An active approach in the treatment of post-concussion syndrome - Evidence-based practice in a collective case study

Abstract

Rational, Aims and Objectives: Prolonged symptoms after a mTBI, known as Post-Concussion Syndrome (PCS), remains a challenging area of rehabilitation. Evidence shows that an active approach can improve prognosis, however PCS is a multifaceted condition with many comorbidities and large variety in patient response. This study investigated the use of submaximal aerobic exercise and body awareness therapy, and the influence on symptoms in PCS cases, viewed through the lens of evidence-based practice (EBP). Method: Four cases were separated into two case studies. Cases in Study A received an aerobic exercise protocol consisting of 8 individual sessions distributed twice a week over 4 weeks, with additional cervical endurance training. Cases in Study B received a body awareness therapy protocol consisting of 6 guided practices distributed twice a week over 3 weeks. Using method triangulation, both quantitative and qualitative data were gathered through the use of the Rivermead Post-Concussion Questionnaire (RPQ) and semi-structured interviews, as well as the Craniocervical Flexion Test (CCFT) in Study A, and the Short Form-36v2 (SF-36) questionnaire in study B. Lastly, research evidence on PCS was included to contextualize cases. Results: Both cases in Study A showed marked improvements in their RPQ scores, but only one showed improvement in the CCFT. In Study B, one case improved in RPQ score and in the mental component of SF-36v2, while the other case did not experience any significant change. All cases expressed positive associations with the interventions during the interviews. Conclusion: These results illustrate how an active and individualized approach can represent important qualities that can be applied to further and larger studies. Based on the results and discussion of this paper, relevant findings and suggestions are summarized in a modified EBP model, which may be of help to practitioners in dealing with PCS patients in the clinical practice.

Ready to Play: A Biopsychosocial Approach to Return-to-Sport in Adults with Prolonged Concussion Symptoms

“…The control group also was within the normal scale for all components of the DASS, whereas the concussion group was in the mild severity for stress and depression and moderate level for anxiety. These are like Rivermead scores found in previous studies in concussion populations (Moussavi et al, 2019;Christensen et al, 2020). For mental health, this is the same as retired Al l s i gni fi ca nce l evel s a re two-tai l ed.…”

Occupational and Physiotherapy modalities used to support interdisciplinary rehabilitation after concussion: A Scoping Review

“…One of the 10 included studies was published in 2013 ( 44 ), and the remaining studies were published between 2017 and 2022. Most studies were conducted in the Nordic countries (three in Denmark ( 15 , 45 , 46 ) and two in Norway ( 25 , 47 )), three in the USA ( 28 , 44 , 48 ), and two in New Zealand ( 29 , 49 ). Regarding study design, three studies were retrospective chart reviews ( 28 , 29 , 44 ), three were RCTs ( 15 , 25 , 47 ), one an open-label parallel-group randomized trial ( 46 ), one a collective case study ( 45 ), and a retrospective ( 48 ) and prospective ( 49 ) case series.…”

“…The number of participants included in the studies ranged from four to 151, with half of the studies having more than 64 participants ( 15 , 44 , 46 , 47 ), and the other studies having 11 ( 49 ), 23 ( 48 ), 32 ( 29 ), and four ( 28 , 45 ) participants. Onset of concussion prior to rehabilitation start for the included patients were very different, ranging from weeks to years; 2–4 months (47–49), 2–6 months ( 46 ), more than 6 months ( 15 ), and ranging from a very broad time-period of between weeks to years ( 28 , 29 , 44 , 45 ).…”

“…Six studies included group or individual home exercises ( 15 , 25 , 44 – 46 , 48 ). In four studies ( 15 , 25 , 44 , 45 ) home exercises were prescribed by a physiotherapist, who in two studies ( 15 , 25 ) also adjusted and evaluated the performance of exercises to accommodate each participants’ level, needs and goals. In the study by Thastum et al ( 46 ) these were prescribed by an interdisciplinary team.…”

“…In Alsalaheen et al’s study ( 44 ) participants performed vestibular exercises 1–3 times, in Christiansen et al’s study ( 45 ) exercises were performed daily, and in Kennedy et al’s study ( 49 ) neck treatment was recommended for a mean of 3.4 hours over a mean of 4.3 weeks. In Kleffelgaard et al’s study ( 25 ) the intervention consisted of a group vestibular rehabilitation session twice a week for eight weeks, a home exercise programme, and an exercise diary.…”