A Multifactorial Framework for Persisting Symptoms after Concussion

Research Objectives: To develop a multifactorial framework for persisting symptoms after concussion (PSaC) and coalesce understudied factors (neuroplastic response, neurobehavioral response, and autonomic nervous system dysfunction) as responses to neurometabolic events leading to PSaC.
To highlight clinically measurable factors in rehabilitation for key concepts of this framework that may have prognostic capabilities for PSaC, inform clinical decision making and research design, and tailor treatment approaches.

Design: Non-experimental development of a framework

Setting: The implications of this framework have potential for implementation in all rehabilitation settings that provide treatment for concussion (physical therapy, neuropsychology, neurology, vision therapy, occupational therapy, speech therapy).

Participants: The intended population is individuals who have sustained a concussion and go on to report PSaC (i.e., dizziness, anxiety, headache) past the accepted recovery time frame.

Interventions: N/A

Main Outcome Measures: This framework presents examples of several measurable factors in rehabilitation for PSaC. This is not meant to be a comprehensive list, but serve as guidelines for future research and clinical practice: 1) Autonomic functioning: HR variability, skin conductance, pupillary response 2) Neuroplastic response: quantitative sensory testing 3) Neurobehavioral responses: self-report measures of hypervigilance, anxiety, fear avoidant behaviors, catastrophizing 4) Cognitive response: cognitive functioning tests (neuropsychological) 5) Intrinsic factors: medical comorbidities, mental illness, personality and 6) Extrinsic factors: mechanism of injury, litigation, marital status, socioeconomic status.

Results: We will present a graphical representation of a framework that highlights how neurometabolic events following a concussion alter synaptic plasticity and predispose the brain to maladaptive synaptic connections, leading to the development of negative neurobehavioral responses (i.e., fear avoidance, catastrophizing) and autonomic dysfunction. This process, as outlined by the framework, leads to PSaC.

Conclusions: Future research should consider each component of the proposed framework to advance understanding of PSaC. Specifically, standardized measures proposed by this framework that are feasible to implement in rehabilitation settings should be considered during research planning stages. The significance for rehabilitation is Integrating this proposed framework into clinical decision-making processes could enhance clinical practice and subsequent patient outcomes.

Author(s) Disclosures: N/A