by Sieto Reitsma, Aida Mehrad

Abstract

Objective: Persistent post-concussion syndrome (PCS) affects a substantial proportion of individuals after mild traumatic brain injury (mTBI). Persistent symptoms may reflect functional dysregulation – including altered autonomic and sensory processing – rather than irreversible structural damage. This pilot case series explored the feasibility and preliminary outcomes of a ReAttach-informed integrated occupational therapy protocol on symptom severity, perceived stress, and functional participation.
Method: Ten adults with post-concussion symptoms persisting more than six weeks post-injury received four 60-minute sessions over four weeks, combining ReAttach with occupational therapy coaching. Outcomes were assessed at baseline (T0), post-treatment (T4, week 4), and follow-up (T12, 12 weeks post-baseline; 8 weeks after treatment completion) using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ-13), the Perceived Stress Scale (PSS-10), and the Canadian Occupational Performance Measure (COPM). Data were analysed with the Friedman test; where the omnibus test was significant, Bonferroni-corrected Wilcoxon signed-rank post-hoc comparisons were conducted. Kendall’s W was reported as the effect size.
Results: All measures showed a significant omnibus effect (p < .01), with large effect sizes (Kendall’s W = .55–.83). Under the Bonferroni-corrected threshold, symptom severity was significantly reduced at post-treatment and at follow-up, and perceived stress and satisfaction were significantly improved at follow-up; the remaining pairwise comparisons did not survive correction. Satisfaction with daily activities showed a stronger overall effect (W = .83) than performance (W = .55). Post-hoc results are reported separately from the omnibus tests, and pairwise comparisons that did not survive Bonferroni correction are interpreted with caution.
Conclusions: These preliminary findings suggest that a ReAttach-informed occupational therapy protocol may be associated with substantial within-participant improvements in persistent PCS. Given the small, uncontrolled sample, the results are exploratory and require confirmation in larger controlled trials. Interpretations regarding autonomic regulation and predictive processing are offered as possible frameworks rather than demonstrated mechanisms, and any cost-related advantages are discussed as potential rather than established.

Key words: post-concussion syndrome, mild traumatic brain injury, occupational therapy, ReAttach, autonomic regulation, predictive processing