Exploring Specialized Pediatric Concussion Services
I recently had the privilege of completing my capstone project with an outpatient pediatric complex concussion clinic in Nebraska. Concussions are categorized as mild traumatic brain injuries (mTBI) and can have large implications on an individual’s daily functioning. Due to my background in athletic training and from personal experience with persistent post-concussion syndrome, concussions have continued to interest me, especially when considering the varying guidelines in terms of recovery. The concussions I experienced have impacted my ability to participate in my valued daily occupations fully. Before my fieldwork placements, I had little knowledge of remediation interventions for concussions, specifically for vision rehabilitation. I am honored to have completed this rotation within this office and continue to advocate for adequate and comprehensive concussion care services. This experience primarily grew my knowledge and skills within this niche practice area, as I was able to work hands-on with pediatric clients with a concussion. I hope to share this experience and how I completed this doctoral capstone in this specific practice field with other occupational therapy students.
Before this capstone rotation, I completed my Level IIA rotation in the school setting and my Level IIB rotation in an inpatient rehabilitation hospital on the stroke unit. For my school-based rotation, I was placed within an educational service unit that worked with two separate districts in rural Nebraska. The students, ages 3 to 18, had many needs and diagnoses. I learned so much about sensory regulation, handwriting, and life skills interventions in this setting. I had the opportunity to plan and implement fine motor coordination activities with preschool students while also developing multiple educational handouts in various languages to best serve the families in our district. Through this rotation, my love and interest for pediatric patients continued to grow as I worked daily with various groups within this population.
My second rotation was vastly different from my first as I transitioned to the inpatient environment. At this rotation, I primarily evaluated and treated adult patients who had experienced a stroke. This complex environment opened my eyes to upper extremity conditions, vision challenges, and adaptive equipment, including mobility devices and splints. Through this rotation, my interest in complex cases grew as I learned more about the connection between occupational engagement and vision and the importance of accessible health care services and patient-friendly education.
During my Level II fieldwork placements, my interest in pediatrics and brain injuries grew as I was exposed to very different clients and rehabilitation focus areas. The combination of appropriate pediatric services and the importance of vision remediation opened my eyes to a new world within concussion rehabilitation. When curating this capstone project, I knew I wanted to focus on pediatric concussions in some capacity because I saw a gap in our community related to knowledge of services and rehabilitation opportunities. The more complex question when designing the project was, “How could I do it? How could I advocate for occupational therapy in this setting while learning valuable clinical skills?” In Nebraska, comprehensive concussion rehabilitation is limited for the pediatric population, with the majority of resources being located on the eastern side of the state. While there are established concussion protocols, there are multiple sources with varying information. Due to this, protocols vary between locations and individuals providing care, which left me feeling lost and confused about where to start with discovering more about occupational therapy’s (OT’s) role in concussion care.
I completed my project at an established pediatric concussion clinic at which I had existing connections with the occupational therapists. For my project, I focused on three objectives to guide my time during the 14 weeks. The first objective focused on growing my knowledge of concussions to advocate for and educate knowledge users, such as clients, families, and other practitioners, on concussions and current treatment options. Within this objective, I completed various trainings and attended a state-wide brain injury conference. From the information I gathered, I created two handouts for the families of our clients on vision home activities and a 7-day sleep journal. This sleep journal was aimed at discovering leading contributors to disruption in sleep post-concussion. I also created a seven-page resource that included important information from the brain injury conference that I shared with the professionals within the clinic where I completed this capstone, under the supervision of my site mentor.
My second objective was to grow my clinical skills within this specific clinic. The role of the occupational therapist within this clinic was focused on vision remediation. After meeting with the clinic neuro-optometrist, the practicing OT would gather information regarding the patient's occupational profile and complete simple vision screens such as pursuits and saccades. Based on these findings, the OTs in this clinic wrote vision-specific goals. They led vision treatment sessions focusing on ocular motility, convergence, accommodation, visual perception, visual vestibular, and peripheral awareness as appropriate. With guidance from the neuro-optometrist and site mentor, I was able to grow my skills with the use of various lenses, techniques, technology, and screening tools.
Objective three was to increase other health care providers' (school nurses, athletic trainers, etc.) knowledge of the currently available services. I did this by meeting with individual athletic trainers from the local high schools to share the importance of timely rehabilitation and how to refer to the multidisciplinary concussion clinic. As part of this objective, I created a handout that was shared with these professionals to be given to students at their schools to take home and share with their guardians. My experience within this outpatient pediatric complex concussion clinic has been a valuable opportunity to deepen my knowledge and skill set with concussion rehabilitation and OT within this specialized field. In addition to my fieldwork experiences, I have gained a well-rounded perspective on various practice areas, including school-based services and inpatient stroke rehabilitation, contributing to my growing passion for brain injury recovery. This capstone project has allowed me to bridge my personal and professional interests: advocating for greater access to comprehensive care while developing practical interventions to improve functional vision skills.
To individuals curating their capstone experiences, I would recommend discovering what you are truly passionate about to allow for continued interest, perseverance, and pursuit of knowledge. Deciding on a capstone or fieldwork site that matches your needs can be difficult. When it comes to learning more about and treating clients with concussions or other niche areas, I would recommend finding a clinic that provides a multidisciplinary approach. Because the clinic I was at for my capstone project provided these services, I was able to network and learn from other disciplines such as speech-language pathologists, physical therapists, and neuro-optometrists. Completing this capstone is truly the culmination of my professional dreams, and I hope this piece gives some encouragement to current students that creating a capstone in a niche area is possible. Your work, no matter the size, will have a larger impact than you know!
Alexis Spicer, ATC, LAT, OTD, completed her degree from the University of Nebraska Medical Center (UNMC) in Omaha in May of 2025. Alexis has accepted a position as an outpatient pediatric occupational therapist. Before attending graduate school, Alexis completed her undergraduate degree in athletic training through Nebraska Wesleyan University. She continues to share her passion for concussion care by practicing as an athletic trainer through a local school system. Alexis is also an advocate for occupational therapy, has spent time as the treasurer of the UNMC’s Students of Occupational Therapy Association, and has participated in the 2025 Nebraska Hill Day.