Tele-Active Rehabilitation for adolescents with concussion: a feasibility study

Abstract

ObjectivesActive rehabilitation involving subsymptom threshold exercise and education/support promotes recovery among adolescents with concussion, but is typically delivered in-person, which limits accessibility. This study explored the feasibility of a remotely delivered Tele-Active Rehabilitation (Tele-AR) intervention for adolescents with concussion.MethodsA precase–postcase series design was used. Three adolescents (ages 14–17 years) experiencing postconcussion symptoms ≥2 weeks postinjury participated with a parent. The Tele-AR intervention was a 6-week programme supervised by a rehabilitation clinician through weekly videoconferencing appointments and included (1) aerobic exercise, (2) coordination drills and (3) comprehensive education and support. Feasibility indicators included rates of recruitment, retention, adherence, as well as adolescent and parent ratings of technology usability using an adapted Telehealth Usability Questionnaire and satisfaction using the Client Satisfaction Questionnaire-8. Prechanges to postchanges in postconcussion symptoms, illness perceptions, and occupational performance and satisfaction were also assessed.ResultsRates of recruitment (n=3/4) and retention (n=3/3) achieved success criteria. Adherence was high among all participants (77%–100%), and there were no adverse events. Participant ratings of technology usability and satisfaction approached 90%. All participants reported improvements in postconcussion symptoms and illness perception. Clinically significant positive changes were also observed in occupational performance and satisfaction.ConclusionsThe Tele-AR intervention appears feasible in a small group of adolescents with concussion, and positive changes were observed in postconcussion symptoms, illness perception and occupational performance. Further study is warranted to evaluate the efficacy of this approach, which may enable access to care that supports recovery in adolescents with concussion.

Brain changes: aerobic exercise for traumatic brain injury rehabilitation

“…Ten studies specifically looked at aerobic interventions post-concussion in adults ( Leddy et al, 2010 ; Leddy and Willer, 2013 ; Polak et al, 2015 ; Clausen et al, 2016 ; Adams and Moore, 2017 ; Dobney et al, 2017 ; Snyder et al, 2021 ; Varner et al, 2021 ; Hutchison et al, 2022 ; Langevin et al, 2022 ), and 21 studies focused on adolescents ( Gagnon et al, 2016 ; Imhoff et al, 2016 ; Chrisman et al, 2017 , 2021 ; Kurowski et al, 2017 ; Yuan et al, 2017 ; Chan et al, 2018 ; Hunt et al, 2018 ; McGeown et al, 2018 ; Micay et al, 2018 ; Bailey et al, 2019 ; Gladstone et al, 2019 ; Leddy et al, 2019a , b , 2021 ; Willer et al, 2019 ; Dobney et al, 2020 ; Howell et al, 2021 , 2022 ; Chizuk et al, 2022 ; Shore et al, 2022 ). Results for adults are presented in Table 3 .…”

“…Twelve studies examined aerobic exercise for adolescents at least 1 month post injury who were experiencing at-least one persistent post-concussion symptom ( Gagnon et al, 2016 ; Imhoff et al, 2016 ; Chrisman et al, 2017 , 2021 ; Kurowski et al, 2017 ; Yuan et al, 2017 ; Chan et al, 2018 ; Hunt et al, 2018 ; McGeown et al, 2018 ; Bailey et al, 2019 ; Gladstone et al, 2019 ; Shore et al, 2022 ). A majority of these studies offered a mix of in-clinic and at-home interventions for 6 weeks ( Chan et al, 2018 ; Hunt et al, 2018 ; Bailey et al, 2019 ; Chrisman et al, 2021 ; Shore et al, 2022 ), with up to an additional two weeks, making an 8-week intervention ( Kurowski et al, 2017 ; Yuan et al, 2017 ; Gladstone et al, 2019 ). One study consisted of a four-week intervention ( McGeown et al, 2018 ).…”

“…Ten studies included effort-based measures (e.g., Borg scale) or physiological measures (i.e., heart rate) to gauge aerobic status during exercise ( Gagnon et al, 2016 ; Imhoff et al, 2016 ; Chrisman et al, 2017 , 2021 ; Kurowski et al, 2017 ; Yuan et al, 2017 ; Chan et al, 2018 ; Bailey et al, 2019 ; Gladstone et al, 2019 ; Shore et al, 2022 ). Recumbent cycling was the exclusive aerobic modality in five studies ( Imhoff et al, 2016 ; Kurowski et al, 2017 ; Yuan et al, 2017 ; McGeown et al, 2018 ; Gladstone et al, 2019 ), while five studies offered participants their choice of activity ( Gagnon et al, 2016 ; Chan et al, 2018 ; Hunt et al, 2018 ; Chrisman et al, 2021 ; Shore et al, 2022 ). Two studies had participants engage in treadmill-based walking or running ( Chrisman et al, 2017 ; Bailey et al, 2019 ).…”

“…While nine of twelve studies in this set examined concussion-related symptoms, many included additional measures of mental health, mood, cognition, intervention experience, balance, saliva-based protein analysis, illness perception and structural connectivity. A total of 100% of studies that examined concussion-related symptoms found improvements post-intervention; however, only five of these studies included appropriate comparison groups ( Gagnon et al, 2016 ; Imhoff et al, 2016 ; Chrisman et al, 2017 , 2021 ; Kurowski et al, 2017 ; Yuan et al, 2017 ; Chan et al, 2018 ; Bailey et al, 2019 ; Shore et al, 2022 ). In terms of cognition, Gladstone et al (2019) found that exercise increased crystallized and fluid cognition composite scores, Gagnon et al (2016) reported improved processing speed and no differences in balance, while Imhoff et al (2016) reported improvements in multiple memory tasks and balance.…”

“…A total of 100% of studies that examined concussionrelated symptoms found improvements post-intervention; however, only five of these studies included appropriate comparison groups (Gagnon et al, 2016;Imhoff et al, 2016;10.3389/fnhum.2023.1307507 TABLE 3 Summary of the effects of aerobic exercise intervention following mild traumatic brain injury in adults. Chrisman et al, 2017Chrisman et al, , 2021Kurowski et al, 2017;Yuan et al, 2017;Chan et al, 2018;Bailey et al, 2019;Shore et al, 2022). In terms of cognition, Gladstone et al (2019) found that exercise increased crystallized and fluid cognition composite scores, Gagnon et al (2016) reported improved processing speed and no differences in balance, while Imhoff et al (2016) reported improvements in multiple memory tasks and balance.…”