Physical Therapy's Role in Concussion Treatment and Management
What is a Concussion?
In the most basic terms, a concussion is an injury of the brain. The medical definition is that a concussion is a complex process affecting the brain, that can be caused by a direct blow to the head, face, neck or elsewhere on the body that is transmitted to the head, resulting in an impairment of neurological function. The sudden movement can cause the brain to bounce around or twist in the skull, which creates chemical changes in the brain. It is important to realize that you do not have to hit your head to have a concussion.
Some risk factors of a concussion include
Female
History of previous head injury
Mood disorder
Learning disorder (ADHD, OCD, dyslexia)
Migraines
Sleep disorders
‘One concussion is one concussion’ , each concussion is unique and has a set of trajectories that describe the symptoms in a broad category. Below is the description of the trajectories presented by UPMC. Refer to their website included at the end of this blog for additional information.
Six Clinical Trajectories (types) of Concussions and their specific triggers (what can cause one to experience the symptom) are listed below.
COGNITIVE/FATIGUE – trouble with extended and/or intricate mental tasks
Complex subject material
Long days
POST TRAUMATIC MIGRAINE – trouble with changes to routine/ a sensitivity to light or noise
Sleeping in
Loud concerts
Loud sporting events
OCULAR – trouble with visual tasks and tracking motion
Visual tasks
Reading long passages
Looking at cell phones/screens
ANXIETY/MOOD – trouble with turning thoughts off and/or being excessively worried
Social interactions
Forced rest for active people
Being held out of routine activities
CERVICAL – trouble with any stress or pressure on the neck, spine and/or spinal cord
Bending over a computer
Carrying heavy backpacks
What is Vestibular Therapy?
Vestibular therapy is a specialised form of physical therapy used to reduce dizziness, imbalance and other symptoms after an injury or disorder of the vestibular system. The brain is our system’s central processing network and uses three sensory inputs to maintain equilibrium.
Vision- our brains use what we see to help figure out where we are in space (ie- it is easier to walk in the light compared to a dark room)
Somatosensory (sensation in the body) - our brains use what we feel (ie- it is easier to walk inside on a solid surface compared to walking in soft sand on the beach)
Inner ear/Vestibular system- providing our brain with information about motion, head position, and spatial orientation
Injury following a concussion can interfere with one or more of these systems.
As a vestibular specialist, following a concussion the therapist will evaluate and test different systems to evaluate what categories the individual who suffered the concussion fit in and guide them in designing an individualized treatment plan. The Evaluation would included some of the following tests
Ocular Assessment VOMS (Vestibular Ocular Motor Screening)
Balance
Functional testing
Near point convergence
A subjective Post Concussive Scale for patient to rate symptoms
Cervical screen
Testing results along with specific patient complaints will allow the therapist to develop a treatment plan to address the individual’s needs as well as provide education and modifications to daily activities, in order to decrease time needed for recovery. The goal of concussion rehabilitation is to return the individual to pre-injury activity safely with a minimal risk of re-injury, be asymptomatic at rest and with full activity,and to have normal balance and ocular testing.
The most important objective to realize with a concussion, is that management of concussions are best with a multidisciplinary approach. If you or a loved one continue to have symptoms following a concussion, consider having further evaluation. There are treatment options available.
Additional Resources:
- vestibular.org
- Rethinkconcussions.upmc.com t here….