Somatization in Adolescents With Persistent Symptoms After Concussion: A Retrospective Chart Review

Green, Katherine E.; Purtzki, Jacqueline; Chapman, Andrea; Oberlander, Tim F.; Silverberg, Noah D.; Dhariwal, Amrit

doi:10.1176/appi.neuropsych.21070169

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…For example, somatic symptoms (i.e., headaches, dizziness, nausea) were the primary predictor of incomplete recovery (GOSE<8) and a significant predictor of worse physical health scores at 6 months but were not significantly associated to any other long-term outcome. Pre-injury somatization and high post-injury somatization is a known risk factor for prolonged recovery from sport-related concussion in younger populations ( 25–27 ), but less is known about the role of somatic symptoms following mTBI in adults. Nelson et al found that higher acute somatic symptoms contributed to a prediction model of longer symptom burden for both patients with mTBI and other trauma ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Network analysis and relationship of symptom factors to functional outcomes and quality of life following mild traumatic brain injury: a TRACK-TBI study

Eagle,

Jain,

Sun

et al. 2023

Front. Neurol.

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IntroductionMild traumatic brain injury (mTBI) is a heterogenous injury which can be difficult to characterize and manage. Using cross-sectional network analysis (NA) to conceptualize mTBI symptoms offers an innovative solution to identify how mTBI symptoms relate to each other. The centrality hypothesis of network theory posits that certain symptoms in a network are more relevant (central) or have above average influence over the rest of the network. However, no studies have used NA to characterize the interrelationships between symptoms in a cohort of patients who presented with mTBI to a U.S. Level 1 trauma center emergency department and how subacute central symptoms relate to long-term outcomes.MethodsPatients with mTBI (Glasgow Coma Scale = 13–15) evaluated across 18 U.S. Level 1 trauma centers from 2013 to 2019 completed the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at 2 weeks (W2) post-injury (n = 1,593) and at 3 months (M3), 6 months (M6), and 12 months (M12) post-injury. Network maps were developed from RPQ subscale scores at each timepoint. RPQ scores at W2 were associated with M6 and M12 functional and quality of life outcomes.ResultsNetwork structure did not differ across timepoints, indicating no difference in symptoms/factors influence on the overall symptom network across time. The cognitive factor had the highest expected influence at W2 (1.761), M3 (1.245), and M6 (1.349). Fatigue had the highest expected influence at M12 (1.275). The emotional factor was the only other node with expected influence >1 at any timepoint, indicating disproportionate influence of emotional symptoms on overall symptom burden (M3 = 1.011; M6 = 1.076).DiscussionSeveral symptom factors at 2-weeks post-injury were more strongly associated with incomplete recovery and/or poorer injury-related quality of life at 6 and 12 months post-injury than previously validated demographic and clinical covariates. The network analysis suggests that emotional, cognitive, and fatigue symptoms may be useful treatment targets in this population due to high centrality and activating potential of the overall symptom network.

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Section: Discussionmentioning

confidence: 99%

Network analysis and relationship of symptom factors to functional outcomes and quality of life following mild traumatic brain injury: a TRACK-TBI study

Eagle,

Jain,

Sun

et al. 2023

Front. Neurol.

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“…It is therefore prudent to consider differential diagnoses such as somatisation, chronic fatigue, chronic pain, or some combination of these conditions. Fear-avoidance beliefs and catastrophising may play an active part in the transition from acute to chronic pain in the concussion spectrum (Green et al 2022 ; Sigurdardottir et al 2013 ). Physiotherapists’ understanding of pain behaviours, screening, and early intervention relevant to other clinical areas such as chronic low back pain are likely to be very valuable (Gatchel et al 2018 ).…”

Section: Our Understanding Of Concussion Todaymentioning

confidence: 99%

The role of the physiotherapist in concussion

Robertson,

McLoughlin

2024

South African Journal of Physiotherapy

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In the last decade, concussion research has exploded in multiple fields of scientific research. This has helped to clarify what causes, influences, and perpetuates human concussion, and displays the integral role physiotherapists play in concussion management. In this article we discuss the latest research relevant to the key role of physiotherapy in concussion management. A narrative review of the literature on concussion was conducted. The current review analyses how concussion has influenced physiotherapy in several categories: assessment, treatment, management, research rigour and building the profile of the profession. Scientific concussion research has largely converged in support of the role of physiotherapists utilising specific components including: (1) autonomic, (2) cervicogenic, (3) vestibulo-ocular and (4) psychological approaches to management. Latest research supports the critical role of physiotherapy in concussion care in the assessment, management, and prevention of concussion with scope for further interdisciplinary collaborations.Clinical implications: Concussion is complex. A basic mental health, Vestibular Ocular Motor Screening (VOMS) and four key components relating to concussion management (autonomic, cervicogenic, vestibular oculomotor, and psychological approaches to management) should be included in the undergraduate and postgraduate curriculum. This will aid clinical physiotherapists to support their patients. A call to advance more intradisciplinary physiotherapy teamwork should be encouraged as valuable knowledge sharing is potentially lost within the framework of ‘specialisation’. If needed, the skills of a greater interdisciplinary team are imperative to facilitate patient management and recovery from this multi-faceted injury.

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“…This needs to be seriously considered when communicating with concussion patients and their families during rehabilitation. More clear, accurate, and well-balanced messaging to the community about concussion recovery is also vital [92,93], especially given that both preinjury and postconcussion somatisation have been identified as risk factors for delayed recovery [94][95][96].…”

Section: Beliefs and Self-efficacymentioning

confidence: 99%

Concussion Rehabilitation and the Application of Ten Movement Training Principles

McLoughlin

2023

Cureus

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Concussion awareness continues to grow in all aspects of healthcare, including the areas of prevention, acute care, and ongoing rehabilitation. Most of the concussion research to date has focussed on the challenges around screening and diagnosing what can be a complex mix of brain impairments that overlay with additional pre-existing comorbidities. While we expect further progress in concussion diagnosis, progress also continues to be made around proactive rehabilitation, with the emergence of interventions that can enhance the recovery process, maximise function and independence with a return to study, work, and play. Traditionally, optimal multimodal assessments of concussion have treated the physical, cognitive, and psychological domains of brain injury separately, which supports diagnosis, and informs appropriate follow-up care. Due to the complex nature of brain injury, multimodal assessments direct care toward professionals from many different disciplines including medicine, physiotherapy, psychology, neuropsychology, ophthalmology, and exercise physiology. In addition, these professionals may work in different fields such as sports, neurorehabilitation, vestibular, musculoskeletal, community, vocational, and general practice clinical settings. Rehabilitation interventions for concussions employed in practice are also likely to use a blend of theoretical principles from motor control, cognitive, and psychological sciences. This scale of diversity can make information dissemination, collaboration, and innovation challenging. The Ten Movement Training Principles (MTPs) have been proposed as a usable and relevant concept to guide and support clinical reasoning in neurorehabilitation. When applied to concussion rehabilitation, these same 10 principles provide a comprehensive overview of key rehabilitation strategies for current and future practice. Future collaborations can use these training principles to support clinical and research innovations including the rapid rise of technologies in this growing field of rehabilitation practice.

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Somatization in Adolescents With Persistent Symptoms After Concussion: A Retrospective Chart Review

Cited by 6 publications

References 34 publications

Network analysis and relationship of symptom factors to functional outcomes and quality of life following mild traumatic brain injury: a TRACK-TBI study

Network analysis and relationship of symptom factors to functional outcomes and quality of life following mild traumatic brain injury: a TRACK-TBI study

The role of the physiotherapist in concussion

Concussion Rehabilitation and the Application of Ten Movement Training Principles

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