Vanderploeg, R. D., Belanger, H. G., Curtiss, G., Bowles, A. O., Cooper, D. B. (2019). Reconceptualizing rehabilitation of individuals with chronic symptoms following mild traumatic brain injury. Rehabilitation Psychology, 64(1): 1-12.
This study provides a clear and concise literature review for the treatment of chronic post- concussive symptoms (PCS) along with follow-up analysis of two exemplary studies for comparison of two alternative treatment approaches. The authors’ literature review showed that a psychoeducational approach in the emergency room results in a fewer symptoms and shorter course, but this approach in the chronic phase can actually worsen problematic PCS. Cognitive rehabilitation (CR) was initially developed for the moderate to severe TBI population. This approach has been applied to PCS with variable success. The authors suggest that CR interventions may be specific to strategy/strategies trained but likely do not generalize to patient-centered outcomes. Cognitive behavioral psychotherapy (CBT) has been shown to impact quality of life measurements but not PCS specifically. A combination of CR and CBT has also been used with only very limited success. The authors point out that multiple longitudinal studies concluded that many or all symptoms in the chronic PCS stage are not related to concussion but rather associated with factors such as pain, insomnia, stress, depression, or PTSD. Therefore, treatment focusing on the underlying factors would intuitively be more effective than other forms of treatment. The authors present two studies along with additional follow-up analysis involving samples of comorbid mild TBI with PCS and PTSD from those two studies to directly compare effects of CR versus prolonged exposure (PE) therapy. The study results supported the suggestion that interventions should focus on comorbid and underlying mental health issues rather than cognitive functioning or complaints among individuals with chronic symptoms they attribute to mild TBI (i.e., individuals with PCS). Among the caveats listed for conclusions of this paper, the authors noted that samples for this follow-up analysis were predominantly male military members and somewhat small in number (N = 31 and 28).
I chose this article because, it illustrates specific, effective treatment modalities for PCS from initial presentation all the way through the chronic phase. The authors provide an excellent, succinct summary and description of the underlying and treatable psychological factors driving the estimated 23% of individual sustaining concussion that attribute their symptoms to that event one or more years later. While broad media coverage on the topic of concussion has improved public awareness, a prevalent and unintended effect seems to be misattribution of symptoms and an increasing fear of potential consequences of contact sports.
I find this article inspiring for hope (as well as reduction of fear) in my roles as both treatment provider and parent of an athlete.
THIS MONTH’S REHABILITATION SCIENCE SPOTLIGHT was chosen by Kier Bison, Ph.D., ABPP RP, Rehabilitation Psychologist at Baylor Scott & White Institute for Rehabilitation Day Neuro Program, Frisco TX and a Member of Division 22's Science Committee.