The Influence of Concussion on Athletes Occupational Identity

1. The Influence of Concussion on Athletes’ Occupational Identity

2. Agenda Topic Research Process Definitions Initial Model Critical Review and Development of Model Final Model Relevance to OS and OT Gaps & Future Directions Facilitated Discussion

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

6. 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

7. 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

8. Definitions Occupational 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)

9. Definitions Cont’d…

10. 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)

11. Initial Model

12. “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)

13. 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.

14. 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

15. 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)

16. Results No 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.

17. 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.

19. 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. 

20. 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

21. Design of study Qualitative study Methods Narrative Analytic Method Individual interviews were conducted: face-to-face or by phone Sample:17 former college athletes whose sport careers were ended by injury Interviews assessed using core-narrative approach

22. 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.

23. 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.

24. FINAL MODEL

27. Relevance Occupational Science Substantiates the link between occupational identity and occupational deprivation/disruption Contributes to the understanding of athletic identity in relation to occupational identity

28. Relevance Cont’d… Occupational Therapy The 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)

29. Gaps and Future Research

31. 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)

32. 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?

33. Thank You!