77

Introduction

Youths who participate in contact sports are prone to different types of physical injuries that put them at risk of injury to their brain and potentially affect their overall cognitive health. An example of a physical injury due to a contact sport, especially amongst youths, is a concussion. Concussions are caused by a traumatic biomechanical force that affects the process of the brain, which, for example, can potentially cause cognitive functioning (Meijer, Moore, Hillman, & Broglio, n.d.). It can affect the youths’ memory, their way of processing, their attention span, and even their approach to executive functioning.

Theory

The PEO model was developed to developed to examine the person-environment-occupation processes and how they come together to contribute to occupational performance (Maclean, 2012). The model explains how an individual, their environment and their occupation interact in a dynamic way (Maclean, 2012). The PEO model states that a person and their environment are connected and that an individual’s behavior cannot be separated from the context where it occurs. The model focuses on what the individual wants or needs rather than on the deficits or the dysfunction.

Evidence

Evidence for the use of cognitive interventions in the treatment of concussions and mild traumatic brain injuries in children and adolescents has been positive. A systematic review of previous studies points to the advantages of cognitive interventions in the treatment of concussions (Broglio, Collins, Williams, Mucha, & Kontos, 2015). Evidence in a nested randomized control study showed that cognitive interventions produced positive results in the long term for children and adolescents suffering from mild traumatic brain injuries (Renaud et al., 2016). Research also indicates a need for further studies to provide an increased awareness amongst professionals into the proper protocols for interventions (Varner et al., 2015).

Case Study

James is a 17-year-old male, currently in the foster care system. James is on the high school football team and recently suffered a concussion and was unconscious for 2 minutes.  He was evaluated by a neuropsychologist to rule out any major complications.  He has been recently  complaining of frequent headaches and dizziness spells lasting several minutes. James has been having trouble with his  working memory and more complex problem solving.  James has met with his psychologist who referred to an occupational therapist to help with his problem solving. He is in agreement with the referral to occupational therapy.

Intervention Plan

Problem Statement

James has difficulty with problem solving and working memory in cognitively over stimulating environments  secondary to a concussion.

Long Term Goals

• James will be able to maintain cognitive rest schedule for 2 hours daily to improve his working memory by the end of the therapy program
• James will be able to adhere to his reduced cognitive diet for “brain rest” in 1 month to improve his cognitive health.
• James will be able to complete intermediate level problem solving task by discharge.

Short Term Goals

• James will be able to return-demonstrate a 4 step task to help improve working memory in 3 therapy sessions.
• James will be able to reduce his caffeine intake to 3 drinks per week (soda, coffee, etc.) in order to maintain his cognitive rest in 2 weeks.
• James will keep a sleep schedule and record his hours of sleep in a sleep log to reduce his cognitive stress and improve his ability to problem solve in 3 therapy sessions.

Intervention Format

Individual

Description of Setting

Residential Hall/Activity Room in the afternoons 4:00pm

Supplies

Agenda/Description

Set up safe learning environment (5 minutes)

• Review the treatment goals
• Assess client’s readiness to learn

Provide demonstration (20 minutes)

• James will be able to complete mild-moderate intensity cognitive worksheet to address problem solving related to football
• Ask client to attend and perform a return demonstration on  three tasks to address working memory

Evaluate learning outcomes (5 minutes)

• Ask client to explain one of the worked on tasks by breaking down into smaller task
• Ask client to write a memo of written directions for future reference

SOAP

S: Client stated that he experienced a dizzy spell this morning, however, with the help of his morning medication was able to overcome symptoms. Client also stated that he was excited for getting back on the field once therapy addressed his memory deficit and problem solving abilities.

O: Client was euthymic, friendly and demonstrate willingness to learn. James’ speech was appropriate and smooth. Client  required extra-time to answer and respond to therapist when given a prompt or problem solving activity. Client was given two mild intensity cognitive tasks and was able to solve them within appropriate time. One intermediate intensity cognitive task was presented, in which James’ required cuing and extra- time. Two times during session, it became evident that James had word-finding difficulty.

A: Client showed his willingness to learn and completed the problem solving activity. Client required verbal cues for writing the memo due to decreased ability to attend to task, secondary to decreased working memory. The client demonstrates that he is having trouble with his working memory and problem solving. Therapist will continue to recommend reducing excessive cognitive stimulus as that may contribute to his inability to complete his tasks.  Client will continue to benefit from OT services.

P: Patient will benefit from attending three thirty minute session from OT bi-weekly for the next two months to address working memory and problem solving abilities. Will continue to monitor progress.

References

Broglio, S. P., Collins, M. W., Williams, R. M., Mucha, A., & Kontos, A. P. (2015). Current and emerging rehabilitation for concussion: A review of the evidence. Clinics in Sports Medicine, 34(2), 213-231. Retrieved from http://ezproxy.fiu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=103131099&site=eds-live

Maclean F, Carin-Levy G, Hunter H, Malcolmson L, Locke E (2012) The usefulness of the Person-Environment-Occupation Model in an acute physical health care setting. British Journal of Occupational Therapy, 75(12), 555-562. DOI: 10.4276/030802212X1354895554553

Meijer, A., Moore, R. D., Hillman, C. H., & Broglio, S. P. (n.d). Sport-Related Concussion and Sensory Function in Young Adults. Journal Of Athletic Training, 49(1), 36-41.

Renaud, M. I., Lambregts, S. A. M., de Kloet, A. J., Catsman-Berrevoets, C., van, d. P., & van Heugten, C. M. (2016). Activities and participation of children and adolescents after mild traumatic brain injury and the effectiveness of an early intervention (brains ahead!): Study protocol for a cohort study with a nested randomized controlled trial. Trials, 17, 1-11. doi:10.1186/s13063-016-1357-6

Varner, C. E., McLeod, S., Nahiddi, N., Lougheed, R. E., Dear, T. E., Borgundvaag, B., . . . Taylor, N. F. (2015). Cognitive rest and graduated return to usual activities versus usual care for mild traumatic brain injury: A randomized controlled trial of emergency department discharge instructions Wiley Subscription Services, Inc. doi:10.1111/acem.13073