Exploring the experiences of youth with persistent post-concussion symptoms and their families with an interprofessional team-based assessment.

A proportion of youth who experience concussion develop persistent or prolonged post-concussion symptoms (PPCS). Owing to the complex clinical presentation of PPCS, an interprofessional approach to care is increasingly recommended. Despite increased research in this area, there remains a dearth of evidence from the perspective of the recipients of interprofessional concussion care. The objective of this qualitative descriptive study was to explore the experiences of youth with PPCS and their parents who participated in an interdisciplinary team-based assessment (ITA) at a children's rehabilitation hospital in Ontario, Canada. Semi-structured interviews were conducted with fifteen individuals (eight youth [8-17 years] and seven parents). Results suggest that the ITA serves as a context for meaningful therapeutic interactions whereby youth, their parents, and the interprofessional team establish and build therapeutic relationships, engage in dialogue emphasizing collaboration, prioritize the young person rather than the injury, and co-create an individualized treatment plan. Results are discussed within the broader literature in the areas of client and family-centered care, interdisciplinary assessment, and concussion management.

Re/producing the Pediatric Concussion Discourse in clinical rehabilitation practice.

PURPOSE: In the field of pediatric concussion, little to no scholarship has examined how clinical practice is shaped by patterned ways of thinking, talking about, and coming to understand concussion and young people (or "discourses of concussion in young people"). In this paper, we examine the ways in which one such discourse, the Pediatric Concussion Discourse (PCD), shapes how young people with concussion, their parents, and clinicians can think about, act in relation to, and experience concussion. MATERIALS AND METHODS: This critical rehabilitation research is informed by the post-structuralist theory of Michel Foucault (1926-1984), and the key concepts of power/knowledge, discourse, and the subject. RESULTS: Circulating through clinical guidelines for the management of pediatric concussion, the PCD re/produces the expectation that young people with concussion and their parents will behave as "responsible" subjects who follow the recommendations of so-called experts without question. If recommendations are not implemented, the PCD has the potential to constitute these same groups as "nonadherent", re/producing problematic discourses of medical compliance. CONCLUSIONS: By examining the effects of the PCD, it becomes possible to imagine how clinical practice and research might evolve in new ways that respect the knowledges and experiences of young people with concussion and their parents.Implications for RehabilitationEngaging in critical examination of clinical rehabilitative practice creates opportunity to imagine how we might approach commonly adopted clinical approaches, including the delivery of health education, differently.Implications for clinical rehabilitation practice include delivering health education in the context of supportive therapeutic relationships that respect the knowledges and experience of young people with concussion and their parents.Implications for rehabilitation research include engaging with critical scholarship within and beyond field and disciplinary boundaries, engaging in formal educational opportunities, and connecting with less formal but invaluable communities of practice.

Researching experiences of childhood brain injury: co-constructing knowledge with children through arts-based research methods.

Objective: In the knowledge base examining experiences of childhood brain injury, the perspectives of children with brain injury are notably lacking. This failure to represent the voices of pediatric clients has resulted in an incomplete knowledge base from which to inform evidence-based rehabilitation practice. In this paper, we examine why the perspectives of children with brain injury are rarely sought and propose a new way forward.Methods: We draw upon current evidence and practices in related fields and present an exemplar from an in-progress qualitative arts-based research project with children with brain injury.Results: Assumptions ingrained in research practices, particularly those surrounding the capacity of 'doubly vulnerable' children with brain injury to produce knowledge, have resulted in the relative exclusion of this group from research that concerns them. For the field to evolve, research practices must value children's first-hand accounts, engage them in co-constructing knowledge about their lives, and invite methods that meet their interests and abilities.Conclusion: By reframing how we think about the capacities of children with disabilities and shifting our research practices to include children with brain injury as knowledgeable participants, it becomes possible to expand the knowledge base upon which clinical rehabilitation practices are built.Implications for RehabilitationCurrent research practices preclude 'doubly vulnerable' pediatric populations, including children with brain injury, from actively contributing to research that concerns them.As a result, the perspectives of children with brain injury are virtually absent from research, rendering the evidence base upon which rehabilitative practices are built incomplete.Reframing how we think about the capacities of children with brain injury can shift how we engage with them, both in research and clinic, and may subsequently impact the knowledge available to us.Implications for client-centred rehabilitation are discussed, including the need to understand children as capable of insight into their own experience, as able to contribute to a more complete understanding of the health phenomena that affect them, and as invaluable and active participants in research and clinical care.

Feasibility and Effects of the CO-OP Approach™ in Postconcussion Rehabilitation.

OBJECTIVE: We determined the feasibility and effects of the Cognitive Orientation to daily Occupational Performance (CO-OP) ApproachTM on activity performance and satisfaction, symptoms, and mood of adolescents with persistent postconcussion symptoms. METHOD: In a prospective case series, 3 participants with persistent symptoms 3 mo after concussion and difficulties resuming activities were taught to use a metacognitive strategy (Goal-Plan-Do-Check) to work toward occupation-based goals in a 7-wk intervention (10 sessions, 30-60 min each). Participants were assessed pre- and postintervention and at 3-mo follow-up. Feasibility was determined by positive changes on study measures, ease of administration, and acceptability to participants. RESULTS: Clinically significant, positive changes were found in participants' activity performance and satisfaction. All participants had decreases in symptoms and improved mood scores at posttest. CONCLUSION: The CO-OP Approach to rehabilitation for youth postconcussion is feasible and may make a positive contribution to recovery.

Perceptions of mild traumatic brain injury in adults: a scoping review.

PURPOSE: The purpose of this article is to synthesise the scholarly literature related to perceptions of mild traumatic brain injury (mTBI) and health outcomes in an adult population. METHODS: A scoping review was undertaken. An electronic search of seven databases was conducted. Studies were included if (1) they related to perceptions of mild traumatic brain injury, (2) the population was adults with mild traumatic brain injury, and (3) health outcomes were reported. Studies were also identified through a hand search of reference lists of articles meeting study criteria. Numerical analysis and qualitative content analysis were employed. RESULTS: Twenty-one studies published between 1992 and 2015 were included. Key findings regarding how perceptions of mTBI have been conceptualised, assessed, manipulated, and associated with health outcomes across the literature are reported. Clinical implications of studies are presented and clinical examples provided. Findings are discussed in the context of the broader literature and rehabilitation practice. CONCLUSIONS: Perceptions of mild traumatic brain injury, or how persons think about and understand mTBI and recovery, have important implications for rehabilitation intervention. Intervention research integrating perceptions of mild traumatic brain injury, while emerging, is needed. Engagement with the health psychology literature is recommended. Implications for rehabilitation Perceptions of mild traumatic brain injury (mTBI) and recovery have been associated with health outcomes and are worth considering in clinical rehabilitation practice. Studies reviewed demonstrate associations between negative perceptions of mTBI and increased symptom report, poor cognitive test performance, and impaired function. Potential implications for the rehabilitation process are discussed, including how to assess perceptions of mTBI in clinical interaction, and how to communicate information regarding symptoms, effects on daily life, and expectations for recovery following injury.

A multi-modal approach to assessing recovery in youth athletes following concussion.

Concussion is one of the most commonly reported injuries amongst children and youth involved in sport participation. Following a concussion, youth can experience a range of short and long term neurobehavioral symptoms (somatic, cognitive and emotional/behavioral) that can have a significant impact on one's participation in daily activities and pursuits of interest (e.g., school, sports, work, family/social life, etc.). Despite this, there remains a paucity in clinically driven research aimed specifically at exploring concussion within the youth sport population, and more specifically, multi-modal approaches to measuring recovery. This article provides an overview of a novel and multi-modal approach to measuring recovery amongst youth athletes following concussion. The presented approach involves the use of both pre-injury/baseline testing and post-injury/follow-up testing to assess performance across a wide variety of domains (post-concussion symptoms, cognition, balance, strength, agility/motor skills and resting state heart rate variability). The goal of this research is to gain a more objective and accurate understanding of recovery following concussion in youth athletes (ages 10-18 years). Findings from this research can help to inform the development and use of improved approaches to concussion management and rehabilitation specific to the youth sport community.