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Sport-Related Concussion and Occupational Therapy: Expanding the Scope of Practice

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Title: Sport-Related Concussion and Occupational Therapy: Expanding the Scope of Practice
Language: English
Authors: Reed, Nick
Source: Physical & Occupational Therapy in Pediatrics. Aug 2011 31(3):222-224.
Availability: Informa Healthcare. Telephone House, 69-77 Paul Street, London, EC2A4LQ, UK. Tel: 800-354-1420; e-mail: healthcare.enquiries@informa.com; Web site: http://informahealthcare.com/action/showJournals
Peer Reviewed: Y
Physical Description: PDF
Page Count: 3
Publication Date: 2011
Document Type: Journal Articles
Opinion Papers
Descriptors: Injuries, Interdisciplinary Approach, Athletes, Occupational Therapy, Brain, Head Injuries, Neurological Impairments, Team Sports, Participation, Rehabilitation, Allied Health Personnel
DOI: 10.3109/01942638.2011.589719
ISSN: 0194-2638
Abstract: Sport participation is a common occupation for many children and youth and can lead to improved physical and psychosocial health. Despite these benefits, it exposes children and youth to the increased risk of injury. Concussion, also referred to as mild traumatic brain injury (mTBI), is one of the most common sports injuries reported in the pediatric population, where a child is six times more likely to suffer a concussion during organized sport participation than during other physical leisure activities (Browne & Lam, 2006). The profession of occupational therapy has yet to be widely recognized or utilized within the world of sport when rehabilitating athletes following a concussion. However, the importance of an interdisciplinary approach to sport-related concussion management has been promoted internationally (McCrory et al., 2005; McCrory et al., 2009). The combinations of symptoms associated with sport-related concussion can have a significant impact on occupational performance, both on and off the playing field. Occupational therapists can assume a variety of roles specific to the safe return of athletes to their meaningful daily occupations. This commentary aims to act as a starting point for exploration of sport-related concussion from an occupational perspective and to expand the scope of occupational therapy practice into the world of sport.
Abstractor: ERIC
Number of References: 6
Entry Date: 2012
Accession Number: EJ962166
Database: ERIC
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  Value: <anid>AN0077641702;ptp01aug.11;2019Apr02.13:20;v2.2.500</anid> <title id="AN0077641702-1">Sport-Related Concussion and Occupational Therapy: Expanding the Scope of Practice. </title> <p>Sport participation is a common occupation for many children and youth and can lead to improved physical and psychosocial health. Despite these benefits, it exposes children and youth to the increased risk of injury. Concussion, also referred to as mild traumatic brain injury (mTBI), is one of the most common sports injuries reported in the pediatric population, where a child is six times more likely to suffer a concussion during organized sport participation than during other physical leisure activities (Browne & Lam, [<reflink idref="bib1" id="ref1">1</reflink>]). Children and youth can experience a range of neurobehavioral deficits following concussion including somatic, cognitive, and emotional/behavioral postconcussive symptoms (Kirkwood, Yeates, & Wilson, [<reflink idref="bib4" id="ref2">4</reflink>]) that can have a significant impact on daily function.</p> <p>The profession of occupational therapy has yet to be widely recognized or utilized within the world of sport when rehabilitating athletes following a concussion. However, the importance of an interdisciplinary approach to sport-related concussion management has been promoted internationally (McCrory et al., [<reflink idref="bib5" id="ref3">5</reflink>]; McCrory et al., [<reflink idref="bib6" id="ref4">6</reflink>]). The combinations of symptoms associated with sport-related concussion can have a significant impact on occupational performance, both on and off the playing field. Occupational therapists can assume a variety of roles (listed later) specific to the safe return of athletes to their meaningful daily occupations. This commentary aims to act as a starting point for exploration of sport-related concussion from an occupational perspective and to expand the scope of occupational therapy practice into the world of sport.</p> <hd id="AN0077641702-2">DEVELOPMENT OF CLIENT-CENTERED REHABILITATION GOALS</hd> <p>Practicing in a client-centered manner is a key competency for occupational therapists and emphasizes equality, sharing and partnership between the therapist and client. Using this approach, rehabilitation goals specific to functional activities that are meaningful and have been impacted by the sports injury can be identified collaboratively between the therapist and the child (and their family), improving client motivation, satisfaction, and rehabilitation outcome.</p> <hd id="AN0077641702-3">ENERGY CONSERVATION</hd> <p>According to the most recent consensus statement on concussion in sport (McCrory et al., [<reflink idref="bib6" id="ref5">6</reflink>]), the current cornerstone of concussion management is physical and cognitive rest until postconcussive symptom resolution has occurred. Although, the recommendation of rest and its relation to avoiding sport and/or school participation may be clear to most (e.g., do not take part in sport-related activities, etc.), its relation to how rest can be incorporated into all aspects of daily function may not be as apparent. Occupational therapists can provide the athlete and family with client-centered energy conservation strategies in order to reduce both physical and cognitive exertion during daily activities and can contribute to achieving the goal of complete rest until postconcussive symptoms have resolved and to effectively re-engaging children and youth back into their daily activities.</p> <hd id="AN0077641702-4">RETURN TO PLAY</hd> <p>When considering a return to sport participation or return to play following a concussion, current international consensus guidelines (McCrory et al., [<reflink idref="bib6" id="ref6">6</reflink>]) recommend following a graduated return to play protocol. This protocol is designed to reintroduce the athlete to sport activity using a step-wise progression of physical exercise and sport-specific skills upon postconcussive symptom resolution. With unique consideration of the occupational and environmental demands of the particular sport an athlete is returning to (e.g., physical and cognitive demands of the particular sport and context in which it is played), occupational therapists can be involved in the design and supervised delivery of individualized gradual return to play protocols. In particular, considering the cognitive demands of a particular sport can be a unique contribution of occupational therapy during the return to play process, where in addition to the currently recommended step-wise increase of physical exertion, occupational therapists can explicitly incorporate gradual escalation in cognitive exertion into the rehabilitation protocol.</p> <hd id="AN0077641702-5">RETURN TO SCHOOL</hd> <p>The postconcussive symptoms experienced by children and youth following a sport-related concussion can have a detrimental effect on school-based performance. Much like returning to sport participation, a gradual return to full school-based occupations with the provision of modifications of school demands and environments is also recommended following a concussion (Kirkwood et al., [<reflink idref="bib3" id="ref7">3</reflink>]). Occupational therapists can be involved at this stage of the rehabilitation process in order to develop client-centered return to school care plans that address the specific functional deficits and needs of the student athlete. Furthermore, the occupational therapist can act as the liaison between the student athlete (and their family) and school personnel, ensuring that appropriate modifications are made within the school environment and adjustments to the return to school care plan are implemented appropriately as recovery progresses.</p> <hd id="AN0077641702-6">COGNITIVE FUNCTION</hd> <p>As stated previously, cognitive symptoms are common following a concussion and may include persisting difficulties with information processing, attention and memory. International sport concussion consensus guidelines (McCrory et al., [<reflink idref="bib6" id="ref8">6</reflink>]) highlight the benefit of neuropsychological assessment following sport-related concussion as a means to measure cognitive recovery. Occupational therapy can contribute to this neuropsychological evaluation by documenting any functional cognitive deficits assessed using function-based standardized assessments or through observation of meaningful daily occupations. When considering cognitive rehabilitation for individuals with traumatic brain injury, there is empirical evidence to support use of compensatory training strategies for memory and attention deficits (Cicerone et al., [<reflink idref="bib2" id="ref9">2</reflink>]). The inclusion of occupational therapy within the sport-related rehabilitation process can enable the provision of compensatory cognitive strategies that may facilitate better overall functioning within daily life and help conserve cognitive resources until one has recovered from their injury.</p> <hd id="AN0077641702-7">CONCLUSION</hd> <p>A holistic, client-centered approach that enables children and youth to return to occupations both on and off the playing field is important following sport-related concussion. The potential roles for occupational therapy presented serve as a springboard for reflection and hopefully, action amongst occupational therapists, to expand their scope of practice into the world of sport.</p> <p> <bold> <emph>Declaration of interest:</emph> </bold> The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.</p> <hd id="AN0077641702-8">ABOUT THE AUTHORS</hd> <p> <bold>Nick Reed</bold>, PhD (candidate), MScOT, OT Reg (Ont) is an occupational therapist and a doctoral candidate within the Graduate Department of Rehabilitation Science at the University of Toronto.</p> <ref id="AN0077641702-9"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Browne, G. J., & Lam, L. T. (2006). Concussive head injury in children and adolescents related to sports and other leisure physical activities. British Journal of Sports Medicine, 40(2), 163–168.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref9" type="bt">2</bibl> <bibtext> Cicerone, K. D., Dahlberg, C., Malec, J. F., Langenbahn, D. M., Felicetti, T., Kneipp, S., (2005). Evidence-based cognitive rehabilitation: Updated review of the literature from 1998 through 2002. Archives of Physical Medicine and Rehabilitation, 86(8), 1681–1692.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref7" type="bt">3</bibl> <bibtext> Kirkwood, M. W., Yeates, K. O., Taylor, H. G., Randolph, C., McCrea, M., & Anderson, V. A. (2008). Management of pediatric mild traumatic brain injury: A neuropsychological review from injury through recovery. The Clinical Neuropsychologist, 22(5), 769–800.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref2" type="bt">4</bibl> <bibtext> Kirkwood, M. W., Yeates, K. O., & Wilson, P. E. (2006). Pediatric sport-related concussion: A review of the clinical management of an oft-neglected population. Pediatrics, 117(4), 1359–1371.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref3" type="bt">5</bibl> <bibtext> McCrory, P., Johnston, K., Meeuwisse, W., Aubry, M., Cantu, R., Dvorak, J., (2005). Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. British Journal of Sports Medicine, 39(4), 196–204.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref4" type="bt">6</bibl> <bibtext> McCrory, P., Meeuwisse, W., Johnston, K., Dvorak, J., Aubry, M., Molloy, M., (2009). Consensus statement on Concussion in Sport 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Clinical Journal of Sport Medicine, 19(3), 185–200.</bibtext> </blist> </ref> <aug> <p>By Nick Reed</p> <p>Reported by Author</p> </aug>
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  Data: Sport participation is a common occupation for many children and youth and can lead to improved physical and psychosocial health. Despite these benefits, it exposes children and youth to the increased risk of injury. Concussion, also referred to as mild traumatic brain injury (mTBI), is one of the most common sports injuries reported in the pediatric population, where a child is six times more likely to suffer a concussion during organized sport participation than during other physical leisure activities (Browne & Lam, 2006). The profession of occupational therapy has yet to be widely recognized or utilized within the world of sport when rehabilitating athletes following a concussion. However, the importance of an interdisciplinary approach to sport-related concussion management has been promoted internationally (McCrory et al., 2005; McCrory et al., 2009). The combinations of symptoms associated with sport-related concussion can have a significant impact on occupational performance, both on and off the playing field. Occupational therapists can assume a variety of roles specific to the safe return of athletes to their meaningful daily occupations. This commentary aims to act as a starting point for exploration of sport-related concussion from an occupational perspective and to expand the scope of occupational therapy practice into the world of sport.
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