Multimodal impairment-based physical therapy for the treatment of patients with post-concussion syndrome: A retrospective analysis on safety and feasibility

Grabowski, Patrick J.; Wilson, J. B.; Walker, Alyssa; Enz, Dan; Wang, Sijian

doi:10.1016/j.ptsp.2016.06.001

Cited by 72 publications

(59 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…20 Deficits found during clinical oculomotor or vestibular examination then determine the course of treatment as neuroplasticity of the brain is exploited and exercises utilizing adaptation or habituation are undertaken to encourage ocular or vestibular compensation. 7,30 VOR creates stable gaze by causing the eyes to move in the equal and opposite direction to the head. 24,31 It is the primary means by which the body controls eye movement and gaze stability, and is especially important for individuals where speed and quick responses are necessary for work, family responsibilities, play, or avocations.…”

Section: Vestibulo-ocular Rehabilitationmentioning

confidence: 99%

“…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.…”

Section: Vestibulo-ocular Rehabilitationmentioning

confidence: 99%

See 1 more Smart Citation

Physical Therapy Management of Adults with Mild Traumatic Brain Injury

Kane

Diaz

Moore³

2019

Semin Speech Lang

View full text Add to dashboard Cite

Rehabilitation for individuals after mild traumatic brain injury (mTBI) or concussion requires emphasis on both cognitive and physical rest, with a gradual return to activity including sports. As the client becomes more active, the rehabilitation professional should pay close attention to symptoms associated with mTBI, such as headache, dizziness, nausea, and difficulty concentrating. The systematic approach to return to play provided by the Berlin Consensus Statement on Concussion in Sport can apply to adults with mTBI. This protocol calls for gradually increasing the intensity of physical activity while attending to postconcussion symptoms. During the incident that led to an mTBI, the injured individual may incur injuries to the vestibular and balance system that are best addressed by professionals with specific training in vestibular rehabilitation, most commonly physical therapists. Benign paroxysmal positional vertigo is a condition in which otoconia particles in the inner ear dislodge into the semicircular canals, resulting in severe vertigo and imbalance. This condition frequently resolves in a few sessions with a vestibular physical therapist. In conditions such as gaze instability, motion sensitivity, impaired postural control, and cervicogenic dizziness, improvement is more gradual and requires longer follow-up with a physical therapist and a home exercise program. In all of the above-stated conditions, it is essential to consider that a patient with protracted symptoms of mTBI or postconcussion syndrome will recover more slowly than others and should be monitored for symptoms throughout the intervention.

show abstract

Section: Vestibulo-ocular Rehabilitationmentioning

confidence: 99%

Section: Vestibulo-ocular Rehabilitationmentioning

confidence: 99%

Physical Therapy Management of Adults with Mild Traumatic Brain Injury

Kane

Diaz

Moore³

2019

Semin Speech Lang

View full text Add to dashboard Cite

show abstract

“…Controlled and progressive aerobic exercise is becoming a popular SRC treatment option as research suggested that exercise positively influenced symptom, 9,11,38 balance, 10 and cognitive 11 domains in populations experiencing prolonged recovery. Our results indicate that aerobic exercise training alone did not meaningfully influence balance, cognitive, or visual outcomes in healthy participants, although a potential for improving symptom outcomes may be present.…”

Section: Translation Of Active Training To Concussed Populationsmentioning

confidence: 99%

“…8 The literature is more conclusive for sustained aerobic exercise training, showing decreased symptom scores after exercise interventions compared with either rest or placebo (ie, stretching) protocols. [9][10][11] Previous SRC rehabilitation investigators focused mainly on symptom outcomes, and little information exists regarding the effect of exercise interventions on other recovery domains after concussion. Some evidence supports the positive effects of aerobic training on balance, 10 cognitive, 11 and mood 11 outcomes.…”

mentioning

confidence: 99%

“…[9][10][11] Previous SRC rehabilitation investigators focused mainly on symptom outcomes, and little information exists regarding the effect of exercise interventions on other recovery domains after concussion. Some evidence supports the positive effects of aerobic training on balance, 10 cognitive, 11 and mood 11 outcomes. Yet these studies were often limited by long time intervals between injury and exercise onset, and recent international guidelines 3 supported earlier intervention after concussion.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Randomized Controlled Trial Evaluating Aerobic Training and Common Sport-Related Concussion Outcomes in Healthy Participants

Teel

Appelbaum

et al. 2018

Journal of Athletic Training

View full text Add to dashboard Cite

Context Aerobic exercise interventions are increasingly being prescribed for concussion rehabilitation, but whether aerobic training protocols influence clinical concussion diagnosis and management assessments is unknown. Objective To investigate the effects of a brief aerobic exercise intervention on clinical concussion outcomes in healthy, active participants. Design Randomized controlled clinical trial. Setting Laboratory. Patients or Other Participants Healthy (uninjured) participants (n = 40) who exercised ≥3 times/week. Intervention(s) Participants were randomized into the acute concussion therapy intervention (ACTIVE) training or nontraining group. All participants completed symptom, cognitive, balance, and vision assessments during 2 test sessions approximately 14 days apart. Participants randomized to ACTIVE training completed six 30-minute exercise sessions that progressed from 60% to 80% of individualized maximal oxygen consumption (V˙o2max) across test sessions, while the nontraining group received no intervention. Main Outcome Measure(s) The CNS Vital Signs standardized scores, Vestibular/Ocular Motor Screening near-point convergence distance (cm), and Graded Symptom Checklist, Balance Error Scoring System, and Standardized Assessment of Concussion total scores. Results An interaction effect was found for total symptom score (P = .01); the intervention group had improved symptom scores between sessions (session 1: 5.1 ± 5.8; session 2: 1.9 ± 3.6). Cognitive flexibility, executive functioning, reasoning, and total symptom score outcomes were better but composite memory, verbal memory, and near-point convergence distance scores were worse at the second session (all P values < .05). However, few changes exceeded the 80% reliable change indices calculated for this study, and effect sizes were generally small to negligible. Conclusions A brief aerobic training protocol had few meaningful effects on clinical concussion assessment in healthy participants, suggesting that current concussion-diagnostic and -assessment tools remain clinically stable in response to aerobic exercise training. This provides normative data for future researchers, who should further evaluate the effect of ACTIVE training on clinical outcomes among concussed populations. Trial Registration Number ClinicalTrials.gov: NCT02872480

show abstract

Consensus statement: An evidence‐based review of exercise, rehabilitation, rest, and return to activity protocols for the treatment of concussion and mild traumatic brain injury

De Luigi,

Bell,

Bramhall

et al. 2023

PM&R

View full text Add to dashboard Cite

ObjectiveEarly diagnosis and appropriate management of concussion/mild traumatic brain injury (mTBI) is critical for preventing poor outcomes and minimizing healthcare burden. Current clinical guidelines for concussion management focus mostly on diagnosis and return to cognitive and physical activity but provide limited guidance on the use of specific therapeutic interventions.ObjectiveTo systematically review the available evidence on therapeutic interventions for concussion/mTBI and develop an evidence‐based consensus statement on the use of these interventions in clinical practice.Literature SurveyA systematic literature search was performed first in 2018 and 2019, and again in 2022, to identify relevant original research on these interventions. A total of 6303 articles were retrieved through the systematic literature search and screened for inclusion. Eighty articles met inclusion criteria and were included in this review and consensus process.MethodologyA multispecialty panel was convened to explore management of concussion/mTBI. Interventions evaluated included rest, exercise, rehabilitation, and return to activity (RTA) protocols. Studies were assessed for relevance and methodologic quality and were voted upon to develop an evidence‐based consensus statement on the therapeutic appropriateness of these interventions for concussion/mTBI. A meta‐analysis was not performed.SynthesisThere was sufficient evidence to recommend exercise as an appropriate therapy for adolescents with acute concussion/mTBI. In other age groups and for other therapeutic modalities, while some studies demonstrated benefits for some of the interventions, mixed results and study limitations prevented the panel from drawing firm conclusions on the efficacy of those interventions. The panel found evidence of detrimental effects from strict rest and high‐intensity physical activity.ConclusionsThe panel recommended exercise as an appropriate therapy for acute concussion in adolescents. The evidence on other therapeutic interventions for concussion/mTBI remains limited to small randomized controlled trials and observational studies of moderate to low quality. The panel found no strong evidence to support or recommend against the other evaluated interventions but found most interventions to be safe when used judiciously and in consideration of individual patient needs. High‐quality randomized studies with sufficient power are needed to evaluate the effects of rest, rehabilitation, and RTA protocols for the management of concussion/mTBI.This article is protected by copyright. All rights reserved.

show abstract

Multimodal impairment-based physical therapy for the treatment of patients with post-concussion syndrome: A retrospective analysis on safety and feasibility

Cited by 72 publications

References 55 publications

Physical Therapy Management of Adults with Mild Traumatic Brain Injury

Physical Therapy Management of Adults with Mild Traumatic Brain Injury

Randomized Controlled Trial Evaluating Aerobic Training and Common Sport-Related Concussion Outcomes in Healthy Participants

Consensus statement: An evidence‐based review of exercise, rehabilitation, rest, and return to activity protocols for the treatment of concussion and mild traumatic brain injury

Contact Info

Product

Resources

About