What is the effectiveness of exercise-based active rehabilitation for youth recovering from concussions in improving performance skills for daily occupations?

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Coghlan, Nicole
Begley, Claire
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Currently in the United States, the concussion rate is thought to be relatively high among youth populations. According to a study conducted by Bryan et al. (2016), somewhere between 1.1 and 1.9 million concussions occur annually in high school athletes in the United States. Furthermore, the annual cost of treating concussions and mild traumatic brain injuries (mTBIs) is around 1 billion dollars per year in the United States, leading these injuries to be considered significant public health issues (Ghaffar et al., 2006). Both of the aforementioned studies demonstrate that the number of concussions sustained annually by youth athletes occur at high rates and cost a great amount of money to treat, so there is a need for effective treatments to be further investigated. Once a concussion is diagnosed in members among the youth population, the consequences can be substantial when examining the impacts through a holistic lens. To further examine the possible negative side effects that concussions may have on youths, Covassin et al. (2017) found that mood disturbance, anxiety, depression, suicide, and negative coping behaviors are all symptoms that could potentially be associated with untreated concussions. Furthermore, other post-concussive symptoms that may develop include visual, vestibular, cognitive, emotional, and sleep disturbances, which are all domains within an occupational therapist’s scope of practice (Finn, 2019). Taking this evidence into consideration, this area presents as a prime opportunity for occupational therapists to insert themselves as part of the concussion treatment and management team due to the negative impacts that concussions may have on performance skills and overall occupational performance. Although occupational therapists are certainly capable of contributing to this area of treatment and it is within our scope of practice, there is currently little evidence to confirm the best practice to do so. However, one upcoming area of treatment includes implementing exercise-based active rehabilitation programs to treat post-concussive symptoms and other areas of performance skills, rather than following the current standardized protocols consisting of stretching and rest. That is the topic of this CAT, focusing on whether exercise-based active rehabilitation programs positively or negatively affect performance skills in members among the chosen population to participate in their daily occupations. Based on the studies included in this CAT, the exercise-based active rehabilitation programs should include components such as submaximal aerobic training, light coordination exercises, visualization and positive mental imagery techniques, home programs, education, and active stretching with the aim of effectively treating concussions in youth and improving performance skills. Overall, occupational therapists may be able to contribute to the area of concussion management by implementing exercise-based active rehabilitation programs.
Creighton University
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