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Bhanu Sharma and Brian W. Timmons

The recent increase in scientific activity related to traumatic brain injury (TBI)—and in particular, mild TBI and concussion—parallels the growth of public interest in the field. As the international scientific community aligns itself to better diagnose, treat, and manage this injury ( 79 ), which

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Carlie K. Elmer and Tamara C. Valovich McLeod

therapy and its effect on symptoms in children and adolescents with diagnosed concussions. Focused Clinical Question Does CBT reduce concussion symptoms among children and adolescents following mild traumatic brain injury? Search Strategy A comprehensive search of PubMed, CINAHL, MEDLINE, SPORTDiscus

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Megan Self, Simon Driver, Laurel Stevens, and Ann Marie Warren

Traumatic brain injury (TBI) is a significant public health issue due to the incidence, complexity, and cost associated with treatment. The purpose of this study was to determine physical activity (PA) knowledge, attitudes, intentions, and barriers among individuals with a TBI undergoing outpatient rehabilitation. Seventeen participants completed a series of group interviews regarding their PA needs. A qualitative research design was adopted and trustworthiness was established through investigator triangulation of data. A cross-case analysis was completed to identify themes and conceptual patterns. The main themes identified were (a) an inability to differentiate between PA and physical therapy, (b) a limited knowledge of PA health benefits and the relationship to rehabilitation, and (c) an interest in participating in a PA based health promotion program. Future interventions should educate individuals about PA, the associated health benefits, and the role PA plays in the rehabilitation process.

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Patricia R. Roby, Robert C. Lynall, Michael J. Cools, Stephen W. Marshall, Janna C. Fonseca, James R. Stevens, and Jason P. Mihalik

therapy has demonstrated benefits in animal studies, 10 as well as those suffering from moderate to severe traumatic brain injury. 11 Unfortunately, it has not been adequately studied as an acute concussion treatment. Giza and Hovda 2 previously described the neurometabolic cascade resulting from

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Krista M. Hixson, Alex N. Allen, Andrew S. Williams, and Tamara C. Valovich McLeod

Clinical Scenario:

Mild traumatic brain injury, or concussion, has been associated with physical, cognitive, and emotional sequelae. Little is understood in regard to many characteristics, such as anxiety, and their effect on post-concussion symptoms.

Clinical Question:

Is state anxiety, trait anxiety, or anxiety sensitivity a clinical predictor of symptoms in those presenting with mild traumatic brain injury or concussion?

Summary of Key Findings:

A literature search returned 3 possible studies; 3 studies met inclusion criteria and included. One study reported in athletes that greater social support was associated with decreased state-anxiety, lower state anxiety post-concussion was associated with increased social support, and that those with greater social support may experience reduced anxiety, regardless of injury type sustained. One study reported baseline trait anxiety in athletes was not significantly associated with post-concussion state anxiety, but that symptoms of depression at baseline was the strongest predictor for post-concussion state anxiety. Three studies reported that state and trait anxiety are not related to increased post-concussion symptom scores. One study reported that greater anxiety sensitivity is related to higher reported post-concussion symptom scores, which may manifest as somatic symptoms following concussion, and revealed that anxiety sensitivity may be a risk factor symptom development.

Clinical Bottom Line:

There is low-level to moderate evidence to support that anxiety sensitivity is linked to post-concussion symptoms. State and trait anxiety do not appear to be related to post-concussion symptoms alone. Post-concussion state anxiety may occur if post-concussion symptoms of depression are present or if baseline symptoms of depression are present. Better social support may improve state anxiety post-concussion.

Strength of Recommendation:

There is grade B evidence to support that state and trait anxiety are not risk factors for post-concussion symptom development. There is grade C evidence to support anxiety sensitivity as a risk factor for developing post-concussion symptoms.

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Lauriece L. Zittel

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Amy M. Roberts, Shane V. Caswell, Trenton E. Gould, and Richard G. Deivert

Column-editor : Joseph J. Piccininni

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Simon J. Driver

The study consisted of (a) assessing the validity and reliability of the Social Influence Scale (SIS) for adults with brain injuries and (b) examining the types and sources of social influence and demographic variables that affect participants’ physical activity behaviors. Three confirmatory factor analyses, intraclass correlations, and a repeated measures MANOVA were completed on responses from 402 adults with brain injuries. Results provide evidence of the validity and reliability of the SIS, and post hoc analyses revealed that participants reported receiving different types of social influence from family, friends, and caregivers. Findings have implications for specialists and suggestions are provided on ways to enhance the physical activity participation of adults with brain injuries.

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Byron Lai, Katie Cederberg, Kerri A. Vanderbom, C. Scott Bickel, James H. Rimmer, and Robert W. Motl

People with neurologic disabilities, including multiple sclerosis (MS), spinal cord injury (SCI), and traumatic brain injury (TBI), remain largely inactive, despite a substantial growth in evidence from clinical trials demonstrating beneficial outcomes following exercise training. For example, a

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Christine C. Center, Samuel J. Wilkins, Ross Mathiasen, and Adam B. Rosen

These signs indicate the potential for increased cranial pressure, which could be fatal if not managed appropriately and promptly. ATs should have preestablished and well-rehearsed emergency action plans specific to each venue. 12 Timely management of a traumatic brain injury could be the difference