013, to February 7, 2023; youth ages 3 to 18 yr old; PPCS for at least 2 wk after injury; interventions within the scope of occupational therapy; and outcomes related to areas of occupation. All levels of evidence (1-5) were included and graded for quality using the Oxford Centre for Evidence-Based Medicine (2009) levels of evidence. This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

FINDINGS

Twenty articles met inclusion criteria (7 randomized controlled trials, 1 nonrandomized controlled group design, 3 single-group designs, 5 case series, and 4 single-subject designs). Interventions reviewed were active rehabilitation, vision-related interventions, psychoeducation, cognitive-behavioral therapy (CBT) techniques, the Cognitive Orientation to daily Occupational Performance (CO-OP), and music therapy. Strong evidence supports CBT, with significant clinical outcomes in sleep and education. Moderate strength of evidence supports psychoeducation and active rehabilitation for improving functional outcomes. More evidence is needed to make clinical recommendations regarding vision-related interventions, the CO-OP, and music therapy.

CONCLUSIONS AND RELEVANCE

Occupational therapists should consider CBT, psychoeducation, and active rehabilitation to improve occupational performance among youth with PPCS. Plain-Language Summary: Some youth will have persistent symptoms that do not resolve within 2 weeks after a concussion. Because of these persistent symptoms, they may have difficulty completing everyday activities. This review evaluated evidence addressing the ability of youth with persistent postconcussion symptoms (PPCS) to complete everyday activities. The authors found that cognitive-behavioral therapy, psychoeducation (aimed at helping youth understand and cope with their concussion symptoms), and active rehabilitation (aerobic and coordination exercises, such as jumping jacks and ball skills) should be considered when working with youth (ages 3-18 years) with PPCS. Using these interventions in occupational therapy sessions may improve the ability of youth to complete their everyday activities after a concussion.

Experiences of Children and Youth With Concussion: A Qualitative Study

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.

Concussion knowledge among North American chiropractors

OBJECTIVES

To investigate the degree of knowledge North American chiropractors have in regards to concussion diagnosis and management.

METHODS

A Concussion Knowledge Assessment Tool (CKAT) survey was administered to North American chiropractors through SurveyMonkey.com. This survey was sent to all practicing members of the American Chiropractic Association (ACA) and Canadian Chiropractic Association (CCA).

RESULTS

1321 surveys were completed and analyzed (response rate of 3.3%). The average score of the CKAT amongst North American Chiropractors was 4.82 out of 9. Using our modified scoring method, chiropractors scored 39.44 out of 48.

CONCLUSIONS

North American chiropractors who participated in this study demonstrated concussion knowledge and management using the CKAT tool. Further investigation is recommended in order to address learning gaps and updating the CKAT based on current literature and guidelines.

Blowing the Whistle on Concussion Knowledge and Education in Youth Sport Referees

Purpose

To gain an understanding of referee concussion knowledge, what sporting organizations were doing to prepare their referees to recognize concussions in youth sport, and what role referees could play in overall concussion safety.

Materials and Methods

A total of 134 referees participated in the study across four provincial sporting organizations (rugby, soccer, ice hockey, and football). Participants completed a concussion knowledge questionnaire that explored knowledge about concussion education, recognition, management, preparedness, and the role of the referee in overall concussion management.

Results

Overall, the sample was found to be moderately knowledgeable about concussions. Referees that received previous formal concussion education had statistically significant higher average scores when compared to those without formalized concussion education (P=0.001). However, only 24% of respondents reported receiving any formal education from their sporting body or referee organization. About 85% felt that referees could play an important role in concussion recognition in youth sport, but only 41% felt they were adequately equipped with the knowledge and skills to recognize these injuries.

Conclusion

The findings from this study suggest that national, provincial, and individual sporting organizations should ensure that all stakeholders (including referees) are formally educated about concussions to encourage a safety-first environment for youth athletes. Educational sessions should focus on the general aspects of SRC while also focusing on the specific role of the referee in concussion recognition.

Establishing Consensus for Essential Elements in Returning to Learn Following a Concussion

BACKGROUND

Returning to learn following a concussion is the process of managing a student's recovery during the school day by implementation of academic supports with varying intensity. Due to a lack of consensus or even guidance on Return to Learn, this paper set out to establish cross discipline consensus on some essential elements of Return to Learn using a Delphi method.

METHODS

Sixteen national organizations participated in a Delphi process to reach consensus on overarching themes of Return to Learn focused on: returning a student to school, composition of the school-based concussion management team, progress-monitoring, educational safeguards, neuropsychological testing, and legislation. Two rounds of questionnaires were disseminated via email using a Delphi process. Consensus was established during round 2.

RESULTS

Twelve national organizations were able to reach consensus and endorse 13 essential elements of Return to Learn following a concussion.

CONCLUSIONS

There continues to be limited research on concussion Return to Learn leading to confusion in the field. In this paper, we demonstrate consensus on a number of essential elements, from a wide variety of professional disciplines who participate in the care of students following a concussion, as a starting place for some guidance on Return to Learn.

Awareness and Perceived Value of Eye Tracking Technology for Concussion Assessment among Sports Medicine Clinicians: A Multinational Study

Objective: The awareness of concussion as a serious and frequently occurring sports injury and its management has evolved significantly. One viable objective diagnostic tool is eye tracking technology. The authors hypothesized that while clinicians may be aware that assessing eye movements in concussed athletes can be beneficial, it is possible that, due to the novelty of the eye tracking technology and limited exposure, only a few actually use it in their practice. The study aimed to assess the awareness of eye movement deficits associated with concussion amongst sports medicine clinicians and to determine the utilization and perceptions of the eye tracking technology for concussion diagnosis.Methods: An online 18-question survey was distributed internationally from January until December 2017 and completed by 171 sports medicine clinicians (sport physicians, therapists, general practitioners, neuropsychologists) from 32 countries.Results: Respondents indicated that subjectivity of assessments remained a major limitation of established diagnostic tools. Eye tracking technology, despite its potential to attenuate this limitation, was only used by 12% of respondents. To diagnose concussion, 77% did not use any eye movement assessment tools other than own clinical assessment. With the exception of abnormal pupil light reflex, which was checked by 68%, eye movement deficits were inspected by less than half of the respondents (46.3 ± 12%).Conclusion: Even among sports medicine clinicians who regularly attend to patients with concussions, there is insufficient awareness that concussion can lead to abnormal eye tracking behavior. Lack of exposure to the sensitive eye tracking equipment may be a limiting factor for using eye movement metrics for concussion diagnostics. Facilitating the awareness of objective methods, like eye tracking technology, may help assure the appropriate continuum of identification and treatment for concussed athletes. Increasing educational opportunities and practical experience of clinicians regarding concussive symptoms and potential innovative technology is strongly advocated.

Beliefs About the Influence of Rest During Concussion Recovery May Predict Activity and Symptom Progression Within an Active Duty Military Population

OBJECTIVES

To evaluate relationships between beliefs about the impact of rest and the level of activities and symptoms over time among active duty Service members sustaining concussion, and whether these relationships vary by provision of concussion education.

DESIGN

Longitudinal study using multilevel modeling to assess the relationship between beliefs about rest within 72 hours of concussion and change in activity and symptom level over time, as well as interaction by concussion education at the initial clinic visit.

SETTING

Three military treatment facilities.

PARTICIPANTS

Study participants included active duty Service members diagnosed with a concussion (N=111; median age, 24 y). Individuals with previous history of concussion within 12 months of study enrollment were excluded.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Activity questionnaire and the Neurobehavioral Symptom Inventory assessed within 72 hours of concussion; at 1 week; and at 1, 3, and 6 month(s) postinjury.

RESULTS

Receipt of concussion education from providers was significantly associated with greater belief that rest influences concussion recovery. Greater belief that rest influences symptom recovery at the acute stage of concussion was associated with a greater increase in activities over time, but only among those who received education from their provider. Additionally, greater belief about the influence of rest was related to a more rapid decrease in symptoms over time.

CONCLUSIONS

Concussed Service members who underestimate the influence of rest during acute recovery may be at risk for poorer recovery. Treatment of Service members with postconcussive symptoms should consider patient knowledge and/or beliefs about rest and recovery, which may influence prognosis. Our results support the provider's use of concussion education to correct potential misconceptions that may negatively impact symptom recovery.

Occupational Therapists' Perceived Confidence in the Management of Concussion: Implications for Occupational Therapy Education

The purposes of this study were to examine occupational therapists' perceived confidence in the treatment and assessment of patients who have sustained concussion, to determine what factors are associated with higher versus lower levels of confidence, and to determine if concussion was a topic covered in occupational therapy curricula. This study utilized an electronic questionnaire sent out to occupational therapists in all areas of practice through social media, AOTA discussion forums, and through a continuing education company. Results indicate that there is variability in occupational therapists' perceived confidence in evaluation and treatment for individuals who have sustained concussion. Chi-square analysis indicates that higher levels of perceived confidence are associated with more clinical experience and greater amounts of continuing education in the area of concussion. Occupational therapists may benefit from additional training and education in the area of concussion.