146| Persistent Symptoms After Concussion – A Conversation with Dr. Noah Silverberg

This episode is a conversation with Dr. Noah Silverberg about persisting symptoms following concussion. The discussion covers prevalence of persistent postconcussive symptoms, risk factors for persisting symptoms, the importance of mental health symptoms and psychological constructs, the relationship between TBI and functional cognitive disorder, assessment, and treatment.

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About Noah

Dr. Silverberg completed his PhD in Clinical Psychology (Clinical Neuropsychology specialty track) from the University of Windsor and a clinical internship at the Vancouver Coastal Health Authority Consortium. Before joining the UBC Department of Psychology in 2020, Dr. Silverberg worked as a staff psychologist at British Columbia’s tertiary rehabilitation hospital (GF Strong Rehab Centre) for over 10 years, where he also led an interdisciplinary brain injury research program as a clinician-scientist. Dr. Silverberg is interested in psychosocial determinants of health in neurological disorders, particularly concussion and traumatic brain injury. His research program aims to better understand the psychological mechanisms (e.g., maladaptive thinking and coping styles) that perpetuate symptoms after concussion and related health conditions. Dr. Silverberg uses these insights to develop and evaluate novel treatments. His other research interests include neuropsychological assessment methods, cognitive rehabilitation, metacognition, functional neurological disorder, and implementation science.

References

Ali, J. I., Mahoney, P., Dance, D., & Silverberg, N. D. (2019). Outcomes of a brief coping skills group intervention for adults with severe postconcussion symptoms. Concussion (London, England)4(3), CNC67. https://doi.org/10.2217/cnc-2019-0011

Cancelliere, C., Verville, L., Stubbs, J. L., Yu, H., Hincapié, C. A., Cassidy, J. D., Wong, J. J., Shearer, H. M., Connell, G., Southerst, D., Howitt, S., Guist, B., & Silverberg, N. D. (2023). Post-Concussion Symptoms and Disability in Adults With Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Journal of Neurotrauma, 40(11–12), 1045–1059. https://doi.org/10.1089/neu.2022.0185

Cassetta, B. D., Cairncross, M., Brasher, P. M. A., Panenka, W. J., & Silverberg, N. D. (2021). Avoidance and endurance coping after mild traumatic brain injury are associated with disability outcomes. Rehabilitation Psychology, 66(2), 160–169. https://doi.org/10.1037/rep0000372

Cook, N. E., Sapigao, R. G., Silverberg, N. D., Maxwell, B. A., Zafonte, R., Berkner, P. D., & Iverson, G. L. (2020). Attention-Deficit/Hyperactivity Disorder Mimics the Post-concussion Syndrome in Adolescents. Frontiers in Pediatrics, 8. https://doi.org/10.3389/fped.2020.00002

Davis, G. A., Patricios, J., Schneider, K. J., Iverson, G. L., & Silverberg, N. D. (2023). Definition of sport-related concussion: the 6th International Conference on Concussion in Sport. British Journal of Sports Medicine, 57(11), 617–618. https://doi.org/10.1136/bjsports-2022-106650

Godena, E. J., Freeburn, J. L., Silverberg, N. D., & Perez, D. L. (2023). A Case of Functional Cognitive Disorder: Psychotherapy and Speech and Language Therapy Insights. Harvard Review of Psychiatry, 31(5), 248–256. https://doi.org/10.1097/hrp.0000000000000379

Green, K., Cairncross, M., Panenka, W. J., Stubbs, J. L., & Silverberg, N. D. (2021). History of Functional Somatic Syndromes and Persistent Symptoms After Mild Traumatic Brain Injury. The Journal of Neuropsychiatry and Clinical Neurosciences, 33(2), 109–115. https://doi.org/10.1176/appi.neuropsych.20060159

Green, K. E., Purtzki, J., Chapman, A., Oberlander, T. F., Silverberg, N. D., & Dhariwal, A. K. (2022). Somatization in Adolescents With Persistent Symptoms After Concussion: A Retrospective Chart Review. The Journal of Neuropsychiatry and Clinical Neurosciences, 34(4), 378–385. https://doi.org/10.1176/appi.neuropsych.21070169

Greenberg, J., Mace, R. A., Funes, C. J., Silverberg, N. D., Iverson, G. L., Caplan, D. N., & Vranceanu, A. M. (2020). Pain Catastrophizing and Limiting Behavior Mediate the Association Between Anxiety and Postconcussion Symptoms. Psychosomatics61(1), 49–55. https://doi.org/10.1016/j.psym.2019.09.004

Greenberg, J., Singh, T., Iverson, G. L., Silverberg, N. D., Macklin, E. A., Parker, R. A., Giacino, J. T., Yeh, G. Y., & Vranceanu, A. M. (2021). A Live Video Mind-Body Treatment to Prevent Persistent Symptoms Following Mild Traumatic Brain Injury: Protocol for a Mixed Methods Study. JMIR Research Protocols,10(1), e25746. https://doi.org/10.2196/25746

Greenberg, J., Kanaya, M. R., Bannon, S. M., McKinnon, E., Iverson, G. L., Silverberg, N. D., Parker, R. A., Giacino, J. T., Yeh, G. Y., & Vranceanu, A. M. (2023). The Impact of a Recent Concussion on College-Aged Individuals with Co-Occurring Anxiety: A Qualitative Investigation. International Journal of Environmental  Research and Public Health/International Journal of Environmental Research and Public Health, 20(3), 1988. https://doi.org/10.3390/ijerph20031988

Holdnack, J. A., Iverson, G. L., Silverberg, N. D., Tulsky, D. S., & Heinemann, A. W. (2017). NIH toolbox cognition tests following traumatic brain injury: Frequency of low scores. Rehabilitation Psychology, 62(4), 474–484. https://doi.org/10.1037/rep0000145

Iverson, G. L., Terry, D. P., Karr, J. E., Panenka, W. J., & Silverberg, N. D. (2018). Perceived Injustice and Its Correlates after Mild Traumatic Brain Injury. Journal of Neurotrauma, 35(10), 1156–1166. https://doi.org/10.1089/neu.2017.5402

Iverson, G. L., Karr, J. E., Gardner, A. J., Silverberg, N. D., & Terry, D. P. (2019). Results of scoping review do not support mild traumatic brain injury being associated with a high incidence of chronic cognitive impairment: Commentary on McInnes et al. 2017. PloS One, 14(9), e0218997. https://doi.org/10.1371/journal.pone.0218997

Jobin, K., Wang, M., Du Plessis, S., Silverberg, N. D., & Debert, C. T. (2023). The importance of screening for functional neurological disorders in patients with persistent post-concussion symptoms. NeuroRehabilitation, 53(2), 199–208. https://doi.org/10.3233/nre-237002

Karr, J. E., Iverson, G. L., Huang, S. J., Silverberg, N. D., & Yang, C. C. (2020). Perceived Change in Physical, Cognitive, and Emotional Symptoms after Mild Traumatic Brain Injury in Patients with Pre-Injury Anxiety or Depression. Journal of Neurotrauma, 37(10), 1183–1189. https://doi.org/10.1089/neu.2019.6834

Leddy, J. J., Burma, J. S., Toomey, C. M., Hayden, A., Davis, G. A., Babl, F. E., Gagnon, I., Giza, C. C., Kurowski, B. G., Silverberg, N. D., Willer, B., Ronksley, P. E., & Schneider, K. J. (2023). Rest and exercise early after sport-related concussion: a systematic review and meta-analysis. British Journal of Sports Medicine, 57(12), 762–770. https://doi.org/10.1136/bjsports-2022-106676

Losoi, H., Silverberg, N. D., Wäljas, M., Turunen, S., Rosti-Otajärvi, E., Helminen, M., Luoto, T. M. A., Julkunen, J., Öhman, J., & Iverson, G. L. (2015). Resilience Is Associated with Outcome from Mild Traumatic Brain Injury. Journal of Neurotrauma, 32(13), 942–949. https://doi.org/10.1089/neu.2014.3799

Mikolic, A., Panenka, W. J., Iverson, G. L., Cotton, E., Burke, M. J., & Silverberg, N. D. (2023). Litigation, Performance Validity Testing, and Treatment Outcomes in Adults With Mild Traumatic Brain Injury. The Journal of Head Trauma Rehabilitation. https://doi.org/10.1097/htr.0000000000000903

Mikolić, A., Brasher, P. M. A., Brubacher, J. R., Panenka, W., Scheuermeyer, F. X., Archambault, P., Khazei, A., & Silverberg, N. D. (2024). External Validation of the Post-Concussion Symptoms Rule for Predicting Mild Traumatic Brain Injury Outcome. Journal of Neurotrauma. https://doi.org/10.1089/neu.2023.0484

Picon, E. L., Perez, D. L., Burke, M. J., Debert, C. T., Iverson, G. L., Panenka, W. J., & Silverberg, N. D. (2021). Unexpected symptoms after concussion: Potential links to functional neurological and somatic symptom disorders. Journal of Psychosomatic Research, 151, 110661. https://doi.org/10.1016/j.jpsychores.2021.110661

Picon, E. L., Todorova, E. V., Palombo, D. J., Perez, D. L., Howard, A. K., & Silverberg, N. D. (2022). Memory Perfectionism is Associated with Persistent Memory Complaints after Concussion. Archives of Clinical Neuropsychology, 37(6), 1177–1184. https://doi.org/10.1093/arclin/acac021

Picon, E. L., Wardell, V., Palombo, D. J., Todd, R. M., Aziz, B., Bedi, S., & Silverberg, N. D. (2023). Factors perpetuating functional cognitive symptoms after mild traumatic brain injury. Neuropsychology, Development, and Cognition. Section a, Journal of Clinical and Experimental Neuropsychology/Journal of Clinical and Experimental Neuropsychology, 1–15. https://doi.org/10.1080/13803395.2023.2247601

Plourde, V., Silverberg, N. D., Cairncross, M., Virani, S., & Brooks, B. L. (2022). Perceptions of Symptom Duration are Associated With Emotional Distress and Functioning in Adolescents With Protracted Concussion Recovery. Journal of Pediatric Psychology, 47(8), 905–915. https://doi.org/10.1093/jpepsy/jsac020

Reed, N., Silverberg, N. D., Iaccarino, M. A., McCrea, M., McCulloch, K. L., Panenka, W., Gregory, E., Dams-O’Connor, K., Iverson, G. L., Jamora, C. W., Belanger, H., McKinney, G., Cogan, A. M., & Provvidenza, C. (2019). Returning to Activity After a Concussion. Archives of Physical Medicine and Rehabilitation, 100(4), 789–791. https://doi.org/10.1016/j.apmr.2018.11.022

Rioux, M. (2023). A novel intervention for persistent memory symptoms after concussion: a pilot randomized controlled trial [Master’s Thesis, University of British Columbia]. UBC Repository. https://open.library.ubc.ca/collections/ubctheses/24/items/1.0435233

Rioux, M., Wardell, V., Palombo, D. J., Picon, E. L., Le, M. L., & Silverberg, N. D. (2022). Memory for forgetting in adults with persistent symptoms following concussion. Neuropsychology, Development, and Cognition. Section a, Journal of Clinical and Experimental Neuropsychology/Journal of Clinical and Experimental Neuropsychology, 44(1), 19–30. https://doi.org/10.1080/13803395.2022.2067326

Schneider, K. J., Critchley, M. L., Anderson, V., Davis, G. A., Debert, C. T., Feddermann-Demont, N., Gagnon, I., Guskiewicz, K. M., Hayden, K. A., Herring, S., Johnstone, C., Makdissi, M., Master, C. L., Moser, R. S., Patricios, J. S., Register-Mihalik, J. K., Ronksley, P. E., Silverberg, N. D., & Yeates, K. O. (2023). Targeted interventions and their effect on recovery in children, adolescents and adults who have sustained a sport-related concussion: a systematic review. British Journal of Sports Medicine, 57(12), 771–779. https://doi.org/10.1136/bjsports-2022-106685

Shi, S., Picon, E. L., Rioux, M., Panenka, W. J., & Silverberg, N. D. (2024). Catastrophizing is associated with excess cognitive symptom reporting after mild traumatic brain injury. Neuropsychology, 38(2), 126–133. https://doi.org/10.1037/neu0000930

Shi, S., Rioux, M., Dhariwal, A. K., & Silverberg, N. D. (2023). Attachment and Clinical Outcomes Among Treatment-Seeking Adults With Persistent Symptoms After Mild Traumatic Brain Injury. The Journal of Neuropsychiatry and Clinical Neurosciences, 35(2), 151–157. https://doi.org/10.1176/appi.neuropsych.20220073

Silverberg, N. D., & Iverson, G. L. (2011). Etiology of the post-concussion syndrome: Physiogenesis and psychogenesis revisited. NeuroRehabilitation, 29(4), 317–329. https://doi.org/10.3233/nre-2011-0708

Silverberg, N. D., & Mikolić, A. (2023b). Management of Psychological Complications Following Mild Traumatic Brain Injury. Current Neurology and Neuroscience Reports, 23(3), 49–58. https://doi.org/10.1007/s11910-023-01251-9

Silverberg, N. D., & Panenka, W. J. (2019). Antidepressants for depression after concussion and traumatic brain injury are still best practice. BMC Psychiatry, 19(1). https://doi.org/10.1186/s12888-019-2076-9

Silverberg, N. D., & Rush, B. K. (2023). Neuropsychological evaluation of functional cognitive disorder: a narrative review. The Clinical Neuropsychologist/Neuropsychology, Development, and Cognition. Section D, the Clinical Neuropsychologist, 1–24. https://doi.org/10.1080/13854046.2023.2228527

Silverberg, N. D., Hanks, R. A., & McKay, C. (2007). Cognitive estimation in traumatic brain injury. Journal of the International Neuropsychological Society : JINS13(5), 898–902. https://doi.org/10.1017/S1355617707071135

Silverberg, N. D., Lange, R. T., Millis, S. R., Rose, A., Hopp, G., Leach, S., & Iverson, G. L. (2013). Post-Concussion Symptom Reporting after Multiple Mild Traumatic Brain Injuries. Journal of Neurotrauma, 30(16), 1398–1404. https://doi.org/10.1089/neu.2012.2827

Silverberg, N. D., Hallam, B. J., Rose, A., Underwood, H., Whitfield, K., Thornton, A. E., & Whittal, M. L. (2013). Cognitive-Behavioral Prevention of Postconcussion Syndrome in At-Risk Patients. The Journal of Head Trauma Rehabilitation, 28(4), 313–322. https://doi.org/10.1097/htr.0b013e3182915cb5

Silverberg, N. D., Iverson, G. L., & Panenka, W. (2017). Cogniphobia in Mild Traumatic Brain Injury. Journal of Neurotrauma, 34(13), 2141–2146. https://doi.org/10.1089/neu.2016.4719

Silverberg, N. D., Panenka, W. J., & Iverson, G. L. (2018). Work Productivity Loss After Mild Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation, 99(2), 250–256. https://doi.org/10.1016/j.apmr.2017.07.006

Silverberg, N. D., Crane, P. K., Dams-O’Connor, K., Holdnack, J., Ivins, B. J., Lange, R. T., Manley, G. T., McCrea, M., & Iverson, G. L. (2017). Developing a Cognition Endpoint for Traumatic Brain Injury Clinical Trials. Journal of Neurotrauma, 34(2), 363–371. https://doi.org/10.1089/neu.2016.4443

Silverberg, N. D., Panenka, W. J., Lizotte, P. P., Bayley, M. T., Dance, D., & Li, L. C. (2020). Promoting early treatment for mild traumatic brain injury in primary care with a guideline implementation tool: a pilot cluster randomised trial. BMJ Open, 10(10), e035527. https://doi.org/10.1136/bmjopen-2019-035527

Silverberg, N. D., Duhaime, A. C., & Iaccarino, M. A. (2019). Mild Traumatic Brain Injury in 2019-2020. JAMA. https://doi.org/10.1001/jama.2019.18134

Silverberg, N. D., Otamendi, T., Dulai, A., Rai, R., Chhina, J., MacLellan, A., & Lizotte, P. P. (2021). Barriers and facilitators to the management of mental health complications after mild traumatic brain injury. Concussion (London, England)6(3), CNC92. https://doi.org/10.2217/cnc-2020-0022

Silverberg, N. D., Cairncross, M., Brasher, P. M., Vranceanu, A. M., Snell, D. L., Yeates, K. O., Panenka, W. J., Iverson, G. L., Debert, C. T., Bayley, M. T., Hunt, C., Baker, A., & Burke, M. J. (2022). Feasibility of Concussion Rehabilitation Approaches Tailored to Psychological Coping Styles: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 103(8), 1565-1573.e2. https://doi.org/10.1016/j.apmr.2021.12.005

Silverberg, N. D., Otamendi, T., Brasher, P. M., Brubacher, J. R., Li, L. C., Lizotte, P. P., Panenka, W. J., Scheuermeyer, F. X., & Archambault, P. (2022). Effectiveness of a guideline implementation tool for supporting management of mental health complications after mild traumatic brain injury in primary care: protocol for a randomised controlled trial. BMJ Open, 12(6), e062527. https://doi.org/10.1136/bmjopen-2022-062527

Silverberg, N. D., Iverson, G. L., Cogan, A., Dams-O-Connor, K., Delmonico, R., Graf, M. J. P., Iaccarino, M. A., Kajankova, M., Kamins, J., McCulloch, K. L., McKinney, G., Nagele, D., Panenka, W. J., Rabinowitz, A. R., Reed, N., Wethe, J. V., Whitehair, V., Anderson, V., Arciniegas, D. B., . . . Zemek, R. (2023). The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation, 104(8), 1343–1355. https://doi.org/10.1016/j.apmr.2023.03.036

Silverberg, N. D., Iaccarino, M. A., Panenka, W. J., Iverson, G. L., McCulloch, K. L., Dams-O’Connor, K., Reed, N., McCrea, M., Cogan, A. M., Graf, M. J. P., Kajankova, M., McKinney, G., & Jamora, C. W. (2020). Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines.Archives of Physical Medicine and Rehabilitation, 101(2), 382–393. https://doi.org/10.1016/j.apmr.2019.10.179

Snell, D. L., Siegert, R. J., Debert, C., Cairncross, M., & Silverberg, N. D. (2020). Evaluation of the Fear Avoidance Behavior after Traumatic Brain Injury Questionnaire. Journal of Neurotrauma, 37(13), 1566–1573. https://doi.org/10.1089/neu.2019.6729

Stubbs, J. L., Green, K. E., Silverberg, N. D., Howard, A., Dhariwal, A. K., Brubacher, J. R., Garraway, N., Heran, M. K. S., Sekhon, M. S., Aquino, A., Purcell, V., Hutchison, J. S., Torres, I. J., & Panenka, W. J. (2020). Atypical Somatic Symptoms in Adults With Prolonged Recovery From Mild Traumatic Brain Injury. Frontiers in Neurology, 11. https://doi.org/10.3389/fneur.2020.00043

Terpstra, A. R., Cairncross, M., Yeates, K. O., Vranceanu, A. M., Greenberg, J., Hunt, C., & Silverberg, N. D. (2021). Psychological mediators of avoidance and endurance behavior after concussion. Rehabilitation Psychology, 66(4), 470–478. https://doi.org/10.1037/rep0000390

Terpstra, A. R., Louie, D. R., Iverson, G. L., Yeates, K. O., Picon, E., Leddy, J. J., & Silverberg, N. D. (2022). Psychological Contributions to Symptom Provocation Testing After Concussion. The Journal of Head Trauma Rehabilitation, 38(2), E146–E155. https://doi.org/10.1097/htr.0000000000000796

Terry, D. P., Brassil, M., Iverson, G. L., Panenka, W. J., & Silverberg, N. D. (2018). Effect of depression on cognition after mild traumatic brain injury in adults. The Clinical Neuropsychologist/Neuropsychology, Development, and Cognition. Section D, the Clinical Neuropsychologist, 33(1), 124–136. https://doi.org/10.1080/13854046.2018.1459853

Wojtowicz, M., Silverberg, N. D., Bui, E., Zafonte, R., Simon, N., & Iverson, G. L. (2017). Psychiatric Comorbidity and Psychosocial Problems Among Treatment-Seeking Veterans With a History of Mild Traumatic Brain Injury. Focus/Focus (American Psychiatric Publishing. Online), 15(4), 384–389. https://doi.org/10.1176/appi.focus.20170028

Yeates, K. O., Schneider, K. J., & Silverberg, N. D. (2021). Advances in Clinical Management of Persistent Postconcussion Symptoms—The Danish National Clinical Guideline. JAMA Network Open, 4(11), e2132424. https://doi.org/10.1001/jamanetworkopen.2021.32424

 

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