Efficacy of an Intensive Exposure Intervention for Individuals With Persistent Concussion Symptoms Following Concussion: A Concurrent Multiple Baseline Single-Case Experimental Design (SCED) Study.

#NPsychPick of the Month: Efficacy of an Intensive Exposure Intervention for Individuals With Persistent Concussion Symptoms Following Concussion: A Concurrent Multiple Baseline Single-Case Experimental Design Study

Efficacy of an Intensive Exposure Intervention for Individuals With Persistent Concussion Symptoms Following Concussion: A Concurrent Multiple Baseline Single-Case Experimental Design (SCED) Study.

King, Skye MSc; Stapert, Sven Z. PhD; Winkens, Ieke PhD; van der Naalt, Joukje PhD, MD; van Heugten, Caroline M. PhD; Rijkeboer, Marleen M. PhD

#NPsychPick of the Month

Abstract

Objective:

After a concussion, 1 in 3 patients report persistent symptoms and experience long-term consequences interfering with daily functioning, known as persistent concussion symptoms (PCS). Evidence suggests PCS is (partly) maintained by anxious thoughts about brain functioning, recovery, and experienced symptoms, leading to avoidance behaviors, which may prevent patients from meeting life demands. We aimed to investigate the efficacy of a newly developed intensive exposure intervention for individuals with PCS after concussion aimed to tackle avoidance behavior.

Setting:

Participants took part in the intervention at the Maastricht University faculty.

Participants:

Four participants who experienced PCS after concussion partook in the exploratory study. Participants’ age ranged between 20 and 32 (mean = 26.5, SD = 5.9) years, with an average length of time after the concussion of 9.8 months.

Design:

A concurrent multiple-baseline single-case design was conducted. The baseline period (A phase) length was randomly determined across participants (3, 4, 5, or 6 weeks). The exposure intervention (B phase) was conducted by psychologists over a 4-week period and consisted of 3 stages: exploration (2 sessions), active exposure (12 sessions conducted over 1 week), and 2 booster sessions.

Main Measures:

Participants answered daily questions on a visual analog scale related to symptom experience, satisfaction with daily functioning, and degree of avoidance of feared activities. Additional outcomes included symptom severity, catastrophizing, fear of mental activity, anxiety, depression, and societal participation.

Results:

Tau-U yielded significant effects (P < .05) for all participants on all measures when comparing baseline and intervention phases. The pooled standardized mean difference was high for all measures (symptom experience = 0.93, satisfaction of daily functioning = 1.86, and activity avoidance = −2.05).

Conclusions:

The results show efficacy of the newly developed intensive exposure treatment for PCS after concussion, which is based on the fear avoidance model. Replication in a larger heterogeneous sample is warranted and needed.

Read More…

Helmet use in preventing acute concussive symptoms in recreational vehicle related head trauma. Brain Injury, 2019

Helmet use in preventing acute concussive symptoms in recreational vehicle related head trauma

Marco Daverio, Franz E Babl, Ruth Barker, Dario Gregori, Liviana Da Dalt & Silvia Bressan

Pages 335-341, Brain Injury. Published online: 22 Jan 2018

https://doi.org/10.1080/02699052.2018.1426107

ABSTRACT
Objectives: Helmets use has proved effective in reducing head trauma (HT) severity in children riding non-motorised recreational vehicles. Scant data are available on their role in reducing concussive symptoms in children with HT while riding non-motorised recreational vehicles such as bicycles, push scooters and skateboards (BSS). We aimed to investigate whether helmet use is associated with a reduction in acute concussive symptoms in children with BSS-related-HT.

Methods: Prospective study of children <18 years who presented with a BSS related-HT between April 2011 and January 2014 at a tertiary Paediatric Emergency Department (ED).

Results: We included 190 patients. Median age 9.4 years (IQR 4.8–13.8). 66% were riding a bicycle, 23% a push scooter, and 11% a skateboard. 62% were wearing a helmet and 62% had at least one concussive symptom. Multivariate logistic regression analysis adjusting for age, gender, and type of vehicle showed that patients without a helmet presented more likely with headache (adjusted odds-ratio (aOR) 2.54, 95% CI 1.27–5.06), vomiting (aOR 2.16, 95% CI 1.00–4.66), abnormal behaviour (aOR 2.34, 95% CI 1.08–5.06), or the presence of at least one concussive symptom (aOR 2.39, 95% CI 1.20–4.80).

Conclusions: In children presenting to the ED following a wheeled BSS-related HT helmet use was associated with less acute concussive symptoms.

ABBREVIATIONS: aOR, adjusted odds ratio; APHIRST, Australasian Paediatric Head Injury Rules Study; BSS, bicycles, push scooters and skateboards; CI, confidence interval; CT, computed tomography; ED, emergency department; HT, head trauma; IQR, interquartile range; OR, odds ratio; RCH, Royal Children’s Hospital; RV, recreational vehicle.

 

Sport-related Concussion Clinical Profiles: Clinical Characteristics, Targeted Treatments, and Preliminary Evidence. Curr Sports Med Rep 2019

Sport-related Concussion Clinical Profiles: Clinical Characteristics, Targeted Treatments, and Preliminary Evidence.

Kontos, Sufrinko, Sandel, Emami, Collins. Curr Sports Med Rep. 2019 Mar;18(3):82-92.

www.doi.org/10.1249/JSR.0000000000000573

Abstract

Sport-related concussion (SRC) is a heterogeneous injury that involves varied symptoms and impairment that presents a significant clinical challenge to sports medicine professionals.

In response to this challenge, clinical researchers have proposed clinical profiles or subtype models for assessing and treating athletes with SRC. One such model emphasizes five concussion clinical profiles including cognitive/fatigue, vestibular, ocular, migraine, and anxiety/mood. Sleep is a common modifier that co-occurs across these clinical profiles. A combination of medical history, risk factors, injury information, clinical characteristics, and assessment outcomes can inform each clinical profile.

Preliminary data involving 236 patients from a concussion specialty clinic indicate that the migraine (26%) and anxiety/mood (24%) profiles are the most common, with vestibular and ocular profiles combined representing more than one third (35%) of clinical profiles.

Findings also support several relationships among different clinical profiles including vestibular and migraine, suggesting that many athletes present with multiple clinical profiles. Targeted, active treatments for each profile are discussed.

Facebook
Twitter
LinkedIn