This study examined the hypothesis that people who receive concussion recovery education would have better outcomes than those who received usual discharge paperwork from the emergency department (ED) and tested whether participants who were in litigation or seeking disability compensation had more symptoms than individuals not engaged in these activities. Two hundred and fifty-five persons with a diagnosis of concussion were assigned randomly to a brief education group (one-page double-sided document), a longer education group (10-page document), and usual care (standard ED discharge instructions), and were these documents in the ED. A (non-concussion) trauma comparison group was enrolled to determine the symptom rate unrelated to brain injury. The Concussion Symptom Checklist (CSC) and litigation and disability status questions were completed by telephone at one week, three months, and six months. Neither long nor brief information handouts had a significant impact on symptoms over time; the standard form had an average decrease of 1.20 symptoms compared with the brief instructional intervention group (p = 0.031). Litigation status and disability seeking status were significant predictors of symptoms on CSC over time: disability seeking (p = 0.017) and litigation status (p = 0.05). Persons seeking Social Security disability or legal compensation endorsed more symptoms over time than those who were not. Number of symptoms on the CSC for the trauma control group was the same as those who sustained concussion. Type of recovery material was not as important as noting that concussion symptoms resolve over time, and that remaining symptoms are not specific to brain injury. Litigation and disability seeking behavior accounted for maintained symptoms, rather than the concussion itself.
Pre-injury psychosocial and demographic factors may be more important than injury severity for predicting some long-term functional outcomes post-TBI. It would likely be beneficial to assess these factors in the inpatient setting, with input from a multidisciplinary team, as an early understanding of prognostic indicators can help guide treatment for optimal functional outcomes.
Patients with cognitive concerns following mild traumatic brain injury (mTBI), often referred to as concussion, present with complex constellations of strengths and limitations. Increasing evidence indicates that psychosocial factors, as opposed to the injury itself, predict persistent symptoms. As an alternative to the traditional medical model, a person-centered model empowers the patient to move forward past the injury in order to optimize function and maximize quality of life. Patient-centered assessment and treatment by speech–language pathologists, neuropsychologists, and rehabilitation psychologists can engender change, reduce perceived limitations, and increase participation in meaningful activities and roles. This article outlines several collaborative, process-oriented approaches to managing cognitive concerns subsequent to mTBI. The emphasis is on maximizing patient participation to guide clinical decision making and build self-efficacy. The authors are members of the Joint Committee on Interprofessional Relations Between the American Psychological Association (APA) and the American Speech–Language–Hearing Association (ASHA).
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