Feasibility and Potential Benefits of a Web-Based Intervention Delivered Acutely After Mild Traumatic Brain Injury in Adolescents: A Pilot Study

Abstract

Background There is a paucity of evidence-based interventions for mild traumatic brain injury (mTBI). Objective To evaluate the feasibility and potential benefits of an interactive, web-based intervention for mTBI. Setting Emergency department (ED) and outpatient settings. Participants Of the 21 adolescents ages 11–18 years with mTBI recruited from November 2013 to June 2014 within 96 hours of injury, 13 completed the program. Design Prospective, open pilot. Intervention The web-based Self-Management Activity-restriction and Relaxation Training (SMART) program incorporates anticipatory guidance and psychoeducation, self-management and pacing of cognitive and physical activities, and cognitive behavioral principles for early management of mTBI in adolescents. Main Measures Primary: Daily post-concussion symptom score (PCSS). Secondary: Daily self-reported ratings of activities and satisfaction survey Results Average time from injury to baseline testing was 14.0 (SD:16.7) hours. Baseline PCSS was 23.6 (range:0–46), and daily activity was 1.8 hours (range:0–5.75). Repeated-measures, generalized linear mixed-effects model analysis demonstrated a significant decrease of PCSS at a rate of 2.0 points/day that stabilized after about two weeks. Daily activities, screen time and physical activity increased by 0.06 (SE=0.04, p=0.09), 0.04 (SE=0.02, p=0.15) and 0.03 (SE=0.02, p=0.05) hours/day, respectively, over the 4-week follow-up. Satisfaction was rated highly by parents and youth. Conclusions SMART is feasible and reported to be helpful and enjoyable by participants. Future research will need to determine the comparative benefits of SMART and ideal target population.

Lived Experiences of Adolescent Athletes Following Sport-Related Concussion

“…This may be in the form of anticipatory guidance, in which instructions are provided to the patient and parent that describe symptoms to be concerned about and when it is necessary to seek re-evaluation. 25 , 41 While 1 study identified that 82% of patients received emergency department discharge instructions following concussion that included anticipatory guidance, 41 this may not often be the case. Clinicians should investigate means of including anticipatory guidance in their patient consultations and should consider using educational technology, 1 mode of which has preliminarily been shown to have positive outcomes following mild traumatic brain injury as evaluated in the emergency department.…”

Blue-Light Therapy following Mild Traumatic Brain Injury: Effects on White Matter Water Diffusion in the Brain

“…Available treatments include cognitive behavior therapy ( 9 ), neuropsychological rehabilitation ( 10 ), educational intervention ( 11 ), and pharmacological intervention ( 12 ). Although the effects are small, some intervention studies report reliable reductions in post-concussion symptoms, including sleep problems, following successful treatment ( 13 ). Considering a range of post-concussion symptoms can also occur as the result of sleep loss, it is likely that improving sleep quality in particular would also lead to improvements of other post-concussion symptoms, such as attention, concentration, memory, and mood disturbances.…”

Usability evaluation of the SMART application for youth with mTBI

“…Feedback from the pilot trial will be used to make additional modifications and updates to make the system more user-friendly prior to larger scale testing. We performed a feasibility study using the SMART application and results suggested that the application helped to improve patient outcomes [43]. We will evaluate the application in a larger study to evaluate the clinical efficacy of the interventions.…”