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    Discussion 2: Overview of Your Interests

          The topic of mTBI, also commonly known as concussion, interests me and how it is currently being treated. One of the most widely implemented interventions for concussion is clinically advised physiological and cognitive rest (DiFazio, 2016). The rationale for this prescribed intervention is based upon expert consensus that following injury the brain is in a state of neurometabolic crisis, that a second injury midst recovery may magnify behavioral deficits and pathophysiology, and lastly, animals that have exercised too soon post injury have not demonstrated exercise-induced neuroplasticity (DiFazio, 2016). Based on these three primary reasons, rest is hypothesized to be the most efficacious treatment for concussion (DiFazio, 2016). Recently however, clinicians are beginning to see harmful psychological and behavioral effects from this type of intervention as it requires withdrawal from normal life activities such as school and work attendance, sports and exercise, and technology. This prolonged rest and activity withdrawal beyond the first couple of days may exacerbate postconcussion symptoms and in some cases, produce new ones (DiFazio, 2016).
          The previously encouraged recovery model of resting until one feels better is now being challenged with how activity restrictions cascade and prolong recovery (DiFazio, 2016). A substantial amount of evidence is suggesting that discontinuation of daily validating activities has an adverse effect on the ability to cope with illness and foster rehabilitation (DiFazio, 2016). A modification to mTBI guidelines now emphasizes and encourages prompt reengagement in life activities as tolerated (DiFazio, 2016). However, there remains limited practice guidelines on how to successfully rehabilitate this particular population using efficacious behavioral and psychological interventions, especially for those whose symptoms are persisting beyond a year. 
            I believe that there are many more psychological, physiological, and social factors that play a role in prolonged recovery from mTBI such as, the nocebo effect and expecting a prolonged recovery, external incentives including litigation and compensation, physical deconditioning, economic strain, mental health stereotypes, and so much more. The rehabilitation approach for individuals with mTBI needs to be updated to target each of these factors. A research project could analyze whether or not incorporating interventions beyond rest and activity withdrawal would decrease post concussive symptoms. Interventions would be focused on slowly integrating the individual back into their behavioral routine only a couple weeks following the injury, teaching them how to be aware of their somatic symptoms (when to rest and when to preserve as it is natural to feel some pain during rehabilitation), and how to cope with social changes such as others reactions to the injury and potential stigma from others. Self-report measures as well as clinically structured interviews can be used to psychometrically evaluate and measure concussive symptoms (somatic) and psychological well-being (depression and anxiety).
    References
    DiFazio, M., Silverberg, N. D., Kirkwood, M. W., Bernier, R., & Iverson, G. L. (2016). Prolonged activity restriction after concussion: are we worsening outcomes?. Clinical pediatrics, 55(5), 443-451.

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