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.