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Article

The sociocultural aspects of sport injury and recovery include the broad landscape of social beliefs, climates, processes, cultures, institutions, and societies that surround the full chronological spectrum of sport injury outcomes, ranging from risk through to rehabilitation and retirement. A social ecological view of research on this topic demonstrates that sociocultural influences affect sport injury outcomes via interrelated sport systems extending from the intrasystem (i.e., within sports persons) through the microsystem (i.e., sport relationships), mesosystem (i.e., sport organizations), exosystem (i.e., sport governing bodies), and macrosystem (i.e., sport cultures). Affected sport injury outcomes include sport injury risks and responses during rehabilitation, return to play, and retirement from sport. Some specific examples of sociocultural themes evident in research literature include personal conformity to the cultural expectation to play hurt, social conventions of behavior when sport injuries occur, institutional character or ethics when making return to play decisions, guidelines for the care of athletes prescribed by sport governing bodies, and the economic costs to society for sport injuries. Many elements of sport injury are affected by these sociocultural influences, such as the risk of injuries, rehabilitation processes, and career terminations. Continuing debates and discussions include advocacy for sport rule changes, bans on dangerous sports, institutional responsibility, and global sport safety efforts. These form the basis for recommendations about sociocultural interventions designed to reduce sport injury risks and optimize effective injury recoveries through social and cultural best practices.

Article

This article aims to provide a narrative overview on injury prevention in sport and performance psychology. Research and applied interest in psychological injury prevention in sport and performance psychology has risen in popularity over the past few decades. To date, existing theoretical models, pure and applied research, and practice-based evidence has focused on conceptualizing and examining psychological injury occurrence and prevention through stress-injury mechanisms, and predominantly in sport injury settings. However, given the inherited similarities across the different performance domains however, it is the authors’ belief that existing injury prevention knowledge can be transferable beyond sport but should be done with caution. A range of cognitive-affective-behavioral strategies such as goal setting, imagery, relaxation strategies, self-talk, and social support have been found beneficial in reducing injuries, particularly when used systematically (a) prior to injury occurrence as part of performance enhancement program and/or as a specific injury prevention measure, (b) during injury rehabilitation, and (c) as part of a return-to-activity process to minimize the risk of secondary injuries and reinjuries. Existing theoretical and empirical evidence also indicates that using cognitive-affective-behavioral strategies for injury prevention are effective when used as part of a wider, multi-modal intervention. Equally, such interventions may also need to address possible behavioral modifications required in sleep, rest, and recovery. Considering the existing empirical and anecdotal evidence to date, this paper argues that injury prevention efforts in sport and performance psychology should be cyclical, biopsychosocial, and person-centered in nature. In short, injury prevention should be underpinned by recognition of the interplay between personal (both physical and psychological), environmental, and contextual characteristics, and how they affect the persons’ cognitive-affective-behavioral processes before, during, and after injury occurrence, at different phases of rehabilitation, and during the return to activity or retirement from activity process. Moreover, these holistic injury prevention efforts should be underpinned by a philosophy that injury prevention is inherently intertwined with performance enhancement, with the focus being on the individual and their overall well-being.

Article

Megan S. Barker, Emily C. Gibson, and Gail A. Robinson

The term “acquired brain injury” refers to any type of brain damage that occurs after birth. Two main types of acquired brain injury are stroke and traumatic brain injury (TBI). A stroke occurs when there is a blockage or bleed in the vascular system of the brain, while a TBI results from an external force to the head. Older adults are at a higher risk of both stroke and TBI; thus, overall incidence is increasing as the proportion of older adults in the population is growing. Stroke and TBI result in immediate and long-term cognitive changes. Impairments in the domains of language, attention, memory, executive functions, perception, and social cognition have been documented following stroke and TBI. However, strokes tend to cause focal or selective cognitive disorders, while cognitive deficits following TBI are widespread and can be generalized. Individuals who have suffered a stroke or TBI may also experience psychosocial changes; for example, symptoms of depression and anxiety are common. Functional outcomes, including independence in activities, are varied and are associated with a range of factors including age, injury severity, cognitive disorders, and psychosocial factors. To achieve optimal outcomes for individuals following stroke and TBI, and to reduce the impact of the injury on everyday functioning, a multidisciplinary rehabilitation process is recommended.

Article

In addition to the disruptive impact of sport injury on physical functioning, injury can have psychological effects on athletes. Consistent with contemporary models of psychological response to sport injury, aspects of psychological functioning that can be affected by sport injury include pain, cognition, emotion, and behavior. Part of the fabric of sport and ubiquitous even among “healthy” athletes, pain is a common consequence of sport injury. Postinjury pain is typically of the acute variety and can be exacerbated, at least temporarily, by surgery and some rehabilitation activities. Cognitive responses to sport injury include appraising the implications of the injury for one’s well-being and ability to manage the injury, making attributions for injury occurrence, using cognitive coping strategies, perceiving benefits of injury, and experiencing intrusive injury-related thoughts and images, increased perception of injury risk, reduced self-esteem and self-confidence, and diminished neurocognitive performance. Emotional responses to sport injury tend to progress from a preponderance of negative emotions (e.g., anger, confusion, depression, disappointment, fear, frustration) shortly after injury occurrence to a more positive emotional profile over the course of rehabilitation. A wide variety of personal and situational factors have been found to predict postinjury emotions. In terms of postinjury behavior, athletes have reported initiating coping strategies such as living their lives as normally as possible, distracting themselves, seeking social support, isolating themselves from others, learning about their injuries, adhering to the rehabilitation program, pursuing interests outside sport, consuming alcohol, taking recreational and/or performance-enhancing substances, and, in rare cases, attempting suicide. Psychological readiness to return to sport after injury is an emerging concept that cuts across cognitive, emotional, and behavioral responses to sport injury.

Article

Heather N. Schuyler, Brieanne R. Seguin, Nicole Anne Wilkins, and J. Jordan Hamson-Utley

The practice of athletic training involves both physical and psychological strategies when leading patients through the injury recovery process. Research on the psychology of injury offers theoretical foundations that guide the application of strategies to assist the patient with stressors that emerge during rehabilitation. This article applies theory to athletic training practice during injury recovery by examining the stressors that patients experience across the phases of rehabilitation. Addressing both physical and psychological aspects of injury recovery is expected by patients and provides a holistic care model for healthcare practitioners.

Article

Anthony P. Kontos and Jamie McAllister-Deitrick

Concussions affect millions of athletes of all ages each year in a variety of sports. Athletes in certain sports such as American football, ice hockey, rugby, soccer, and combative sports like boxing are at higher risk for concussion. Direct or indirect mechanical forces acting on the skull and brain cause a concussion, which is a milder form of brain injury. Conventional neuroimaging (e.g., computerized tomography [CT], magnetic resonance imaging [MRI]) for concussion is typically negative. Concussions involve both neurometabolic and subtle structural damage to the brain that results in signs (e.g., loss of consciousness [LOC], amnesia, confusion), symptoms (e.g., headache, dizziness, nausea), and functional impairment (e.g., cognitive, balance, vestibular, oculomotor). Symptoms, impairment, and recovery time following concussion can last from a few days to weeks or months, based on a variety of risk factors, including younger age, female sex, history of concussion, and history of migraine. Following a concussion, athletes may experience one or more clinical profiles, including cognitive fatigue, vestibular, oculomotor, post-traumatic migraine (PTM), mood/anxiety, and/or cervical. The heterogeneous nature of concussion warrants a comprehensive approach to assessment, including a thorough clinical examination and interview; symptom inventories; and cognitive, balance, vestibular, oculomotor, and exertion-based evaluations. Targeted treatment and rehabilitation strategies including behavior management, vestibular, vision, and exertion therapies, and in some cases medication can be effective in treating the various concussion clinical profiles. Some athletes experience persistent post-concussion symptoms (PCS) and/or psychological issues (e.g., depression, anxiety) following concussion. Following appropriate treatment and rehabilitation strategies, determination of safe return to play is predicated on being symptom-free and back to normal levels of function at rest and following exertion. Certain populations, including youth athletes, may be at a higher risk for worse impairment and prolonged recovery following concussion. It has been suggested that some athletes experience long-term effects associated with concussion including chronic traumatic encephalopathy (CTE). However, additional empirical studies on the role of concussion on CTE are needed, as CTE may have multiple causes that are unrelated to sport participation and concussion.

Article

Ian Q. Whishaw and Megan Okuma

A brain lesion is an area of damage, injury, or abnormal change to a part of the brain. Brain lesions may be caused by head injury, disease, surgery, or congenital disorders, and they are classified by the cause, extent, and locus of injury. Lesions cause many behavioral symptoms. Symptom severity generally corresponds to the region and extent of damaged brain. Thus, behavior is often a reliable indicator of the type and extent of a lesion. Observations of patients suffering brain lesions were first recorded in detail in the 18th century, and lesion studies continue to shape modern neuroscience and to give insight into the functions of brain regions. Recovery, defined as any return of lost behavioral or cognitive function, depends on the age, sex, genetics, and lifestyle of patients, and recovery may be predicted by the cause of injury. Most recovery occurs within the first 6 to 9 months after injury and likely involves a combination of compensatory behaviors and physiological changes in the brain. Children often recover some function after brain lesions better than adults, though both children and adults experience residual deficits. Brain lesion survival rates are improved by better diagnostic tools and treatments. Therapeutic interventions and treatments for brain lesions include surgery, pharmaceuticals, transplants, and temperature regulation, each with varying degrees of success. Research in treating brain lesions is progressing, but in principle a cure will only be complete when brain lesions are replaced with healthy tissue.

Article

Neuropsychological rehabilitation (NR) is concerned with the amelioration of deficits caused by insult to the brain. It adopts a goal-planning approach and addresses real-life difficulties. Neuropsychology studies how the brain affects behavior, emotion, and cognition. Rehabilitation is a process whereby people who are disabled work together with professional staff, relatives, and others to achieve optimum physical, psychological, and vocational well-being. Rehabilitation is not synonymous with recovery, nor is it treatment. It is a two-way interactive process with professional staff and others who aim to remediate or alleviate difficulties, adopting a holistic approach in which cognition, emotion, and psychosocial problems are treated together, aided by an increasing use of technological aids. NR enables people with disabilities to achieve their optimum level of well-being, reduce problems in everyday life, and help them return to the most appropriate environments. There may also be some partial or limited recovery of function and certainly some substitution of function. Accepting that return of normal functioning is highly unlikely, rehabilitation finds ways to help people learn more efficiently, compensate for their difficulties, and, when necessary, modify the environment. While theoretical models have proved helpful, indeed essential, in identifying cognitive strengths and weaknesses, in explaining phenomena, and in making predictions about behavior, they are insufficient, on their own, to seriously influence rehabilitation aimed at making lives more adaptable to problems encountered in everyday living. NR should focus on goals relevant to a person’s individual everyday life, it should be implemented in the environment where the person lives, and have personally meaningful themes, activities, settings, and interactions. We know from numerous studies that NR can be clinically effective. Although rehabilitation can be expensive in the short term, there is evidence that it is cost-effective in the long term.