Background and rationale
Concussion/mild Traumatic Brain Injury (mTBI) is a commonly occurring injury and data from the Ontario Neurotrauma Foundation indicate that, in the province of Ontario, Canada, almost 150,000 people are diagnosed every year with a concussion, by a family or emergency department doctor or pediatrician.  While the majority of individuals recover without complications, approximately twenty percent will go on to experience persistent and potentially debilitating symptoms that negatively impact returning to functional activities, including school, work, and recreation.  Impairments in aspects of communication, that may include difficulties following complex conversations, finding words, formulating sentences, reading, writing, and social communication have been reported clinically among those with persistent symptoms. These difficulties are not routinely evaluated and the emerging evidence regarding assessment and treatment of communication and cognitive-communication issues following mTBI/concussion has not been well established.    

Objectives: 	
The purpose of this review was to synthesize and chart the literature regarding assessment and management of communication and cognitive-communication issues following mTBI/concussion.  Gaps in the literature and future research directions were also identified. 

Methods:
This scoping review was conducted according to the framework proposed by Arksey and O’Malley (2005).  Searches were conducted by an Information Specialist in Medline, Embase, CENTRAL, PubMed, CINAHL, and SpeechBite databases for studies published in English between 1995 and August 2016.  An additional search was conducted in April 2018 to capture current literature. The search was focused on literature examining communication and cognitive-communication impairments in adults and children who have sustained an mTBI or concussion.  Inclusion/exclusion criteria were applied to select the relevant papers. Two levels of screening were conducted (title and abstract, full text reading), by two independent reviewers and conflicts resolved by consensus.

Results: 
A total of 1081 articles were identified following the database searches.   Of these, 39 studies met inclusion criteria.  These were charted and categorized into 11 main categories based on the communication and cognitive-communication impairments or management programs identified:  Cognitive-Communication, Naming/Reaction Time, Discourse/Pragmatics, Language, Dysfluency, Assessment, Protocols, Knowledge/Survey, Epidemiology, and Return To Work.  Most articles crossed a number of categories and these categories were expanded and charted.    

Conclusions: 
Results of this scoping review suggest that adults and children who have sustained an mTBI/concussion, regardless of mechanism of injury, may present with ongoing communication and/or cognitive-communication impairments.  These persisting impairments can benefit from assessment and management.  Limitations and gaps in the literature were identified regarding studies specific to mTBI or concussion, as the majority of studies combined participants of all severity levels or there were different definitions of concussion used across studies to identify participants.   An additional gap in the literature was identified related to the impact of communication and cognitive-communication impairments on return-to-work.  These gaps may suggest directions for future research.

Communication and Cognitive-Communication Assessment & Management in Mild Traumatic Brain Injury/Concussion: A Scoping Review