Applying the Common-Sense Self-Regulation Model to Understand Illness Representations of Mild Traumatic Brain Injury in College Students.

OBJECTIVE: The Common Sense Model (CSM) describes cognitive, emotional, and psychosocial factors that influence how health threats are processed and subsequently inform health-related decisions or actions. The purpose of this study was to examine psychosocial factors influencing coherence, or usefulness, of mild traumatic brain injury (mTBI) representations and their relationship to health-related decisions and actions. SETTING: Public university. PARTICIPANTS: There were 458 graduate and undergraduate college students who participated in a web-based survey (mean age = 22 years; SD = 3.6). DESIGN: A mixed-methods design randomized participants into 2 groups to examine perceptions of mTBI across differing injury mechanisms, or causes, by comparing actions recommended to a friend (Other; n = 214) with those generated for self (Self; n = 244). MAIN MEASURES: Seven common injury mechanisms representative of university student mTBI experiences were presented as vignettes (cause). Each vignette included open- and closed-ended questions framed from CSM constructs (identity, consequences, action plans, timeline, and social context). Data were analyzed using a series of chi-square tests and multiple analysis of variance. Post hoc analysis identified differences in the injury vignettes. RESULTS: Students were more likely to identify the injury as mTBI ( = 8.62, P = .035) and recommend immediate healthcare (F1,415 = 316.89, P < .001) for all causes if the injury occurred to a friend as compared with themselves. Action plans also varied by cause, with post hoc analysis revealing a higher likelihood of healthcare seeking for motor vehicle crashes and assault and a lower likelihood for falls while intoxicated. Students were generally more likely to talk to closest confidants than doctors (F8,398 = 33.66, P < .001). CONCLUSION: Cause appears to be a key construct in generating illness representations and associated action plans for seeking care, with lower perceived severity causes (eg, falls) resulting in little to no health-seeking action. In addition, social support appears to be important for college students when making decisions about their health.

Critical Elements of Return to Learn for Students With Concussion: A Scoping Review.

OBJECTIVE: To identify critical elements of return to learn (RTL) for students with concussion and examine the state of the peer-reviewed published literature through a scoping review. METHODS: Three electronic databases were systematically searched, and reference lists screened for articles addressing components of RTL protocols and accommodations for students with concussion. In total, 100 articles met inclusion criteria, including 56 empirical studies and 44 expert articles. RESULTS: Four key components to RTL protocols were identified: RTL teams, management approaches, outcome measurement, and accommodations. Both bodies of literature agree on the importance of RTL teams, but evidence for specific monitoring tools and management approaches is less robust. Accommodations have been better addressed by experts than empirical evaluation. Empirical studies are largely cross-sectional, and many are survey based. Just 24 include student perspectives. Publication of expert literature has declined in frequency, as empirical studies have become more common. CONCLUSION: This scoping review describes the current landscape of RTL and provides guidance toward expanding the empirical literature to systematically determine best practices to serve students with concussion.

Investigating the Student in Returning to Learn After Concussion: A Systematic Review and Meta-Analysis.

PURPOSE: Examine concussion effects on academic outcomes, including student perspectives. METHODS: This study included a systematic review and meta-analysis examining post-concussion school attendance, academic performance, perceptions of academic difficulty, and accommodations for students in elementary through college settings. The analysis considered pre- and post-injury factors, along with injury factors that contribute to post-concussion academic outcomes. RESULTS: The systematic review showed that students with concussion miss more school days and perceive higher levels of academic difficulty, but results about academic performance varied. Meta-analysis yielded small concussion effects on school absence and academic performance and moderate effects on perceptions of academic difficulty. Female sex, older age, history of migraine, prior concussions, severe or persistent symptoms, vestibular-ocular motor, and cognitive disruptions are risk factors, but these moderators were not identified in the meta-analysis due to lack of effect sizes. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: This study confirmed negative concussion effects on academic absences, performance, and perceptions of academic difficulty. Identified contributing factors will guide future practices to support students returning to learn after concussion. CONCLUSIONS: Negative impacts to academics from concussion may be amplified by complicating factors. Future investigations are needed to confirm risk factors and mitigating effects of early identification and post-injury supports.

Reconceptualizing Recovery After Concussion: A Phenomenological Exploration of College Student Experiences.

PURPOSE: Typical measures of recovery from concussion-such as symptom scales, neurocognitive testing, or exertion measures-may not capture individualized experiences of concussion. This report examines how college students with concussion interact with and consider their recovery. METHOD: Sixteen college students who sustained concussions while in college completed 40- to 75-min semistructured interviews. All were enrolling to become mentors in a peer mentoring program for students with concussion. Questions addressed experiences as a college student with concussion, life changes following concussion, and role of peers in recovery. Using phenomenological reduction, analysis focused on the phenomenon of recovery and motivation for participation in a mentoring program. RESULTS: Two main themes were found: (a) What Recovery Looks Like and (b) Gaining Perspective, Learning to Cope and Adapting to Change. Thirteen participants denied the label of "recovered" even though all had been deemed recovered and discharged from medical care. Instead, two subthemes emerged within What Recovery Looks Like: Ongoing Recovery and Reconceptualizing Recovery. Perceptions of recovery were influenced by effort, capacity, and resilience. In the second theme, students described strategies, resources, and supports used to cope with their injuries; most commonly used was emotion-focused coping. CONCLUSIONS: College students with concussion consider recovery as an ongoing process rather than a dichotomized condition. Student experiences may not be reflected in commonly used symptom scales or objective assessments. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21084925.

A theory-based exploration of psychosocial factors influencing concussion health seeking intentions in college students.

Objective: This mixed method study examined how psychosocial factors from the Theory of Planned Behavior and Reasoned Action (TPB/RA) influence health-seeking behaviors after concussion, expanding from student-athlete TPB/RA research to assess the influence of psychosocial factors within a general college population. Participants: Two hundred and forty-four students participated from a large Southeastern public university. Methods: A concurrent nested mixed-methods approach involving closed- and constructed- response survey questions. Results: Subjective norms (direct: B = .499, p = .002; indirect: B = .023, p = .046) and attitude (indirect: B = .034, p = .041) were significant predictors of intention to seek medical care after a hypothetical concussion. Open-ended responses were coded by anticipated post-injury behaviors. Only 36.2% of the sample indicated intention to seek medical care. The most common response (38.3%) was students would self-treat a suspected concussion. Conclusions: Subjective norms and indirect attitudes are important to understanding how general college students seek care after a concussion, particularly how the influence of others are important in the decision to seek healthcare.

Pilot testing the SUCCESS peer mentoring program for students with concussion: the role of personas in mobile technology development.

PURPOSE: College students with concussion experience academic, cognitive and psychosocial challenges, yet frequently lack supports necessary for successful reintegration into school. Success in College after Concussion with Effective Student Supports (SUCCESS) is a virtual peer mentoring program designed to provide education, support and connection through a mobile application. The purpose of this study was to describe use of personas as components of mobile app development and conduct preliminary testing of SUCCESS using personas. METHODS: Personas were developed from case studies and portrayed by college students trained as fictitious mentees. Mentors were blinded to use of personas. Eleven mentors completed measures pre and post a 4-week mentoring cycle. Mentors and personas interacted in the app via chat, video calls and sharing of educational materials. Measures included the Post-Concussion Symptom Scale (PCSS); PROMIS Self-Efficacy; Depression, Anxiety and Stress Scale (DASS); and a series of focus groups. RESULTS: Mentors suggested improvements to resolve instability of video calls, expand educational materials to address psychosocial functioning, and add structure to the mentoring relationship. Some preferences around communication, like groups chats and emoji keyboards, were not able to be addressed. As expected, PCSS scores were stable. DASS score (p = .04), especially depression (p = .03), decreased. PROMIS scores showed a trend towards growth (p = .057), although were not statistically significant. CONCLUSIONS: Use of personas allowed technical challenges and program refinements to be addressed before including students with subacute concussion in testing. Although continued development will address enhancement of communication modalities preferred by students, future efficacy testing of SUCCESS is warranted.

Personas can be useful for the development of mobile applications, particularly those that include interaction between users, allowing for testing of complex usage scenarios to improve app functionality.Students who have recovered from concussion may benefit from providing peer mentoring to students with more acute injuries.Mentoring programs should have a clear structure that considers relationship closure as much as relationship building. Mobile apps can deliver just-in-time prompts that support both of these activities.Postsecondary students express a preference for augmenting written app-based communication with digital images such as emojis and gifs, considering these important towards relationship-building in virtual spaces.

The SUCCESS Peer Mentoring Program for College Students with Concussion: Preliminary Results of a Mobile Technology Delivered Intervention.

Concussions are caused by a hit or blow to the head that alters normal brain functioning. The Success in College after Concussion with Effective Student Supports (SUCCESS) program was developed to provide students with psychosocial support and resources-both key components of concussion management-to assist in recovery and return-to-learn following concussion. In this preliminary evaluation of intervention efficacy, SUCCESS was delivered through a mobile application connecting mentors (students who have recovered from concussion and successfully returned to school) with mentees who were currently recovering. Mentor-mentee pairs met virtually through the app, using chat and videoconferencing features to share support, resources, and program-specific educational materials. Results from 16 mentoring pairs showed that mentee symptoms (V = 119, p = 0.009) and academic problems decreased (V = 114.5, p = 0.002), while academic self-efficacy increased (V = 13.5, p = 0.009) following mentoring. As expected, mentor measures were stable, indicating that providing mentoring did not exacerbate previously resolved concussion complaints. Virtual peer mentoring provided through a mobile application may be a feasible intervention to support academic success and psychosocial processing during recovery for college students with concussion.

Cognitive-Communication Complaints and Referrals for Speech-Language Pathology Services Following Concussion.

PURPOSE: Speech-language pathologists are increasingly being recognized as key members of concussion management teams. This study investigates whether self-report of communication problems postconcussion may be useful in identifying clients who could benefit from speech-language pathology services. METHOD: Participants included 41 adolescents and adults from an outpatient specialty concussion clinic. All completed the La Trobe Communication Questionnaire (LCQ) at admission, and 23 repeated this measure at discharge. Participants were prospectively enrolled, with chart reviews providing demographic, injury, and medical factors. The analysis considered (a) communication complaints and resolution over time, including comparison to two previously published LCQ studies of typical adults and adults with and without traumatic brain injury (TBI); (b) the relationship between communication complaints, participant factors, and common concussion assessments; and (c) factors related to speech-language pathology service referral for rehabilitation. RESULTS: At first visit, 12 of 41 participants (29%) reported communication problems, although 19 (46%) reported difficulty with greater than half of LCQ items. At a group level, compared to published reference data of both people with chronic mixed severity TBI and controls, participants in this study reported more problems at first visit with communication overall, as well as greater difficulty with the LCQ Initiation/Conversation Flow subscale. Partner Sensitivity subscale scores at first visit were also greater than published control data. LCQ subscale scores of Initiation/Conversation Flow and Partner Sensitivity decreased from first visit to last visit, demonstrating resolution over time. Only concussion symptom scales and not demographic, injury, or cognitive screenings were related to LCQ scores. The same two LCQ subscales, Initiation/Conversation Flow and Partner Sensitivity, predicted referral for speech-language pathology services, along with symptom scales and being injured due to motor vehicle crash. DISCUSSION: A subset of people recovering from concussion report experiencing communication problems. Reporting of particular communication problems was related to referral for speech-language pathology rehabilitation services and may be useful in directing care after concussion.

The School-Based Speech-Language Pathologist and Students With Concussion: An Examination of Evolving Knowledge and Confidence.

PURPOSE: This study examines school-based speech-language pathologists' (SLPs') experience, knowledge, and confidence in supporting students as they return to the classroom following concussion, with a particular focus on knowledge of new management guidelines over the last decade. METHOD: Participants were 74 school-based SLPs who completed an electronic survey about their knowledge and experiences serving students with concussion. We examined participants' accuracy and confidence across knowledge questions using Kruskal-Wallis tests. We also conducted linear regression to explore the relationships between training, work experiences, knowledge, and confidence. RESULTS: Nearly half of participants who are currently working with students with concussion reported having no clinical or training experiences related to concussion. Participants who had more concussion-related training or working experiences reported higher confidence. Participants were confident about general concussion knowledge but less confident about providing assessment and supporting students with concussion as they returned to school. Participants had the lowest confidence and accuracy for the most recent guidelines around rest and activity, as well as the differential impact of concussion on children as compared to adults. CONCLUSIONS: Many school-based SLPs have limited training around concussion management and are often not specifically consulted to work with students following concussion. Despite this, SLPs have good awareness of their knowledge about concussion, but show gaps in knowledge surrounding more recent evidence-based guidelines. Additional investigation is needed to determine better ways to move research into clinical practice and to increase the involvement of SLPs in school-based concussion teams. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20361969.

Student Perspectives on the Role of Peer Support Following Concussion: Development of the SUCCESS Peer Mentoring Program.

Purpose College students with concussion are often ill-equipped to manage their health and learning needs, and college campuses are slow to react. We present the development of a peer mentoring program for college students with concussion: Success in College after Concussion with Effective Student Supports (SUCCESS), focusing on the process by which student needs and preferences drove development of the program for testing. Method Principles of person-centered design were used to guide program development, engaging stakeholders at each stage of development and resulting in the intervention package presented to student participants here. A series of interviews and focus groups with 11 students with concussion addressed student needs after concussion, student perceptions of the role of peers in recovery, and feedback on program development. Results Findings indicate students have limited knowledge about concussion, and concussion impacts extend beyond school, although students are most concerned about their studies. Students reported struggling to communicate with professors and find resources on campus to aid in their reentry to learning. Regarding peer mentoring, students report benefiting from hearing about other's successes and sharing personal narratives of injury and recovery. Students reported high acceptability of a peer mentoring program, both for psychosocial support and access to resources. Conclusions College students with concussion have unmet needs as they return to learn. The SUCCESS peer mentoring program is highly acceptable to students, who report that they would expect such a program to be engaging and to meet their needs. The program's impact on student academic and psychosocial outcomes should be investigated through comparative efficacy trials.

Effects of Task Demands on Neural Correlates of Acoustic and Semantic Processing in Challenging Listening Conditions.

Purpose Listeners shift their listening strategies between lower level acoustic information and higher level semantic information to prioritize maximum speech intelligibility in challenging listening conditions. Although increasing task demands via acoustic degradation modulates lexical-semantic processing, the neural mechanisms underlying different listening strategies are unclear. The current study examined the extent to which encoding of lower level acoustic cues is modulated by task demand and associations with lexical-semantic processes. Method Electroencephalography was acquired while participants listened to sentences in the presence of four-talker babble that contained either higher or lower probability final words. Task difficulty was modulated by time available to process responses. Cortical tracking of speech-neural correlates of acoustic temporal envelope processing-were estimated using temporal response functions. Results Task difficulty did not affect cortical tracking of temporal envelope of speech under challenging listening conditions. Neural indices of lexical-semantic processing (N400 amplitudes) were larger with increased task difficulty. No correlations were observed between the cortical tracking of temporal envelope of speech and lexical-semantic processes, even after controlling for the effect of individualized signal-to-noise ratios. Conclusions Cortical tracking of the temporal envelope of speech and semantic processing are differentially influenced by task difficulty. While increased task demands modulated higher level semantic processing, cortical tracking of the temporal envelope of speech may be influenced by task difficulty primarily when the demand is manipulated in terms of acoustic properties of the stimulus, consistent with an emerging perspective in speech perception.

Effects of Task Difficulty on Neural Processes Underlying Semantics: An Event-Related Potentials Study.

Purpose Improving the ability to listen efficiently in noisy environments is a critical goal for hearing rehabilitation. However, understanding of the impact of difficult listening conditions on language processing is limited. The current study evaluated the neural processes underlying semantics in challenging listening conditions. Method Thirty adults with normal hearing completed an auditory sentence processing task in 4-talker babble. Event-related brain potentials were elicited by the final word in high- or low-context sentences, where the final word was either highly expected or not expected, followed by a 4-alternative forced-choice response with either longer (1,000 ms), middle (700 ms), or shorter (400 ms) response time deadlines (RTDs). Results Behavioral accuracy was reduced, and reactions times were faster for shorter RTDs. N400 amplitudes, reflecting ease of lexical access, were larger when elicited by target words in low-context sentences followed by shorter compared with longer RTDs. Conclusions These results reveal that more neural resources are allocated for semantic processing/lexical access when listening difficulty increases. Differences between RTDs may reflect increased attentional allocation for shorter RTDs. These findings suggest that situational listening demands can impact the demands for cognitive resources engaged in language processing, which could significantly impact listener experiences across environments.

[Medical reform in Brazil and the US: a comparison of two rhetorics]. / A reforma médica no Brasil e nos Estado Unidos: uma comparação entre duas retóricas.

The article examines the genesis of the medical education model proposed by A. Flexner in the United States and compares it with Antonio da Silva Mello's 1930s proposal to apply the German university model to Brazilian medical teaching. The heart of these medical reforms - which sought to introduce the teaching of biomedicine and to boost the esteem of the scientific career - did not depend solely on these two reformers' perfect understanding of the bases of the new model. Each rhetoric expressed a political arrangement wherein any expectations for change in the consolidated educational system depended upon its power structure and upon traditional career expectations.

A reforma médica no Brasil e nos Estados Unidos: uma comparação entre duas retóricas / Medical reform in Brazil and the US: a comparison of two rhetorics

Discute-se, aqui, a gênese do modelo de educação médica proposto por A. Flexner nos Estados Unidos, comparando-o com a proposta de aplicação do modelo universitário germânico à educação médica brasileira, na década de 1930, por Antonio da Silva Mello. Argumentamos que o núcleo das reformas médicas - que almejavam a introdução do ensino da biomedicina e a valorização da carreira científica - não dependia somente da perfeita compreensão, por parte dos dois reformadores, dos fundamentos do novo modelo. Cada retórica expressava um arranjo político no qual as expectativas de mudança no sistema educacional consolidado dependiam de sua estrutura de poder e das expectativas de carreira consagradas pela tradição.