Importance: Occupational performance limitations (OPLs) are poorly understood sequelae of concussion. This study aimed to establish the need for occupational therapy services for people who have sustained a concussion and to support the profession’s role in facilitating occupational performance for college students experiencing signs and symptoms after concussion. Objective: To describe the types and frequency of, and assess risk factors for, OPLs in college students after concussion. Design: Cross-sectional descriptive study. Setting: Web-based survey on Qualtrics. Participants: A total of 220 participants completed the survey; of those, 52 (23.6%) self-identified as having sustained a concussion and were further asked about OPLs after the concussion. Results: Eighty-nine percent (n = 46) of the participants reported an OPL in at least one area, and higher OPL scores were associated with the number of concussion symptoms (r = .34, p = .02) and increased recovery time (≥3 days vs. <3 days, p = .006). Conclusions and Relevance: College students reporting concussions with more symptoms that persisted for longer periods were more likely to experience occupational performance loss. Frequent OPLs were reported in occupations associated with the participants’ primary role of student. These results indicate a unique need for occupational therapy intervention with students to facilitate their continued success in academic pursuits. What This Article Adds: People who have sustained a concussion experience OPLs. Occupational therapy has a role in facilitating a return to occupational performance during recovery, especially in helping college students with concussion return to the classroom.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This descriptive study examined OT referrals in an interdisciplinary concussion clinic. Data analyzed show that patients referred to OT presented to clinic evaluation further out from injury; had missed more days from school, work, and physical activity; were lacking a routine; and were not socially active. These results provide variables that indicate the need for OT assessment, guide clinicians in the referral process, and advance the role of OT in concussion management. Primary Author and Speaker: Shannon S. Westerberg Additional Authors and Speakers: Madison Harris Contributing Authors: Samia Rafeedie, David McArthur, and Christopher Giza

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This descriptive, qualitative study describes the OT process used by expert practitioners for adults with persistent mild traumatic brain injury symptoms in outpatient concussion clinics. OTs are uniquely trained to return persons to their everyday activities, without requiring a military or sport background. This evidence empowers practitioners to advocate for the client and for the professional to be part of the rehabilitation team and raise the perceived value of the profession. Primary Author and Speaker: Mary Ann B. Roelke Contributing Authors: Vanessa Jewell

Date Presented 04/13/21 Concussion is a common sport-related injury for collegiate student athletes. Pressures exist that influence athletes' perceptions and attitudes, consequently impacting the decision-making process surrounding concussion and symptom reporting. Therefore, a holistic approach is needed for education and care. OT can contribute to the interprofessional process with a focus on health, wellness, and prevention that is inclusive of student athlete values, beliefs, and roles both on and off the field. Primary Author and Speaker: Elizabeth Kloczko Additional Authors and Speakers: Carole Dennis, Matthew Darby, Keanna Morales, Carly Wellner, Amanda Wetmore, Tiani Ziegler

Postconcussion syndrome (PCS) affects physical, cognitive, and emotional functioning. Existing reviews of interventions to address PCS are limited to psychological and rehabilitation interventions and to child and adolescent populations. We conducted a systematic review integrating current evidence about interventions for adults with PCS. The inclusion criteria were intervention studies of adults (ages ≥18 yr) with PCS that evaluated recovery from PCS symptoms and focused on functional outcomes; 10 studies met the criteria. Included studies demonstrated medium to high levels of evidence and investigated psychotherapy, counseling, social support, self-management strategies, individualized rehabilitation, hyperbaric oxygen interventions, and group-based cognitive–behavioral therapy. Outcomes included reduced postconcussion symptoms, improved cognitive function, enhanced quality of life, and increased community integration. The evidence supports psychotherapy, counseling, and social support interventions as being beneficial for cognitive and emotional functions in adults with PCS.

OBJECTIVE. We explored the potential impact of mindfulness-based yoga (MBY) for youth with persistent concussion by examining occupation-based and neurophysiological outcomes. METHOD. In this case series design study, 6 youths ages 13–17 yr with concussion symptoms for >4 wk participated in an 8-wk MBY intervention, 1×/wk for 45 min. Participation, self-efficacy, and heart rate variability (24 hr) were collected before, after, and 3 mo after the intervention. Heart rate variability was also measured during each session. RESULTS. Trends of increased self-efficacy in academic, social, and emotional domains were found after MBY and maintained at 3-mo follow-up. Trends of increasing heart rate variability were also found pre- to postintervention and within the eight MBY sessions. CONCLUSION. Preliminary results reveal positive trends after a novel, safe intervention for youth with persistent concussion symptoms and the value of exploring both occupation-based and neurophysiological measures. Future research with a larger sample and control group is warranted.

OBJECTIVE. We determined the feasibility and effects of the Cognitive Orientation to daily Occupational Performance (CO–OP) Approach^TM on activity performance and satisfaction, symptoms, and mood of adolescents with persistent postconcussion symptoms. METHOD. In a prospective case series, 3 participants with persistent symptoms 3 mo after concussion and difficulties resuming activities were taught to use a metacognitive strategy (Goal–Plan–Do–Check) to work toward occupation-based goals in a 7-wk intervention (10 sessions, 30–60 min each). Participants were assessed pre- and postintervention and at 3-mo follow-up. Feasibility was determined by positive changes on study measures, ease of administration, and acceptability to participants. RESULTS. Clinically significant, positive changes were found in participants’ activity performance and satisfaction. All participants had decreases in symptoms and improved mood scores at posttest. CONCLUSION. The CO–OP Approach to rehabilitation for youth postconcussion is feasible and may make a positive contribution to recovery.

OBJECTIVES. Executive functioning deficits may result from concussion. The Charge of Quarters (CQ) Duty Task is a multitask assessment designed to assess executive functioning in servicemembers after concussion. In this article, we discuss the rationale and process used in the development of the CQ Duty Task and present pilot data from the preliminary evaluation of interrater reliability (IRR). METHOD. Three evaluators observed as 12 healthy participants performed the CQ Duty Task and measured performance using various metrics. Intraclass correlation coefficient (ICC) quantified IRR. RESULTS. The ICC for task completion was .94. ICCs for other assessment metrics were variable. CONCLUSION. Preliminary IRR data for the CQ Duty Task are encouraging, but further investigation is needed to improve IRR in some domains. Lessons learned in the development of the CQ Duty Task could benefit future test development efforts with populations other than the military.