Summary of CSM course: The Role of the Physical Therapist in the Evaluation and Management of Athletes Following Sports Concussion
By Mary Roche, PT, CHT
[On February 8, 2012, I attended a 1 day conference given on:The Role of the Physical Therapist in the Evaluation and Management of Athletes Following Sports Concussion, in Chicago, IL at the Combined Sections Meeting of the American Physical Therapy Association. It was presented by the staff of the University of Pittsburgh Sports Medicine Center: Dr. Michael Collins; Dana Hinderliter, DPT; Anne Mucha, PT, DPT, NCS; and Susan Whitney, PT, DPT, PhD, NCS. The summary is as follows…]
There are approximately 3.8 million concussions that occur annually in the US each year. Concussion, whether from a sports injury, MVA or a fall, can result in a variety of symptoms, deficits in cognitive functions and impairments in balance. Serious long term effects from incomplete recovery and improper management has garnered much national attention. The role of the physical therapist is becoming more prevalent to assist in the recovery of the symptoms of balance issues, motion sensitivity, and deconditioning.
When a concussion occurs, there are chemical changes that occur in the brain. These changes take time to rebalance or ‘heal’. During this time of healing, it is imperative that you allow the brain to rest and avoid any type of second injury or trauma via another impact or increased stress levels. The brain is ‘starved for energy’ during healing. Resting means physical and mental resting. Limiting your aerobic activities and mental activities such as computer, TV, video games and reading/learning in the early stages of your injury can make a substantial difference. Your doctor or therapist can advise you on what would be proper levels of activity depending on your specific condition.
Healing from a concussion can take days, weeks, months or longer depending on the injury itself. The most commonly reported symptoms in the first 3 days post injury are headaches, difficulty concentrating, fatigue and drowsiness. It appears that the younger you are the more complicated the recovery and greater care should be taken. Symptoms of ‘fogginess’, dizziness, difficulty with typical sleep patterns, visual disturbances, nausea and attention/ memory dysfunctions are typical descriptors from individuals who are >3 weeks from the time of injury and still having issues.
Return to activity is determined by three factors: 1. Asymptomatic at rest, 2. Asymptomatic with progressive exertion and 3. Neurocognitive test scores back to baseline (if performed and available in your case). This time frame is determined by your health care provider and is closely monitored. The International Conference on Concussion in Sport, (2008 Zurich), has a graduated program for return to play but it should be noted that this is dependent on the individuals response to exercise and modified for those individual’s with prolonged symptoms. There is research to show that uncontrolled activity too soon after concussion can have negative effects on recovery. (Majerske et al, 2008)
The role of the physical therapist in this recovery is to be a part of the ‘team approach’ for the athlete’s full and safe recovery. This team can consist of but is not limited to: Neuropsychologists, MDs trained in TBI, Physical Therapists, Athletic Trainers, Neuro-Otologists, Neuro-Opthalmologists, Neuro-Optometrists, Psychologists, Cognitive therapists, guidance counselors, teachers and school nurses. A physical therapist will assess the athlete’s balance, vestibular and neurologic functions and guide them in the rehabilitation activity as appropriate with intervention for balance/ vestibular therapy, management of co-existing cervicogenic issues related to headaches and dizziness and return to exertion. A full evaluation by the therapist can help guide your treatment to focus on your personal needs.
Submitted by Mary Roche, PT, CHT