Physical Therapy Management of Adults with Mild Traumatic Brain Injury

Abstract

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.

Specialty-Specific Diagnoses in Pediatric Patients With Postconcussion Syndrome: Experience From a Multidisciplinary Concussion Clinic

“…Balance retraining and vestibular rehabilitation can significantly improve imbalance and dizziness after concussion. 35,36 Postconcussion syndrome patients are also frequently impacted by deconditioning, which can be supported by a reconditioning program under PT guidance, 37 as reflected in a large proportion of our MDCC cohort. The inclusion of PT in MDCC teams should be strongly considered given the numerous indications for PT in PCS patients across multiple specialties.…”

Building Wellbeing in People With Chronic Conditions: A Qualitative Evaluation of an 8-Week Positive Psychotherapy Intervention for People Living With an Acquired Brain Injury

“…NTBIs occur both from an internal or external source, but are not directly caused by external force, (e.g., stroke, hypoxia, encephalitis, etc.). ABI can be associated with significant and chronic impairments across multiple areas of functioning including physical, cognitive, emotional, behavioral and social domains (Milders et al, 2003;Barman et al, 2016;de Freitas Cardoso et al, 2019;Kane et al, 2019). Critically, the psychological consequences of ABI are generally hidden and are associated with poor involvement in rehabilitation, hospital readmission, long-term disability, limited social activity, reduced ability to manage physical conditions, increased health service usage, suicide and a general increase in risk for mortality (Gillen et al, 2001;Naylor et al, 2012;Ayerbe et al, 2013;van Eeden et al, 2016).…”

Comparison of Prescribed Physical Therapy to a Home Exercise Program for Pediatric Sports-Related Concussion Patients

“…Regardless of the reason for the present study’s unexpected results, the current findings provide an incentive to develop an empirically validated PT protocol for pediatric SRC patients. At present, there are differing opinions within the PT discipline regarding number of visits, length of treatment, and when to commence and discontinue treatment for concussion patients [ 24 , 33 , 40 ]. Based on our results, future protocols should be supported with research that delineates the frequency with which patients should complete vestibular/ocular motor rehabilitation, at home or in-clinic, and should additionally include definitive discontinuation criteria to avoid burdening patients with undue travel and expenses.…”