Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (Drs Simpson, Peterson, and Forster); Department of Neurology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle (Dr Patrick); Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Facility, Aurora, Colorado (Dr Forster); and Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus (Dr McNally).
J Head Trauma Rehabil. 2021;36(2):E79-E88. doi: 10.1097/HTR.0000000000000592.
To evaluate the feasibility and potential benefits of a manualized, brief cognitive-behavioral therapy-based intervention program for children and adolescents with persistent postconcussive symptoms.
Two outpatient pediatric concussion programs in the United States.
Patients aged 8 to 17 years who sustained concussions between 2 and 12 months prior to enrollment.
Pre-/postretrospective study.
SCAT-3; HBI; PedsQL 4.0 Generic Core Scales; and RCADS.
Thirty children and adolescents completed the treatment program. Self- and parent-reported postconcussive symptoms, quality of life, and internalizing symptoms significantly improved with treatment. Mixed-effects models revealed a significant decline in self-reported postconcussive symptoms across treatment sessions, a = -2.07, SE = 0.25, P < .001. The largest change occurred between sessions 2 and 3, following the session focusing on concussion psychoeducation and sleep hygiene (estimated mean change between sessions 2 and 3 = -4.72, P < .0001).
Our findings indicate that a 6-session manualized cognitive behavioral intervention is feasible to initiate in an outpatient clinic 1 to 12 months following a pediatric mild traumatic brain injury. With a manualized format, clinicians at most levels of training should be able to implement this treatment manual and flexibly adapt as needed when working with children and adolescents who are experiencing delayed symptom recovery following concussion.
评估基于手册的简短认知行为疗法干预方案对持续性脑震荡后症状的儿童和青少年的可行性和潜在益处。
美国的两个儿科脑震荡门诊项目。
年龄在 8 至 17 岁之间，在入组前 2 至 12 个月发生脑震荡的患者。
预/回顾性研究。
SCAT-3；HBI；PedsQL 4.0 通用核心量表；和 RCADS。
30 名儿童和青少年完成了治疗计划。自我报告和父母报告的脑震荡后症状、生活质量和内化症状在治疗后显著改善。混合效应模型显示，治疗过程中自我报告的脑震荡后症状显著下降，a = -2.07，SE = 0.25，P <.001。最大的变化发生在第 2 次和第 3 次治疗之间，这是在专注于脑震荡心理教育和睡眠卫生的治疗之后（估计第 2 次和第 3 次治疗之间的平均变化为-4.72，P <.0001）。
我们的研究结果表明，6 次基于手册的认知行为干预方案可以在儿科轻度创伤性脑损伤后 1 至 12 个月在门诊开始实施。通过手册格式，大多数培训水平的临床医生都应该能够实施这种治疗手册，并在与脑震荡后症状恢复延迟的儿童和青少年一起工作时根据需要灵活地进行调整。
