Re/producing the Pediatric Concussion Discourse in clinical rehabilitation practice

Abstract

Purpose

In the field of pediatric concussion, little to no scholarship has examined how clinical practice is shaped by patterned ways of thinking, talking about, and coming to understand concussion and young people (or “discourses of concussion in young people”). In this paper, we examine the ways in which one such discourse, the Pediatric Concussion Discourse (PCD), shapes how young people with concussion, their parents, and clinicians can think about, act in relation to, and experience concussion.

Materials and methods

This critical rehabilitation research is informed by the post-structuralist theory of Michel Foucault (1926-1984), and the key concepts of power/knowledge, discourse, and the subject.

Results

Circulating through clinical guidelines for the management of pediatric concussion, the PCD re/produces the expectation that young people with concussion and their parents will behave as “responsible” subjects who follow the recommendations of so-called experts without question. If recommendations are not implemented, the PCD has the potential to constitute these same groups as “nonadherent”, re/producing problematic discourses of medical compliance.

Conclusions

By examining the effects of the PCD, it becomes possible to imagine how clinical practice and research might evolve in new ways that respect the knowledges and experiences of young people with concussion and their parents.

Implications for Rehabilitation

• Engaging in critical examination of clinical rehabilitative practice creates opportunity to imagine how we might approach commonly adopted clinical approaches, including the delivery of health education, differently.

• Implications for clinical rehabilitation practice include delivering health education in the context of supportive therapeutic relationships that respect the knowledges and experience of young people with concussion and their parents.

• Implications for rehabilitation research include engaging with critical scholarship within and beyond field and disciplinary boundaries, engaging in formal educational opportunities, and connecting with less formal but invaluable communities of practice.

Keywords:

• Young people
• pediatric
• concussion
• critical social theory
• discourse
• Foucault

Acknowledgements

KM would like to thank the Centre for Critical Qualitative Health Research, University of Toronto, for the training and mentorship received throughout her doctoral training. The contributions of this community of practice to her early and continued development cannot be overstated.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by a Kimel Family Graduate Student Scholarship in Paediatric Rehabilitation.