A psychological intervention improves kids’ function and quality of life even years after a concussion.
For most children and adolescents that experience concussions, symptoms resolve after a week or two. However, a small subset of kids has persistent symptoms lasting for months or even years after the injury. These symptoms can be disruptive and stressful, impacting many areas of their lives.
Kelly McNally, PhD, a pediatric neuropsychologist at Nationwide Children’s Hospital and clinical assistant professor of Pediatrics at The Ohio State University, along with colleagues, evaluated a brief cognitive behavioral intervention program for children and teens with persistent post-concussive symptoms. The intervention program, which involves education, activity management, cognitive restructuring techniques and coping skills, is described in the January 2017 issue of the journal Child Neuropsychology.
In this pilot study, 31 patients aged 10-18 years underwent up to five treatment sessions aimed at helping children and teens who were experiencing persistent problems after a concussion. Although some patients had experienced their concussions recently, others had been suffering with persistent post-concussive symptoms for more than a year. The sessions drew from four modules: psychoeducation (providing information to help patients and families identify and understand concussions and factors that might contribute to symptoms), activity and sleep management (helping patients come up with a plan to get back to their typical activities and improve sleep behaviors), relaxation training, and cognitive restructuring (helping patients identify and replace negative automatic thought patterns regarding their injury).
The results suggest that even a brief cognitive behavioral intervention may be a promising treatment for children and teens experiencing persistent post-concussive symptoms.
“The main benefits we saw were reductions in symptoms and increases in function and quality of life,” says Dr. McNally.
“We thought that kids who were treated sooner would respond to the treatment better, but we actually saw a similar effect whether we treated them a few months out from their concussion or up to a year or two later. This is promising because it means that even a brief treatment might be effective for kids who have had symptoms for a long period of time.”
Dr. McNally emphasizes that this is a pilot study. Data were collected in the context of ongoing clinical care, so a randomized controlled design was not feasible. Because there was no experimental control group, the researchers cannot completely answer the question of whether these patients would have recovered on their own without the treatment. However, the results seem unlikely to be explained by spontaneous recovery, as the patients experienced significant symptom reductions only after participating in the intervention.
“The main questions that remain are which kids benefit the most from this type of treatment and which components of the treatment are most effective,” says Dr. McNally.
“Clinically, we are implementing this right now at Nationwide Children’s. We have a program where we do this cognitive behavioral intervention for kids who are referred to us with significant stressors with their post-concussive symptoms. The hope in publishing this study is to encourage people at other institutions to use similar approaches.”
McNally, K. A., Patrick, K. E., LaFleur, J. E., Dykstra, J. B., Monahan, K., and Hoskinson, K. R. Brief cognitive behavioral intervention for children and adolescents with persistent post-concussive symptoms: A pilot study. Child Neuropsychology. 2017 Jan 26. [Epub ahead of print]
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