ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurotrauma
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1621265
This article is part of the Research TopicNeurological and Neuropsychiatric Disorders Affecting Military Personnel and Veterans - Volume IIView all 5 articles
Development of the Common Cognitive Complaints after Concussion (C4) Questionnaire: A treatment-planning tool for military service members and veterans with mild traumatic brain injury
Provisionally accepted
Mollie Ann McDonald1
Lisa H Lu2,3,4Glenn Curtiss5Douglas B Cooper6,7Amy O Bowles3Melissa R Ray3M Marina LeBlanc3Blessen C Eapen8,9
Robert Shura1,10
Lyn Turkstra11*- 1Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Salisbury VAMC, Salisbury, NC, United States
- 2Traumatic Brain Injury Center of Excellence (TBICoE), Military Health System, Silver Spring, Maryland, United States
- 3Department of Rehabilitation, Brooke Army Medical Center, JBSA Ft Sam, Houston, TX, United States
- 4General Dynamics Information Technology, Falls Church, VA, United States
- 5Independent practice, Fort Myers, FL, United States
- 6Polytrauma Rehabilitation Center, Audie L. Murphy VA Medical Center, San Antonio, TX, United States
- 7Departments of Psychiatry and Rehabilitation Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
- 8Division of Physical Medicine and Rehabilitation, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- 9Department of Physical Medicine and Rehabilitation, Greater Los Angeles Health Care System, Los Angeles, CA, United States
- 10Department of Neurology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina, United States
- 11School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Objective: To develop an activity-focused self-report tool to guide selection of treatment targets in cognitive rehabilitation for adults with mild traumatic brain injury (mTBI). Setting: Military and veteran treatment facilities. Participants: 21 service members and 32 veterans with a history of mTBI; 25 veterans with orthopedic injury (OI). Design: Clinical tool development. Main Measures: Common Cognitive Complaints after Concussion (C4) questionnaire.Results: We reviewed measures used in mTBI research or clinic, to identify items that could be used for selecting activity-level therapy targets as part of a treatment planning tool. To establish face and content validity, an initial item pool was reviewed by five speech-language pathology or occupational therapy mTBI experts who selected items relevant to their clinical practice, gave feedback on item wording, and suggested additional items. The result was a questionnaire with 22 activity-based items and one bias-check item. The C4 was then used in a feasibility mTBI treatment trial to identify treatment targets, and clinicians provided feedback on its utility. The C4 was also administered to an OI group to evaluate the distinctiveness of the items to mTBI symptoms.The C4 adequately captured activity-level functional impairments common to mTBI, and clinicians endorsed its utility as a useful tool to personalize treatment targets.
Keywords: concussion, self-report, treatment planning, Cognitive rehabilitation, Cognition, Occupational Therapy, Speech-Language Pathology
Received: 30 Apr 2025; Accepted: 08 Jul 2025.
Copyright: © 2025 McDonald, Lu, Curtiss, Cooper, Bowles, Ray, LeBlanc, Eapen, Shura and Turkstra. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lyn Turkstra, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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