Clinical practice in occupational therapy for treatment of concussion in schoolboys: An integrative review

Abstract

Rugby in South Africa is one of the fastest growing contact sports and schoolboys competing in rugby will sustain injuries such as concussions. Concussion protocol regulations indicate that young players be removed from play and training for two weeks as there are many misconceptions about the long-term implications of concussion. Concussion has been shown to impact on cognitive functioning and the ability to perform at school. Occupational therapy has a role in the intervention of occupational performance post-concussion in learners playing this contact sport. A clinical practice framework to provide guidelines for the occupational therapy intervention for schoolboy rugby players post-concussion in the South African setting is presented. The framework was based on the occupations, client factors, performance skills, performance patterns and context and environments in the Occupational Therapy Practice Framework III (OTPF III). Screening assessment including the learners, parents and teachers were suggested to determine the use of specific occupational performance assessments in education, social participation, activities of daily living and rest and sleep as well as client factor assessments to determine the outcomes of concussion. Intervention guidelines include the occupational therapy process approaches for Create/Promote, Establish/Restore, Maintain, Modify (compensate) and Prevent with a focus on create/promote; or promotion of safety in rugby. The assessments given in this framework are easily accessible in the South African setting and provide knowledge for all level of practitioners. The role of occupational therapy in reducing residual risks of concussion sustained while playing rugby at school and the long-term consequences of concussion on occupations needs to be researched further. Key words: concussion, schoolboy concussion, concussion management, occupational therapy management