2.1 Ethical Foundation

Permission for initiating the study was granted from The Danish National Committee on Health Research Ethics prior to the beginning of the project, concluding that cases were not at risk of harm, and the ethical aspects of the project were assessed according to the Helsinki Declaration.42 Cases were given oral and written information about the protocols and signed an informed consent form with the right to withdraw at any time. All cases were anonymized, and qualitative data collection was handled with discretion with no sharing of personal information.

2.2 Case and Study Descriptions 

Case characteristics are presented in Table 1 and 2. The four cases were recruited through a collaboration with a center of rehabilitation in the capital region of Denmark and separated into two different case studies, Study A and Study B, examining two different intervention protocols. Cases in Study A participated in a submaximal graded aerobic exercise intervention supplemented by postural correction of the cervical spine and cases in Study B participated in a modified body awareness intervention with additional group feedback sessions.
TABLE 1
Study A Inclusion criteria; Persistent symptoms of mTBI for more than 12 months following initial trauma, above the age of 18 and able to sit on a stationary bike without referred pain.
Study B inclusion criteria; Persistent symptoms of mTBI for more than 12 months following initial trauma, above the age of 18, able to stand for a duration up to 20 minutes, able to lie flat on their backs.
Excluding criteria; Unable to communicate in Danish, unable to attend twice a week and contraindicated disorders making the planned interventions impossible.
TABLE 2

2.3 Data and Analysis

All four cases underwent a clinical examination before the interventions covering relevant injury history, current and previous work history, social participation, daily activities and bodily functions in relation to the International Classification of Functioning Disability and Health (ICF) model.43 All cases were scored on the Rivermead-Post Concussion Questionnaire (RPQ), a standardized post-concussion questionnaire with two subscores,44pre- and post-intervention, as well as a semi-structured qualitative interview post intervention. Additionally, cases in Study A underwent a Craniocervical Flexion Test (CCFT)45 pre and post intervention, and cases in Study B were scored on the SF-36v2 Quality of Life (QOL) questionnaire46 pre and post intervention. RPQ, SF-36 and CFFT have shown to be valid testing tools in measuring prolonged symptoms of mTBI, QOL and cervical function in different population groups with moderate to high construct validity and reliability.47–50 Questionnaires followed the guidelines for analysis of RPQ47 and SF-36v251,52 using simple comparative statistics in calculating averages and the semi-structured interviews were recorded, transcribed and analysed by identifying codes and sub-codes, which were clustered ad modum Kvale.53 The CFFT was administered as per standardized guidelines.45

2.4 Interventions