Persistent post-concussive symptoms: A model of predisposing, precipitating, and perpetuating factors

Rickards, Tyler; Cranston, Christopher C.; McWhorter, Jessica

doi:10.1080/23279095.2020.1748032

Cited by 32 publications

(27 citation statements)

References 116 publications

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“…There are several explanations for the heterogeneity in PPCS definitions, one of which was most recently applied to the predisposing, precipitating, and perpetuating (PPP) model. The PPP model proposes that factors contributing to the course and development of PPCS are individualistic, and must consider personal attributions ( 120 ). While it is understandable that PPCS duration and symptoms are variable due to individual and personal factors, it does not make it easier to form a consensus on definitions and criteria, or to gather all pertinent literature on the subject matter.…”

Section: Discussionmentioning

confidence: 99%

Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review

et al. 2022

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Objective:Concussion is a common yet heterogenous injury. Approximately 15–30% of cases present with persistent post-concussion symptoms (PPCS), continuing 4 weeks or more post-injury in children, youth, and adolescents, and 3 months or more in adults. There are known bidirectional links between PPCS and mental health outcomes. The focus of this scoping review is to explore the literature on mental health outcomes in individuals experiencing PPCS. Research objectives were to explore: (1) the mental health outcomes of individuals with PPCS and types of assessments used to identify mental health outcomes this group, and (2) how mental health outcomes compare in terms of similarities and differences among pediatric and adult populations with PPCS.MethodOvid MEDLINE; EMBASE; CINAHL, and PsycInfo databases were searched. After title and abstract screening of 11,920 studies, 481 articles were reviewed. Twenty-five papers met inclusion criteria. Results were organized by mental health outcomes of pediatric and adult populations, separately.ResultsThere was a significantly higher number of studies devoted to adult populations. Of the 25 studies, 19 (76%) focused on adults, while six (24%) focused on adolescents. In adult populations, studies focused on symptoms of: anxiety (n = 2), depression (n = 8), and anxiety and depression (n = 9). Two studies assessed other emotional outcomes (10.5%). Within pediatric populations, an equal number of studies explored symptoms of: anxiety (n = 2), depression (n = 2), and anxiety and depression (n = 2). No studies focused on other emotional outcomes. Studies ranged greatly in methods, design, and control group. Most studies reported higher psychiatric symptoms of anxiety and/or depression in those with PPCS compared to individuals with recovered concussion or healthy controls.DiscussionThis review contributes to the understanding of mental health outcomes in those experiencing PPCS. Mental health and PPCS requires greater attention in pediatric populations, and consider strategies for those experiencing PPCS and mental health impacts. Future studies should consider including a wider range of emotional outcomes in their design, not limited to anxiety and depression. Study results may lead to improvements and research in the identification, assessment, and management of PPCS and mental health.

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Section: Discussionmentioning

confidence: 99%

Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review

et al. 2022

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“…In rSRC patients, the persistence of symptoms long beyond the generally accepted time frame for recovery may reflect the development of postconcussion syndrome (PCS) [58,59]. There is, however, no consensus regarding the clinical neuroradiological criteria for PCS and, increasingly, the term persistent post-concussive symptoms (PPCS) is used [60]. Despite persisting symptoms, many of these athletes have normal MRI investigations [59].…”

Section: Discussionmentioning

confidence: 99%

Refined Analysis of Chronic White Matter Changes after Traumatic Brain Injury and Repeated Sports-Related Concussions: Of Use in Targeted Rehabilitative Approaches?

Latini

Fahlström

Vedung

et al. 2022

JCM

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Traumatic brain injury (TBI) or repeated sport-related concussions (rSRC) may lead to long-term memory impairment. Diffusion tensor imaging (DTI) is helpful to reveal global white matter damage but may underestimate focal abnormalities. We investigated the distribution of post-injury regional white matter changes after TBI and rSRC. Six patients with moderate/severe TBI, and 12 athletes with rSRC were included ≥6 months post-injury, and 10 (age-matched) healthy controls (HC) were analyzed. The Repeatable Battery for the Assessment of Neuropsychological Status was performed at the time of DTI. Major white matter pathways were tracked using q-space diffeomorphic reconstruction and analyzed for global and regional changes with a controlled false discovery rate. TBI patients displayed multiple classic white matter injuries compared with HC (p < 0.01). At the regional white matter analysis, the left frontal aslant tract, anterior thalamic radiation, and the genu of the corpus callosum displayed focal changes in both groups compared with HC but with different trends. Both TBI and rSRC displayed worse memory performance compared with HC (p < 0.05). While global analysis of DTI-based parameters did not reveal common abnormalities in TBI and rSRC, abnormalities to the fronto-thalamic network were observed in both groups using regional analysis of the white matter pathways. These results may be valuable to tailor individualized rehabilitative approaches for post-injury cognitive impairment in both TBI and rSRC patients.

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“…However, outcomes varied between participants. Emerging models evaluating the predisposing, precipitating, and perpetuating factors related to PPCS [4] may provide insights into the variable responses between participants, and should be considered in future investigations.…”

Section: Discussionmentioning

confidence: 99%

“…As described in a recent review article [3], there is a lack of consensus about numerous issues related to PPCS including causation. However, considering predisposing, precipitating, and perpetuating factors appears to be a fruitful approach [4]. Nevertheless, PPCS are problematic because they decrease quality of life.…”

Section: Introductionmentioning

confidence: 99%

Impact of Biofeedback Interventions on Driving Performance in Individuals with Persistent Post-Concussive Symptoms

Bonn¹,

Alvarez²,

Thompson³

et al. 2021

Therapy Approaches in Neurological Disorders

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Low resolution electromagnetic tomography (LoRETA) neurofeedback and heart rate variability (HRV) biofeedback may improve driving ability by enhancing attention, impulse control, and peripheral vision, and reducing stress. However, it is unclear whether combined LoRETA neurofeedback and HRV biofeedback can improve driving performance for individuals experiencing persistent post-concussive symptoms (PPCS). In this study, seven individuals with PPCS completed an eight-week LoRETA neurofeedback and HRV biofeedback intervention. Changes in participants’ simulated driving performance and self-reported symptoms were measured and compared to two control groups: individuals with PPCS (n = 9), and healthy control participants (n = 8). Individuals in the intervention and PPCS control groups reported reduced PPCS severity (p < .05) compared to healthy control participants. Interestingly, individuals in the intervention group responded variably. These results indicate that more research is necessary to identify the subgroup of individuals that respond to LoRETA neurofeedback and HRV biofeedback and confirm these preliminary results.

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Persistent post-concussive symptoms: A model of predisposing, precipitating, and perpetuating factors

Cited by 32 publications

References 116 publications

Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review

Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review

Refined Analysis of Chronic White Matter Changes after Traumatic Brain Injury and Repeated Sports-Related Concussions: Of Use in Targeted Rehabilitative Approaches?

Impact of Biofeedback Interventions on Driving Performance in Individuals with Persistent Post-Concussive Symptoms

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