The effects of person-centred active rehabilitation on symptoms of suspected Chronic Traumatic Encephalopathy: A mixed methods single case design

Hearn, Rachael (2023) The effects of person-centred active rehabilitation on symptoms of suspected Chronic Traumatic Encephalopathy: A mixed methods single case design. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Background: For almost a century, cases of former contact sport athletes who have developed cognitive impairments, changes in mood/behaviour, or motor dysfunction have been reported within scientific journals and major news outlets. In 2015, Chronic Traumatic Encephalopathy (CTE) was established as a unique neurodegenerative pathology linked to the repeated exposure to mild traumatic brain injury. Due to the observed long-term effects, multiple generations of former athletes are at-risk of developing symptoms of CTE. With no pathology-led intervention yet established, these athletes remain vulnerable and unsupported. Aim: The aims of the thesis included (1) to establish the potential for active rehabilitation as an intervention strategy for the management of symptoms associated with suspected CTE, and (2) to equally consider evidence-based medicine (EBM) and person-centred care (PCC) when designing and evaluating a programme for the management of suspected CTE. Methods: An umbrella review was carried out to examine the effect that active rehabilitation had on symptoms of tauopathies. Six mixed-method n-of-1 studies were carried out to assess the effect that a person-centred active rehabilitation programme had on symptoms of suspected CTE. Results: The umbrella provided preliminary evidence to support the use of active rehabilitation in the management of tauopathies, with specific implications for the management of suspected CTE. A key observation was the positive effect of active rehabilitation on motor and cognitive symptoms in tauopathies. The mixed methods single case series provided preliminary evidence of a positive effect on some symptoms of suspected CTE. A positive effect was primarily seen in cognitive functioning, with mood and behavioural symptoms (e.g., anxiety, depression, loneliness, irritability, and insomnia) largely reporting a mix of positive and inconclusive effects. Conclusions: For the first time, this thesis has offered preliminary evidence which suggests active rehabilitation may offer some benefit to individuals with symptoms of suspected CTE. This is supported by the findings of a one-year observational study which demonstrated positive effects across a range of symptoms utilising a person-centred rehabilitation approach. Further, this thesis has illustrated the benefit of PCC in clinical research and practice.