Integrating Neuropsychology Services in a Multidisciplinary Concussion Clinic

Baker, J. G.; Willer, Barry; Leddy, John J.

doi:10.1097/htr.0000000000000541

Cited by 14 publications

(8 citation statements)

References 25 publications

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“…There were no adverse effects resulting in the removal of individuals from the exercise intervention. These results are aligned with other trials providing individualized exercise prescription following treadmill assessment [ 1 , 3 – 5 , 45 ]. Two individuals had temporary exacerbation of symptoms during an exercise session.…”

Section: Discussionsupporting

confidence: 86%

Randomized controlled trial of early aerobic exercise following sport-related concussion: Progressive percentage of age-predicted maximal heart rate versus usual care

et al. 2022

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Objective To examine the effect of a readily accessible, structured aerobic exercise intervention on days to asymptomatic status and days to medical clearance compared to usual care exercise prescription in a cohort of adolescents and young adults following sport-related concussion (SRC). Methods A longitudinal, randomized, non-blinded clinical trial consisting of a structured aerobic exercise protocol (SAEP) group and a usual care exercise prescription (UCEP) group. Participants in the SAEP group underwent an exercise protocol including 8 sessions over 11 days progressing in duration and intensity stepwise based on participants’ age-predicted maximal heart rate. Symptom follow-ups were on days 7, 14, 21, and 28. The primary outcome measures of the study were days to asymptomatic status and days to medical clearance, while the secondary outcome measure was symptom severity on days 7, 14, 21, and 28. Results 38 participants (SAEP, n = 20; UCEP, n = 19) were recruited and completed all follow-up appointments. Compared to the UCEP group, the SAEP had a faster time to asymptomatic status with 96% posterior probability. In addition, the SAEP group displayed an earlier time to medical clearance with 93% posterior probability. While symptom severity scores did not differ between groups at enrolment (SAEP symptom severity, 30; UCEP, 29), they were subsequently lower in the SAEP group at all assessments throughout the trial with 100% posterior probability. Conclusions An aerobic exercise protocol based on percentages of age-predicted maximum heart rate is a safe and effective treatment for reducing symptoms and can be initiated during the first week following SRC. Trial registration ClinicalTrials.gov, no. NCT02969824.

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Section: Discussionsupporting

confidence: 86%

Randomized controlled trial of early aerobic exercise following sport-related concussion: Progressive percentage of age-predicted maximal heart rate versus usual care

et al. 2022

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“…In contrast, significant improvement was observed in visual attention for moderate-severe TBI patients. This might be attributed to the fact that given the severity of injury patients with moderate-severe TBI may receive early intervention and more medical attention such as comprehensive neuro rehabilitation compared to patients with mild TBI [ 74 – 76 ]. Neuro rehabilitation programs have been shown to improve attention and other cognitive function and future studies may wish to compare visual attention performance in TBI patients who have or have not received neuro rehabilitation treatments or any other therapies (see [ 77 ]), with the possibility that such treatments may improve visual attention deficits.…”

Section: Discussionmentioning

confidence: 99%

Changes in the components of visual attention following traumatic brain injury: A systematic review and meta-analysis

2022

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Purpose We conducted a systematic review and meta-analysis to understand the impact of traumatic brain injury (TBI) on visual attention and whether different components and processes of visual attention (such as selective, sustained, divided, and covert orientation of visual attention) are affected following brain injury. Methods A literature search between January 1980 to May 2021 was conducted using Medline, Scopus, PubMed, and Google Scholar databases was undertaken for studies that assessed visual attention using different tasks that target specific or multiple components of visual attention. Three hundred twenty-nine potentially relevant articles were identified, and 20 studies met our inclusion criteria. Results A total of 123 effect sizes (ES) were estimated from 20 studies that included 519 patients with TBI and 530 normal participants. The overall combined ES was statistically significant and large (ES = 0.92), but with high heterogeneity (Q = 614.83, p < 0.0001, I2 = 80.32%). Subgroup analysis showed that the impact of TBI severity, with the ES for moderate-severe TBI significantly higher than mild TBI (t (112) = 3.11, p = 0.002). Additionally, the component of visual attention was differentially affected by TBI (F (2, 120) = 10.25, p<0.0001); the ES for selective attention (ES = 1.13) and covert orientation of visual attention (ES = 1.14) were large, whilst for sustained attention, the ES was medium at 0.43. A subgroup analysis comparing outcome measures showed that reaction time (ES = 1.12) was significantly more affected compared to performance accuracy (ES = 0.43), F (1, 96) = 25.98, p<0.0001). Conclusion Large and significant deficits in visual attention was found following TBI which can last for years after the initial injury. However, different components of visual attention were not affected to the same extent, with selective visual attention and orientation of visual attention most affected following TBI.

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“…3 Neurological Rehabilitation Group, Melbourne, Australia. 4 Olympic Park Sports Medicine Centre, Melbourne, Australia. 5 Australian Football League, AFL House, 140 Harbour Esplanade, Docklands, Melbourne, VIC 3008, Australia.…”

Section: Supplementary Informationmentioning

confidence: 99%

“…Specialised concussion services generally include a range of disciplines, primarily neuropsychology, physiotherapy, and medicine [ 3. , 4. , 119.…”

Section: Introductionmentioning

confidence: 99%

Interdisciplinary Rehabilitation for Concussion Recovery (i-RECOveR): protocol of an investigator-blinded, randomised, case series with multiple baseline design to evaluate the feasibility and preliminary efficacy of a 12-week treatment for persistent post-concussion symptoms

Nguyen

McKay

Ponsford

et al. 2022

Pilot Feasibility Stud

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Background Up to 25% of concussed individuals experience persistent post-concussion symptoms (PPCSs) which may interfere with the return to pre-injury activities and cause significant stress. Given that multiple etiological factors are thought to contribute to PPCSs, an interdisciplinary approach is recommended. This pilot study aims to primarily investigate the feasibility of a novel interdisciplinary treatment for PPCSs. Given this intervention is novel, uncertainty exists in terms of potential recruitment and retention rates, adverse events, and treatment adherence and fidelity. These factors will be explored to inform the feasibility of a phase-2 randomised controlled trial. Preliminary efficacy of this intervention will also be explored. Methods Fifteen individuals with mild traumatic brain injury and PPCSs will receive up to 12 weeks of interdisciplinary treatments including psychology, physiotherapy, and medical interventions. Primary feasibility outcomes including data on recruitment and retention rates and treatment adherence will be explored descriptively. The cognitive therapy rating scale will be used to assess treatment fidelity. A single-case series with multiple baseline design will be used to explore preliminary efficacy. Participants will be randomly assigned to baseline phases of 2, 4, or 6 weeks. Regarding patient-centred secondary outcomes, the Rivermead Post-Concussion Symptoms Questionnaire will be assessed three times a week during baseline and treatment phases. Secondary outcomes also include measures of mood, sleep and fatigue, physical functioning, return to activity, and health-related quality of life. Patient-centred outcomes will be assessed at baseline, pretreatment, post-treatment, and one- and three-month follow-up. Thematic analysis of participant experiences will be explored through qualitative interviews. Discussion Results from this trial will inform the feasibility and preliminary efficacy of this interdisciplinary concussion intervention and whether proceeding to a future definitive phase-2 randomised controlled trial is worthwhile. Understanding the end-user perspective of the treatment will also enable modifications to the treatment protocol for future trials to best suit the needs of individuals with PPCSs after mTBI. Outcomes from this trial can be directly translated into community rehabilitation programmes. Trial registration ANZCTR, ACTRN12620001111965. Registered 27 October 2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379118

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Integrating Neuropsychology Services in a Multidisciplinary Concussion Clinic

Cited by 14 publications

References 25 publications

Randomized controlled trial of early aerobic exercise following sport-related concussion: Progressive percentage of age-predicted maximal heart rate versus usual care

Randomized controlled trial of early aerobic exercise following sport-related concussion: Progressive percentage of age-predicted maximal heart rate versus usual care

Changes in the components of visual attention following traumatic brain injury: A systematic review and meta-analysis

Interdisciplinary Rehabilitation for Concussion Recovery (i-RECOveR): protocol of an investigator-blinded, randomised, case series with multiple baseline design to evaluate the feasibility and preliminary efficacy of a 12-week treatment for persistent post-concussion symptoms

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