Finnish practices: Cognitive assessment and interventions

Transcription

1 Finnish practices: Cognitive assessment and interventions Kati Peltonen, psychologist, MSc, MA University of Helsinki, Clinical Neuropsychology Research Group

2 Cognitive assessment and interventions 1. Heads in the Game 2. Cognitive assessment Concussion management protocol Assessment methods Baseline cognitive functioning 3. Interventions Rest,return to school/ to learn, return to play Activity progression after mtbi Cognitive Interventions. Heads in the Game Future Prospects

3 Heads in the Game project Funded by Ministry of Social Affairs and Health. Aims Awareness of concussions Concussion management protocol Interventions Professional network

4 Nation wide 17 clubs 51 teams around 2700 players 70 concussions in season

5 Concussion Management Protocol Baseline assessment before season (ImPACT, K-D, D2-R, SCAT-3, ATTEX) Post-injury Sideline test Post injury- assessment (3, 7,14 and 30 days after injury) Physical and cognitive activity Comprehensive Neuropsychological tests if needed

6 Cognitive symptoms after concussion Problems with memory Difficulty concentrating Feeling slowed down Feeling mentally foggy

7 Cognitive assessment: Sport Concussion Assessment Tool 3rd edition (SCAT3) Symptom evaluation Cognitive and physical evaluation

8 Cognitive assessment methods: ImPACT Immediate Post-Concussion Assesment and Cognitive Testing Takes about 30 minutes, 6 testing modules Measures attention span and time, working memory, response variability, non-verbal problem solving and reaction time Composite scores for verbal and visual memory, visual motor speed, reaction time and impulse control

9 Cognitive assessment: King-Devick Test (K-D) (King-Devick Test) Brief Screening test Measures reading speed and saccadic eye movements

10 Cognitive assessment: D2-R: Test of Attention (Hogrefe 2016) Measures sustained attention, focused attention, selective attention Computer based test 5-10 minutes

11 Cognitive assessment: ATTEX for self evaluation (Klenberg et al. 2010) (The Attention and Executive Function Rating Inventory) 55 questions Distractibility, Impulsivity and Motor hyperactivity Directing attention, Sustaining attention and Shifting attention Initiative, Planning, Execution of action and Evaluation

12 Cognitive functioning at baseline ImPACT Composite Scores Sarja1 Sarja2

13 Cognitive functioning at baseline ImPACT Composite Scores 8,7 6,9 6,8 9, ,63 0, Sarja1 Sarja2

14 Interventions after Concussion Rest Definition? Duration? (Scneider, Iverson, Emery, McCrory, Herring & Meeuwisse 2013) Return to school/learn (Halstead et al. 2013, McGrant 2010) Return to play (McCrory et al. 2013)

15 Return to Activity After Military mtbi: guideline (McCulloch et al. 2015)

16 Activity progression after mtbi: cognitive aspect (McCulloch et al. 2015) Rehabilitation stage Description of stage Objective(s) 1 - Rest Physical and cognitive rest. No videogames, study, driving. 2 - Light routine activity Cognitive activity for 30 min, followed by 1 h rest. Limit activity to promote recovery Initiate and promote limited effort in cognitive domain 3 - Light occupationoriented activity Activity demands not to exceed 60 min periods, followed by rest. No collision sports/contact, videogames, driving. Full body, complicated,coordinated movements. 4 - Moderate activity Cognitive activity min, with rest 1:2 ratio 5 - Intensive activity Cognitive activity up to 50 min. No contact or collision sports. Increase intensity and complexity of exercise and cognitive activity. Taking part to normal activities with maximum exertion. 6 - Urestricted activity No restrictions. Normal cognitive activities.

17 Treatment or rehabilitation after an injury Physical therapy Psychological treatment Symptoms Medication Vestibular Rehabilitation Exersice

18 Cognitive rehabilitation after mtbi Psychological interventions or behavioural therapy Depression or anxiety, pain, insomnia Neurocognitive rehabilitation after mtbi (Kaldoja 2015, Leddy et al. 2012, Ponsford 2005, ) Problems with attention, memory or executive functioning

19 Cognitive Intervention: Heads in the Game Post-injury assessments, follow up the recovery process Concussion education What is concussion? Symptoms? Recovery? Emotional support Gradual return to learn Avoiding environments that might provoke symptoms Rest when needed, explaining what rest means Shorter school days, allow rest brakes, reduced course load Extra time in tests and in class assignment completion Help with homework Compensatory strategies

20 Future Prospects More research on cognitive rehabilitation Web-based methods

21 Thank you! For more information: University of Helsinki, Institute of Behavioural Sciences Heads in the Game Project coordinator, PhD Student Kati Peltonen Project planner, Matti Vartiainen Director, Laura Hokkanen

22 References Halstead ME, McAvoy K, Devore CD, Carl R, Lee M & Logan K. Returning to Learning Following a Concussion. Pediatrics 2013, 132 (5): Harmon K, Drezner J, Gammons M, Guskiewicz K, Halstead M, Herring S et al. Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 2013;47: Kaldoja M-L. Mild traumatic brain injury in childhood: pre-injury social-emotional behavior, social-emotional and cognitive outcome and implications for attention rehabilitation. 2015, University of Tarto. Klenberg L, Jämsä S, Häyrinen T, Lahti-Nuuttila P & Korkman M. The Attention and Executive Function Rating Inventory (ATTEX):Psychometric properties and clinical utility in diagnosing ADHD subtypes. Scandinavian Journal of Psychology 2010, 51, Leddy J, Sandhu H, Sodhi V, Baker J & Willer B. Rehabilitation of Concussion and post-concussion Syndrome. Sports Health 2012; 4(2); McCulloch K, Goldman S, Lowe L, Radomski M V, Reynolds J, Shapiro R & West T A. Development of Clinical Recommendations for Progressive Return to Activity After Military Mild Traumatic Brain Injury: Guidance for Rehabilitation Providers. J Head Trauma Rehab 2015; 30(1): McGrath N. Supporting the Student-Athlete s Return to the Classroom After a Sport-Related Concussion. Journal of Athletic Training 2010;45(5): McCrory P, Meeuwisse W, Aubry M, Cantu, Dvořák J, Echemendia R. et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November Br J Sports Med 2013;47: Ponsford J. Rehabilitation interventions after mild head injury. Current Opinion in Neurology 2005, 18: Schneider K J, Iverson G L, Emery C A, McCrory P, Herring S A & Meeuwisse W H. The effect of rest and treatment following sportrelated concussion: a systemic review of the literature. Br Sports Med 2013; 47: