Physical Therapys Role in Management after Concussion Becky

Physical Therapy’s Role in Management after Concussion Becky Hansen, PT, NCS

Objectives > To define concussion > To understand the process of recovery after concussion > To understand the role of rest in recovery after concussion > To understand the role of physical therapy in treating people with persistent movement related symptoms after concussion

What is a Concussion? > A concussion is a mild traumatic brain caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. > https: //youtu. be/Sno_0 Jd 8 Gu. A

What is a Concussion? > The impact damages your brain cells causing chemical and cellular changes > The forces that cause a concussion can also cause injury to the neck and the vestibular system > May or may not have a loss of consciousness

Causes > > > Falls Motor Vehicle Accidents Blast exposures (military) Sport and recreational injuries Assault, acts of violence

Diagnosis > Clinical Diagnosis > Normal neuroimaging findings (CT, MRI) > Cannot be diagnosed by a blood test

Symptoms > > > > > Headache Dizziness > Anxiety Neck Pain > Irritability Nausea > Sleep disturbance Blurred vision Fatigue Balance Problems with exertion Light and sound sensitivity Difficulty thinking or concentrating

Recovery > Many people recover from a concussion within a couple of days or weeks. > Others may have symptoms that persist > Risk factors for pronged recovery are age, sex, history of migraines, mood disorders, learning disability, history of previous concussion > Even if you have persistent symptoms there is a high probability of a good/complete recovery

Rest > Strict rest (dark room, “cocoon” therapy) is no longer recommended > Reduction in physical and cognitive activity for the first 48 hours followed by gradual return to activity as tolerate > Too much activity too soon can be problematic

Second Impact Syndrome > When a person experiences a second head injury before complete recovery from an initial head injury > Rare, but can be deadly > Seen in athletes who return to play after getting a concussion

Zachery Lystedt Law > Prohibits young athletes who are suspected of sustaining a concussion from returning to play without approval from a licensed healthcare professional > “When in doubt sit them out”

Concussion and Physical Therapy > Physical therapists are movement experts who improve quality of life through prescribed exercise, hands-on care, and patient education. > PTs can have different specialty areas > Typically PTs who specialize in treating patients with neurological injuries, sports injuries, or orthopedic injuries treat patients after a concussion

Concussion and Physical Therapy > People who have ongoing movement related symptoms may benefit from seeing a physical therapist with expertise and training in treating people with brain injury

Medical Team > A team of providers may be necessary to address the range of physical, cognitive, visual, and behavioral complaints including a physician, physical therapist, speech language pathologist, occupational therapist, psychologist, and neuro-optometrist

Physical Therapy Clinical Practice Guideline > Developed by experts in the field of physical therapy who reviewed the most up-to-date scientific research about concussion > Looked at > 100 research articles > Provides recommendations to guide evaluation and treatment of people after concussion > Applies to people > 8 years of age

Role of Physical Therapy After Concussion > PTs have a role in the evaluation and treatment of 4 areas 1) Problems with the cervical spine (neck) 2) Problems with the vestibular (inner ear) and ocular (eye) systems 3) Problems tolerating exercise 4) Problems with balance and/or coordination

Cervical Spine > Injury to the neck can cause pain, headaches, dizziness, and balance problems

PT Examination of the Cervical Spine > > > Flexibility Strength Tenderness How well the joints are moving Joint position sense

Vestibular System > Many studies show that vestibular (inner ear) and oculomotor (eye) problems are common after concussion > Can lead to symptoms of dizziness, balance problems, blurred vision, nausea, headaches, sensitivity to light and sound, difficulty reading, difficulty concentrating, and fatigue

PT Examination of the Vestibular System > > > Eye alignment Eye movement Reflexes Coordination of your eye and head movement Vertigo

Exercise Tolerance > Reduced tolerance to physical activity is common after concussion > Not fully understood why, but may be problem with the brain and the autonomic nervous system, or a secondary effect of being less active

PT Examination of Exercise tolerance > Blood pressure and heart rate in different positions > Treadmill or Bike test > The evidence supports a progressive aerobic exercise program to improve exercise tolerance

Balance and Coordination > Studies show that people after concussion may have problems with balance, coordination, dual/multi-tasking > These problems are usually minor, but could increase risk for another injury or concussion

PT Treatment > Personalized plan to address problems identified during evaluation > Consideration of the patient’s goals, values, and priorities > Education about self management strategies (sleep, pacing, stress management) > Reassess and monitor progress over time > Refer to other healthcare providers and specialists as needed

Questions? ?