Reattach-Informed Integrated Occupational Therapy In Persistent Post-Concussion Syndrome: A Pilot Case Series.
- 1Sieto Reitsma, Occupational Therapy Practice, Kollum, the Netherlands.
- 2Universitat Internacional de Catalunya, Barcelona, Spain.
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.
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BibTeX
@article{reitsma2026reattachinformed,
title = {{Reattach-Informed Integrated Occupational Therapy In Persistent Post-Concussion Syndrome: A Pilot Case Series.}},
author = {Sieto Reitsma and Aida Mehrad},
journal = {Clinical neuropsychiatry},
year = {2026},
month = oct,
doi = {10.36131/cnfioritieditore20260502},
url = {https://europepmc.org/article/MED/42909944},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Reattach-Informed Integrated Occupational Therapy In Persistent Post-Concussion Syndrome: A Pilot Case Series.
AU - Sieto Reitsma
AU - Aida Mehrad
PY - 2026
DA - 2026/10/01
JO - Clinical neuropsychiatry
DO - 10.36131/cnfioritieditore20260502
UR - https://europepmc.org/article/MED/42909944
AB - 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.
SN - 1724-4935
SN - 2385-0787
ER -