Persistent post-concussive symptoms: A model of predisposing, precipitating, and perpetuating factors

While the majority of individuals make full recovery within a short period following mild traumatic brain injury (mTBI), some continue to experience a more chronic course of symptoms termed persistent post-concussive symptoms (PPCS). Previous models and conceptualizations of PPCS have typically not differentiated the time at which factors present across the injury timeline spectrum or have considered a limited array of contributory factors. In the current review, PPCS are examined within the predisposing, precipitating, and perpetuating (PPP) model, which has been applied to explain other syndromes resulting in a clear framework to explain, disseminate, and further research the specified condition. Previous PPCS models are reviewed and integrated into this comprehensive model, as well. To do so, a literature review was completed which included previous PPP models applied to other conditions, other PPCS models, and more recent findings of factors related to PPCS. This new iteration and application of the PPP model more clearly, completely, and validly identifies contributing factors to PPCS. Future prevention, early identification, clearer questions for future research, and treatment of PPCS is possible with clarity provided by this model.