Implementation of active injury management (AIM) in youth with acute concussion: A randomized controlled trial.

BACKGROUND: Nearly 2 million youth seek acute medical care following concussion in the U.S. each year. Current standard of care recommends rest for the first 48 h after a concussion. However, research suggests that prolonged rest may lengthen recovery time especially for patients with certain risk profiles. Research indicates that physical activity and behavioral management interventions (sleep, stress management) may enhance recovery. To date, there is limited empirical evidence to inform acute (<72 h) concussion recommendations for physical activity and behavioral management in adolescents. OBJECTIVE: To determine the effectiveness of physical activity and behavioral management for acute concussion in adolescents and young adults, and to evaluate the role of patient characteristics on treatment response. METHODS: This multicenter prospective randomized controlled trial will determine which combination of physical activity and behavioral management is most effective for patients 11-24 years old who present to the emergency department or concussion clinic within 72 h of injury. Participants are randomized into: 1) rest, 2) physical activity, 3) mobile health application (mHealth) behavioral management, or 4) physical activity and mHealth app conditions. Assessments at enrollment, 3-5 days, 14 days, 1 month, and 2 months include: concussion symptoms, balance, vestibular-ocular and cognitive assessments, quality of life, and recovery time. Somatic symptoms and other risk factors are evaluated at enrollment. Compliance with treatment and symptoms are assessed daily using actigraph and daily self-report. The primary study outcome is symptoms at 14 days. CONCLUSION: Prescribed physical activity and behavioral management may improve outcomes in youth following acute concussion.

Then as an indicator of deictic discontinuity in adults' oral descriptions of a film.

An analysis of film descriptions of 20 normal-language adults revealed the adults' selective and systematic use of the word then. Then served to indicate an upcoming shift in discourse deixis. It occurred in clauses that told of a shift to a different discourse frame (conversation vs. story world of the film), to a new scene location, to a different character, and a shift in who was doing the viewing. The regularity in the use of then is taken to be evidence that speakers conceptualize their descriptions as being located in a variety of related frames, all having to do with the perspective taken on the current talk. A conceptual model underlying the speakers' use of then would need to include distinctions between the conversational and story world, the various scenes in the objective world of the story, and various subjective views that different observers can have when experiencing the described events. The results are taken as support for viewing discourse discontinuity as an important factor in discourse analysis.