Concussion and the Collegiate Student: Impact on Quality of Life,Academic Participation,and Coping

A paucity of literature exists examining perceived long-term effects of concussion on college students. The purpose of this study was to examine the perception of students with documented history of concussion on quality of life (QoL) and participation and coping strategies employed to sustain engagement in campus life.

RESEARCH QUESTION: How does experiencing concussion impact QoL and academic performance in college students and what coping strategies are used to sustain participation? Findings provide insight to the perceived impact and to the potential role of occupational therapists as consultants to the Office of Disabilities to ensure holistic care and engagement post-concussion. This research utilized a mixed method exploratory design combining quantitative questionnaires with qualitative phenomenological research. The population was University students with a documented history of concussion during high school and/or college. Instruments used were the COPE Inventory, Rivermead Post Concussion Symptoms Questionnaire, WHOQOL-BREF, and a semi-structured interview exploring symptoms, changes in academic performance and QoL and coping strategies. Descriptive statistics were used with quantitative data to describe symptoms, QoL and coping methods. Thematic analysis was conducted on qualitative data derived from the semi-structured interviews. Coding, categorization and thematic clustering occurred. Triangulation was completed via field notes.

Post injury, 66% reported headache, fatigue and taking longer to think and 55% reported forgetfulness and poor concentration as a moderate to severe problem. When suffering 2 or more concussions 88% required over 22 days to return to academics. 89% reported unchanged grades, however increased effort, time and use of strategies to maintain academic standing and grade point average. 89% used positive reinterpretation and growth and 67% used emotional social support as coping strategies. 56% reported social relationships as the most negatively impacted QoL domain. Headaches, difficulty concentrating and emotional instability were the most common persistent symptoms that negatively influenced academic performance. Care and recommendations for return to academics varied for each person and after each concussion. Common academic accommodations were extra time, quiet test taking areas and paper copies of notes/exams. Sports and socialization were the two biggest negatively impacted QoL areas. Relationships with acquaintances suffered while those with close friends and family strengthened. The most common coping themes were acceptance of the diagnosis, relying on family/friends, and use of adaptations to the environment or structuring of the day to promote successful engagement.

Variable and inadequate care can result in poor recommendations and management. This can lead to lingering symptoms impacting the ability to engage in academic life, thus creating a need for study habit modifications and accommodations to maintain grades. Coping strategies such as social support was crucial and highly utilized yet one of the most negatively impacted QoL domains. Social support was specific to close family, as friends did not always understand the impact of symptoms on socialization as these experiences were not visible. If the impact of concussions is minimized, students in higher education may have lasting effects which impact education. A need exists for comprehensive care of collegiate students for successful return to academics. Occupational therapists are holistic, can adapt learning environments, and can consult with and support the Office of Disabilities to promote student success and reengagement in academics.

References

Centers for Disease Control and Prevention. (2017). Basic information about traumatic brain injury and concussion. Retrieved from https://www.cdc.gov/traumaticbraininjury/basics.html

Giza, C. C., & Hovda, D. A. (2014). The New Neurometabolic Cascade of Concussion. Neurosurgery, 75(0 4), S24–S33. doi: 10.1227/NEU.0000000000000505

Irvine, A., Babul, S., & Goldman, R. D. (2017). Return to learn after concussion in children. Canadian Family Physician, 63(11), 859-862.

Kontos A. P., Covassin T., Elbin R. J., & Parker T. (2012). Depression and neurocognitive performance after concussion among male and female high school and collegiate athletes. Archives of Physical Medicine & Rehabilitation, 93, 1751–1756. doi:10.1016/j.apmr.2012.03.03