Clinical characteristics and outcomes of treatment of the cervical spine in patients with persistent post-concussion symptoms: A retrospective analysis

Kennedy, Ewan; Quinn, Dusty; Tumilty, Steve; Chapple, Cathy

doi:10.1016/j.msksp.2017.03.002

Cited by 41 publications

(44 citation statements)

References 38 publications

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“…Nevertheless, if a Cervical strain 43-46 46,47 Neurotological disorders Chronic bodily pain 48,49 Deconditioning 50 Analgesic medication use 51,52 Post-traumatic stress 53,54 Depression 55,56 Developmental disorders (eg, ADHD) 57 Fig 1 Conditions that can mimic or exacerbate "postconcussion" symptoms. [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] patient experiences new or worsened physical, cognitive, or emotional symptoms after a plausible mechanism of mTBI in the absence of AMS and confounding factors that might account for those symptoms (see fig 1), it would be prudent to proceed with clinical management under the assumption that the individual may have sustained an mTBI, 22 for example, by temporarily restricting the patient from safety-sensitive activities until their symptoms resolve and/or an alternative etiology is identified and addressed.…”

Section: List Of Abbreviationsmentioning

confidence: 99%

Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines

Silverberg

Iaccarino

Panenka

et al. 2020

Archives of Physical Medicine and Rehabilitation

224

133

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At least 3 million Americans sustain a mild traumatic brain injury (mTBI) each year, and 1 in 5 have symptoms that persist beyond 1 month. Standards of mTBI care have evolved rapidly, with numerous expert consensus statements and clinical practice guidelines published in the last 5 years. This Special Communication synthesizes recent expert consensus statements and evidenced-based clinical practice guidelines for civilians, athletes, military, and pediatric populations for clinicians practicing outside of specialty mTBI clinics, including primary care providers. The article offers guidance on key clinical decisions in mTBI care and highlights priority interventions that can be initiated in primary care to prevent chronicity.

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Section: List Of Abbreviationsmentioning

confidence: 99%

Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines

Silverberg

Iaccarino

Panenka

et al. 2020

Archives of Physical Medicine and Rehabilitation

224

133

View full text Add to dashboard Cite

show abstract

“…3 In fact, neck pain and stiffness were common symptoms (46% and 26%, respectively) in individuals who sustained concussions. 4 Another common neck-related injury in young individuals was whiplash injury from a motor vehicle accident and, again, females were at a higher risk of developing chronic NP. 5 Potential explanations for a higher prevalence of NP, neck injuries, and concussions in females are multifactorial and complex.…”

mentioning

confidence: 99%

“…Neck stiffness is also a common symptom after concussions and whiplash injuries. 4,5 However, researchers do not yet know which regions or muscles are involved and how much stiffness is present in individuals with concussions or whiplash injuries. Similarly, possible sex differences in USbased SWE stiffness of the cervical-flexor and -extensor muscles in young and athletic individuals have been largely unexamined.…”

mentioning

confidence: 99%

Sex Differences in Ultrasound-Based Muscle Size and Mechanical Properties of the Cervical-Flexor and -Extensor Muscles

Nagai

Schilaty

Krause

et al. 2020

Journal of Athletic Training

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Context Neck pain (NP), neck injuries, and concussions are more prevalent in female athletes than in their male counterparts. Females exhibit less neck girth, strength, and stiffness against a perturbation. As part of the clinical examination for individuals with NP, ultrasound (US)–based imaging of the cervical muscles has become common. Muscle size or thickness and stiffness can be measured with US-based B-mode and shear-wave elastography (SWE), respectively. Information on reliability, normative values, and sex differences based on US-based muscle size or thickness and stiffness in young and athletic individuals is limited. Objective To evaluate sex differences in US-based muscle size or thickness and biomechanical properties of the cervical-flexor and -extensor muscles. Design Cross-sectional study. Setting Laboratory. Patients or Other Participants A total of 13 women (age = 23.7 ± 1.9 years, height = 167.1 ± 6.1 cm, mass = 63.8 ± 5.6 kg) and 11 men (age = 25.6 ± 4.9 years, height = 178.7 ± 8.3 cm, mass = 78.9 ± 12.0 kg). Main Outcome Measure(s) The same examiner collected all measures, using US B-mode to scan the cross-sectional area and thickness of the longus colli (LC), sternocleidomastoid (SCM), cervical-extensor muscles, and upper trapezius (UT) muscle. The US SWE-mode was used to measure the stiffness of the SCM and UT. Independent t tests or Mann-Whitney U tests were calculated to determine sex differences. The intraclass correlation coefficient (ICC) measured intrarater test-retest reliability. Results Men had thicker SCMs than women (P = .01). No sex differences were present for longus colli cross-sectional area, cervical-extensor muscle thickness, or UT thickness (P > .05). In addition, no sex differences were evident for SCM (P = .302) or UT (P = .703) SWE stiffness. Reliability was good to excellent (ICC = 0.715–0.890) except for SCM SWE stiffness (ICC = 0.554). Conclusions The only sex difference was in SCM thickness. However, smaller SCMs in women did not result in less SCM SWE stiffness. We provided normative values for US-based imaging of the cervical-flexor and -extensor muscles in young and athletic men and women.

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“…When asymptomatic at rest, concussed individuals should progress to light physical activity [11]. Some literature and clinicians' experience show promising avenues for treating PCS [12], but further studies are still required as the American Academy of Neurology stated that "data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae post concussion" [13]. Because of the diverse symptoms associated with PCS, a coordinated multidisciplinary team service is preferable to treat not only the brain but also other structures involved [14] in the PCS.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, treating other structures such as the cervical region can alleviate persistent symptoms after concussive insults. Many other authors also suggested that the cervical spine and vestibular system, other than brain, contribute to the ongoing symptoms[12] [41]…”

mentioning

confidence: 99%

Effects of Electrical Stimulation in People with Post-Concussion Syndromes: A Pilot Study

Wu¹,

Gravel²,

Chatiwala³

et al. 2018

Health

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Post-concussion syndrome (PCS) is a complex disorder with various symptoms. There is limited evidence to support that any intervention enhances recovery after a concussion. This pilot study aimed to examine the efficacy of neck paraspinal muscles electrical stimulation (ES) in conjunction with physical therapy (PT) on reducing the severity of post concussive symptoms. Twenty-four individuals with PCS were randomly assigned to the ES group (PT + ES) or the control group (PT only). Both groups received the intervention twice a week for eight weeks. Clinical measures including the Concussion Signs/Symptoms Checklist, balance error scoring system, King-Devick test, ImPACT, and the Standardized Assessment of Concussion were used to evaluate the symptoms. We investigated the recovery rate by calculating slopes of changes over time for each participant. A changing slope was derived by linearly fitting the symptoms severity over time with the initial severity score as the intercept. Significant overall improvement was observed in both groups after the interventions. There was no significant difference seen in total symptom recovery rate between two groups (−1.49 ± 1.59 versus −1.2 ± 1.56, p = 0.32). The cognitive symptoms recovery rate of the ES group was faster than the control group (−0.5 ± 0.49 and −0.13 ± 0.46 respectively, p = 0.04). Physical therapy targeting the cervical region is beneficial for persons with PCS. Moreover, peripheral electrical stimulation on the paraspinal muscles surrounding the neck region could potentially advance the cognitive function recovery of persons with PCS.

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Clinical characteristics and outcomes of treatment of the cervical spine in patients with persistent post-concussion symptoms: A retrospective analysis

Cited by 41 publications

References 38 publications

Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines

Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines

Sex Differences in Ultrasound-Based Muscle Size and Mechanical Properties of the Cervical-Flexor and -Extensor Muscles

Effects of Electrical Stimulation in People with Post-Concussion Syndromes: A Pilot Study

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