The Influence of Concussion on Athletes’ Occupational

Identity

Presented by: Ruth Bakewell, Aldith Dawson, Lizna Husnani, Erin McQuay, Christy Pickles and Keely Slessor

Agenda

TopicResearch ProcessDefinitionsInitial ModelCritical Review and Development of ModelFinal ModelRelevance to OS and OTGaps & Future Directions Facilitated Discussion

What is the influence of concussion on athletes’ occupational identity?

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

Research Process Cont’d…

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

DefinitionsOccupational Identity “a composite sense of who one is and wishes to become as

an occupational being generated from one’s 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)

Definitions Cont’d…

Post-concussion Syndrome• Personality changes• Headaches• Dizziness• Fatigue• Irritability• Depressed Mood• Anxiety

(Putukian, 2001)

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

(stedmans.com)

Definitions Cont’d…

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)

ATHLETIC

IDENTITY

Initial Model

“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 that’s not who you are anymore, then you’re kind of lost”

(Female, Trainer, Age 21)(Granito, 2001)

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

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

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)

ResultsNo 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.

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.

TIME OUT OF PLAY

BIO-CHEMICALDISTUR-BANCE

PSYCHOLOGICAL/EMOTIONAL EFFECTS

CONCUSSION

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

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

Design of studyQualitative study

MethodsNarrative Analytic Method Individual interviews were conducted: face-

to-face or by phoneSample:17 former college athletes whose

sport careers were ended by injury Interviews assessed using core-narrative

approach

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.

Conclusion Information about the athlete’s 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.

FINAL MODEL

TIME OUT OF PLAY

BIO-CHEMICALDISTUR-BANCE

PSYCHOLOGICAL/EMOTIONAL EFFECTS

CONCUSSION

ATHLETICIDENTITY

Relevance to Occupational

Science and

OccupationalTherapy

Research

Relevance

Occupational ScienceSubstantiates the link between

occupational identity and occupational deprivation/disruption

Contributes to the understanding of athletic identity in relation to occupational identity

Relevance Cont’d…

Occupational TherapyThe 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)

ENVIRONMENTSocial Support

SEVERITY

OCCUPATIONAL IDENTITY

TIME OUT OF PLAY

BIO-CHEMI-CALDISTUR-BANCE

PSYCHOLOGICAL/EMOTIONAL EFFECTS

CONCUSSION

ATHLETICIDENTITY

Gaps and Future Research

TIME OUT OF PLAY

CONCUSSION

ATHLETICIDENTITY

BIOCHEMICAL DISTURBANCES

PSYCHOLOGICAL/EMOTIONALEFFECTS

PSYCHOLOGICAL/EMOTIONALEFFECTS

Discussion“I was disappointed. One, because you’re not in the spotlight anymore and I think that whenever you’re in the spotlight and then it’s shut off for you, I think there’s always some kind of identity crisis and I’m sure there was.”

“All the sudden you’re standing on the outside looking in. You feel kind of lost for a while. And I felt that way for a long time … It wasn’t 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)

Discussion Cont’d…

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?

Thank You!