Julia Schmidt

Background. Concussions are highly prevalent injuries, particularly among youth populations. Symptoms of concussion are broad and varied among individuals, across physical, cognitive, emotional, and sleep-related domains. Most people experience full recovery from concussions; however, approximately 30% of individuals continue to experience symptoms beyond the normal recovery period. Guidelines to manage concussion recovery indicate a gradual return to activity. However, there is limited evidence on how engagement in activity influences recovery and how to effectively promote activity re-engagement in youth with concussion. This thesis will build evidence to support the integration of activity following a concussive event in youth.Aims. 1) To examine the influence of physical and social activity on recovery in children and youth with concussions.2) To develop an intervention that will enable an early return to activity after a concussion in an effort to improve the recovery trajectory in youth.Methods. Two study designs were utilized to address our aims:1) A systematic review and meta-analysis was conducted to assess the influence of social and/or physical activity on concussion recovery in adolescents. All types of intervention studies investigating social and physical activity to improve concussion recovery in youth were identified. 2) An intervention mapping framework was used to design an intervention to improve activity engagement after concussion in youth, encompassing current return to activity guidelines and using a personalized rehabilitation approach. Results. Overall, engagement in activity positively influenced recovery concussion outcomes in youth, with results used to guide the development of a novel intervention. In the systematic review, 19 studies were included, of which 8 were RCTs. There was a significant effect of activity interventions on decreased symptom reporting (SMD = 0.39 [95% CI = 0.14 to 0.64], I2 = 0%, p = 0.002), but no significant effect on quality of life. The Concussion Coach intervention was developed to improve recovery outcomes after concussion in youth through a guideline-based, individualised, goal-oriented telerehabilitation approach. Conclusion. Findings from this thesis extend knowledge of concussion recovery in youth. This thesis indicated that activity-based interventions, individualized rehabilitation, and health delivery innovations may be important components for youth concussion interventions.

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Background: Traumatic Brain Injury (TBI) affects a substantial number of Canadians every year, with individuals experiencing changes to their everyday life. Objectives: This thesis aimed to 1) explore perceived changes in social participation and self-identity post-injury, and 2) characterise individuals displaying higher and lower levels of posttraumatic growth, in terms of their social participation, self-awareness, and self-identity. Methods: Study 1 used a constructivist grounded theory methodology. In study 2, a sequential explanatory/exploratory mixed-methods design was followed. For study 1, qualitative data were obtained from a semi-structured interview, conducted to explore the participants’ experiences of living with their TBI; for study 2, quantitative data were collected using questionnaires about social participation, self-awareness, and self-identity. Results: Participants were 16 adults with a moderate to severe TBI living in the community (average age= 49.8, male= 11). In study 1, an overarching theme ‘living in a reshaped reality’ was identified which comprised of three themes: 1) ‘there’s nothing that’s the same’ identified the daily challenges of living with a TBI, 2) ‘rebuilding and restarting’ described how participants navigated their post-injury life, and 3) ‘embrace it and run with it’ explored the participants’ responses to life with TBI. An explanatory model of these themes was developed, which illustrated how changes in social participation and self-identity may impact an individual’s post-injury life. In study 2, qualitative data were used to categorise individuals into two groups of higher (n=8) and lower (n=7) posttraumatic growth. The quantitative data were then used to characterise the two groups, indicating that participants portraying higher posttraumatic growth had greater social participation, more self-awareness, and fewer discrepancies in pre-and post-injury identities. Significance: This thesis builds understanding of the experience of life after TBI. Clinical rehabilitation could be framed to facilitate both social participation and positive self-identity changes given the explanatory model. Using the findings of posttraumatic growth characterisation, future research could explore the experiences of the development of posttraumatic growth after TBI.

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