The Influence of Concussion on Athletes

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The Influence of Concussion on Athletes
Occupational Identity
Presented by Ruth Bakewell, Aldith Dawson, Lizna
Husnani, Erin McQuay, Christy Pickles and Keely
Slessor
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Agenda

• Topic
• Research Process
• Definitions
• Initial Model
• Critical Review and Development of Model
• Final Model
• Relevance to OS and OT
• Gaps Future Directions
• Facilitated Discussion

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What is the influence of concussion on athletes
occupational identity?
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Research Process

• Search interfaces Ovid, Pubmed, Cambridge
  Scientific
• Databases PsychInfo, Medline, Sport Discus,
  Cinahl, ERIC
• Keywords concussions, mild traumatic brain
  injury, head injury, athletic injury,
  career-ending injury, athletes, elite athletes,
  athletic identity, athletic role, sports injury,
  depression, psychological effects

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Research Process Contd

• Inclusion criteria for research articles
• Related to at least one component of the topic
• Well designed study
• Added new information to topic area
• Shortfalls in research process
• General difficulty in finding relevant research
  topic
• Concussion specific literature
• Occupational identity and lack of participation
  in sports

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Definitions

• Occupational Identity
• a composite sense of who one is and wishes to
  become as an occupational being generated from
  ones history of occupational performance
• shaped by capacities, interests, roles,
  relationships, obligations, routines, environment
  contexts and expectations
• volition, habits and lived, bodily experiences
  combine to create an occupational identity that
  is a means of self definition and a blueprint
  for upcoming action
• (Kielhofner, 2002)
• Athletic Identity
• "degree to which an individual identifies with
  the athlete role"
• (Brewer, Van Raalte Linder, 1993)

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Definitions Contd

• Concussion
• A violent shaking or jarring
• An injury of a soft structure, as the brain,
  resulting from
• a blow or violent shaking
• (stedmans.com)

• Post-concussion Syndrome
• Personality changes
• Headaches
• Dizziness
• Fatigue
• Irritability
• Depressed Mood
• Anxiety
• (Putukian, 2001)

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Definitions Contd

• Occupational Deprivation
• a state of prolonged preclusion from engagement
  in occupations of necessity and/or meaning due to
  factors which stand outside of the control of the
  individual
• Occupational Disruption
• a transient or temporary condition of being
  restricted from participation in necessary or
  meaningful occupations such as that caused by
  illness, temporary relocation, or temporary
  unemployment
• (Townsend, 1996)

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Initial Model
ATHLETIC IDENTITY
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• I think it just really bummed her out, because
  she had been doing it for so long and that
  becomes part of who she was. When thats not who
  you are anymore, then youre kind of lost
• (Female, Trainer, Age 21)
• (Granito, 2001)

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Mainwaring, L. M., Bisschop, S. M., Green, E. A.,
Antoniazzi, M., Comper, P., Kristman, V.,
Provvidenza, C. Richards, D. W. (2004).
Emotional Reaction of Varsity Athletes to
Sport- Related Concussion. Journal of Sport
Exercise Psychology, 26, 119-135.
CRITICAL ANALYSIS
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• Purpose
• To compare emotional functioning of university
  athletes with MTBI (concussion) to that of
  uninjured teammates and physically active
  undergraduates.
• Literature
• Previous studies lack pre-injury mood assessment
• Design of Study
• Quantitative study

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• Methods
• Sample Groups of U of T students concussed
  athletes, uninjured teammates of concussed
  athletes and healthy, physically active
  undergraduate students
• Measured baseline mood state with a preseason
  medical and neuropsychological assessment
• Following concussion, athletes completed a series
  of assessments for 4 weeks
• Demographic questionnaire
• Short version of the Profile of Mood States
  (POMS)

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• Results
• No difference in POMS ratings among the three
  groups at pre-injury. 
• Significant interactions were observed for the
  POMS subscales of depression, confusion and total
  mood disturbance, which indicate that concussion
  and control groups respond differently in terms
  of mood across the 4 sessions.

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• Conclusions
• The three groups were not emotionally different
  according to baseline testing.
• Concussed group showed higher ratings of
  depression, confusion and total mood disturbance
• Emotional reactions may be the result of
• removal of play
• transient biochemical disturbances following
  brain injury.

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CONCUSSION
BIO- CHEMICAL DISTUR-BANCE
TIME OUT OF PLAY
PSYCHOLOGICAL/EMOTIONAL EFFECTS
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Brock, S.C. Kleiber, D.A. (1994). Narrative in
Medicine The stories of elite college athletes
career-ending injuries. Qualitative Health
Research, 4(4), 411- 430.
CRITICAL ANALYSIS
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• Purpose
• To illustrate the relevance of narrative to
  medical practice
• To demonstrate systematic method for assessing
  illness narratives using the stories of elite
  college athletes who experienced career-ending
  injury
• Literature Review
• Narrative has been used as an explanatory
  complement to quantitative research
• Injured athletes are ideal to demonstrate the
  general view of illness and how another approach
  would be helpful to understand the illness
  experience

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• Design of study
• Qualitative study
• Methods
• Narrative Analytic Method
• Individual interviews were conducted
  face-to-face or by phone
• Sample17 former college athletes whose sport
  careers were ended by injury
• Interviews assessed using core-narrative approach

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• Results
• Injury interpreted as a disruption in the life
  narrative had a negative impact on self-esteem
  and identity
• Stories of injured athletes follow a clinically
  relevant pattern, like a book with 6 chapters.
• The impact of sport culture
• laminility - the experience of an ambiguous,
  undefined, and invisible condition because of
  lack of role (on team)
• stigma - feelings regarding the loss of a
  celebrated state and acquisition of a state of
  relative ordinariness.

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• Conclusion
• Information about the athletes personal
  experiences with injury gives insight into the
  psychosocial impact of injury not just
  physiological impact.
• It is important to include narrative in medical
  practice in order to get a holistic picture of
  the client and capture what the injury means to
  them.
• The perspective derived from illness narratives
  would be an appropriate complement to the
  biomedical view.

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FINAL MODEL
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CONCUSSION
BIO- CHEMICAL DISTUR-BANCE
TIME OUT OF PLAY
PSYCHOLOGICAL/EMOTIONAL EFFECTS
ATHLETIC IDENTITY
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Relevance to Occupational Science and
Occupational Therapy Research
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Relevance

• Occupational Science
• Substantiates the link between occupational
  identity and occupational deprivation/disruption
• Contributes to the understanding of athletic
  identity in relation to occupational identity

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Relevance Contd

• Occupational Therapy
• The extent to which an athlete identifies with
  their athlete role may determine adherence to
  the rehabilitative process
• Reinforces the importance of a holistic approach
  to clinical intervention (i.e.,
  psychological/emotional effects of concussion)

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Gaps and Future Research
SEVERITY
ENVIRONMENT Social Support
OCCUPATIONAL IDENTITY
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CONCUSSION
TIME OUT OF PLAY
BIOCHEMICAL DISTURBANCES
ATHLETIC IDENTITY
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Discussion

• I was disappointed. One, because youre not in
  the spotlight anymore and I think that whenever
  youre in the spotlight and then its shut off
  for you, I think theres always some kind of
  identity crisis and Im sure there was.
• All the sudden youre standing on the outside
  looking in. You feel kind of lost for a while.
  And I felt that way for a long time It wasnt
  so much a loss of self-esteem as maybe I always
  felt like people were looking at me differently,
  like I was something less than I was before.
• (Brock Kleiber, 1994)

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Discussion Contd

• Tell us about your rehabilitation experience
  (with respect to concussion or other athletic
  injury)
• How do you think seeing an OT could have
  contributed to the rehabilitation process?

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Thank You!