Case study: Neuropsychology-informed brief intervention for persisting symptoms after pediatric concussion in a multi-disciplinary clinic setting.

Although the majority of youth recover relatively quickly from concussion, there is a subset of individuals who experience persisting symptoms after concussion. Consensus guidelines recommend multi-disciplinary care for youth with persisting symptoms, though the role of neuropsychology within multidisciplinary care can vary significantly across different care models. The current case study describes a 16-year-old girl who sustained a concussion after a fall from a horse. She received around 2 months of standard concussion care with worsening, rather than improvement of symptoms then was referred to a multidisciplinary clinic for a higher level of care. She presented with a high post-concussion symptom burden but neurocognitive testing was largely normal and neurologic exam identified functional gait disturbance. We describe a multi-disciplinary care approach utilizing a neuropsychology-informed brief cognitive behavioral therapy (CBT) intervention in addition to medical management, guided exercise progression, and physical therapy. The CBT intervention was delivered in three weekly treatment sessions. This involved several components including psychoeducation, parent-directed intervention, behavioral intervention to gradually increase activity tolerance, sleep intervention, and cognitive restructuring. We describe how the neuropsychology-informed CBT intervention was integrated within a multidisciplinary clinic setting and how this type of treatment can compliment other needed specialty interventions in youth with persisting symptoms after concussion.