Feasibility of early physical therapy for dizziness after a sports‐related concussion: A randomized clinical trial

Abstract

The purpose of this study was to (a) assess the feasibility of recruitment/retention of participants, protocol/resource management, and participant safety, and (b) estimate the size of the effect between the experimental and control groups. This was a feasibility study conducted as a prospective pilot double-blind randomized clinical trial. Subjects aged 10-23 years old with acute concussion and dizziness were enrolled from sports medicine centers. Forty-one participants were randomized into treatment and were seen for physical therapy beginning at 10 days post-concussion. Subjects in the experimental group received individually tailored, pragmatically delivered progressive interventions. Subjects in the control received prescriptive sham to minimally progressive interventions. The two primary outcomes were medical clearance for return-to-play and symptomatic recovery. The median number of days to medical clearance for the experimental group was 15.5 and for the control was 26. The median number of days to symptomatic recovery was 13.5 for the experimental group and was 17 for the control. According to Cox proportional hazards regression for time to medical release for return-to-play, the experimental group demonstrated a hazard ratio of 2.91 (95% CI: 1.01, 8.43) compared to the control. For time-to-symptomatic recovery, those in the experimental group demonstrated a hazard ratio of 1.99 (95% CI: 0.95, 4.15) compared to the control. The results indicate that it is feasible and safe to complete this type of intervention study. The results provide strong support for the allocation of resources to conduct well-powered randomized clinical trials of this intervention.

Clinical predictors of symptom resolution for children and adolescents with sport-related concussion

“…Identifying these high-risk individuals early after injury may allow for their referral to physical therapy or a mental health provider, depending on the clinical scenario, to reduce concussion symptoms, as has been observed previously. 25,43 Of course, understanding whether the abnormality represents a neurological injury or exaggeration or feigning of symptoms is key to making appropriate referrals, including the consideration of neuroimaging. Neuropsychology may be particularly useful in detecting and beginning to address noncredible effort.…”

Physical Therapy Management of Adults with Mild Traumatic Brain Injury

“…Change to a moving target going the opposite direction to head movement (called gaze stability x2). 7,30,32 The above task can become even more difficult by decreasing the size of the target and adding in another task, thus making a dualtask exercise. Again, the goal of these activities is not to avoid symptoms altogether, but to provoke mild to moderately severe symptoms in order for the patient to handle progressively more complex activities and environments.…”

“…Again, the goal of these activities is not to avoid symptoms altogether, but to provoke mild to moderately severe symptoms in order for the patient to handle progressively more complex activities and environments. 30,32 Patients recovering from an mTBI may progress more slowly in this activity than patients with gaze instability due to other causes. 30,32 Visual motion discomfort, sometimes called visual motion sensitivity, can occur as one symptom of PCS.…”

“…30,32 Patients recovering from an mTBI may progress more slowly in this activity than patients with gaze instability due to other causes. 30,32 Visual motion discomfort, sometimes called visual motion sensitivity, can occur as one symptom of PCS. 19,23 The condition is characterized by increased mTBI symptoms when visual and vestibular input to the brain do not match, resulting in sensations of disequilibrium, diplopia, headache, trouble reading, dizziness, and postural imbalance for patients.…”

A Physiological Approach to Assessment and Rehabilitation of Acute Concussion in Collegiate and Professional Athletes

“…Treatment with vestibular rehabilitation consisting of habituation exercises, sensorimotor/balance retraining, and otolith repositioning maneuvers as well as cervical spine physiotherapy resulted in an increased proportion of patients obtaining medical clearance to return to sport within 8 weeks compared to those who were managed with usual care (73 and 7%, respectively). More recently, Reneker et al (111) conducted a randomized controlled trial feasibility study evaluating the effect of individually tailored cervical and vestibular physiotherapy initiated 10 days post-injury in concussion patients with migraine cluster symptoms including dizziness and physical examination findings suggestive of vestibulo-ocular or cervical spine dysfunction. Treatment with individualized and progressive rehabilitation plans was associated with a shorter duration of symptoms (13.5 vs. 17 days) and fewer days until medical clearance (15.5 vs. 26 days) compared to treatment with a non-progressive treatment program.…”