Test 3: Concussion Interventions Flashcards
Common concussion S&S/complaints
HA
dizziness
N&V
poor balance
fatigue
disrupted sleep
visual deficits
fogginess
emotional liability
noise sensitivity
light sensitivity
poor concentration
memory impairments
neck pain
areas of intervention for concussion
cervical
ocular
vestibular
exertional
motor function
edu
best practice concussion standards apply to what age groups
8 years and up
rest/activity guidelines from best practice standards
rest for 24-48 hours
after 48-72 hours initiate light activity based on tolerance
avoid high risk activities that would be a high risk for another concussion
in acute phase stay away from extremes (i.e. strict rest and intense cognitive/physical activity)
5 domains for concussion intervention
exertional tolerance and aerobic
cervical MSK
vestibular oculomotor
motor function
education
level of evidence for exertional tolerance and aerobic intervention
grade A
symptom guided
when pt exhibits extertional intolerance and/or are planning to return to vigorous activity
recs for aerobic/exertional exercise guidelines
based on exertional testing
rec below 90% HR threshold for 20-30 min daily
how to progress aerobic exercise post concussion
may increase HR by 5-10 bpm every 1-2 weeks; want no new S&S or mild increase in S&S that is transient in nature
goal is to reach APMHR for 20 min w/o symptom exacerbation
cervical MSK intervention level of evidence post concussion
grade B
can address cervical and thoracic
C/S dysfunction can contribute to what S&S
HA
dizziness
TMJ disorder
treatment options for C/S dysfunction
manual therapy
dry needling
modalities
stretching
postural control exercises
cervcial kinesthesia exercises
what makes vestibular ocular interventions grade A vs grade B
grade A = if BPPV is a potential impairment then PT can use canalith repositioning maneuvers
Grade B = PTs with appropriate VRT/VOR expertise can implement an individualized vestibular and oculomotor rehab plan
BPPV treatment considerations post concussion
can be bilateral or multi canal
consider cervical pain and/or ROM limits
be mindful of order of treatment
convergence insufficiency exercises
brock string
dot card
pencil push up
shuttle pass
barrel cards
oculomotor exercises
marsden ball (pursuits)
michigan tracking (saccades)
column jumps (saccades)
HART charts (saccades)
when to refer oculomotor issues to vision specialist or OT
moderate to severe impairments i.e.:
ocular misalignment
diplopia
>1 month since onset
VOR 1 and 2 considerations
vary plane of head movement
consider C/S irritability
vestibular oculomotor exercise progression
seating to standing
wide to narrow BOS
firm to compliant surface
simple to complex background
add cog task
increase reps and speed of mvmt
motor function intervention level of evidence post concussion
grade C
PTs should implement interventions that address identified or suspected motor function impairments and help progress the pt towards higher level functional performance
i.e. static/dynamic balance, coordination, and dual/multi-tasking
cognitive tasks to add to balance challenges
counting
serial subtraction by 6s or 7s
reciting months bwd
spell word bwd
imediate word recall/delayed recall
list generation
tell a story
athletes post concussion gait speed compared to age matched norm
slower gait speeds when doing a dual task compared to norms
Grade B evidence for pt edu examples
self management of S&S
relative rest vs strict
importance of sleep
pacing strategies
S&S that may require additional med care
grade A evidence for pt and family/caregiver edu
impairments
functional limits
reinforce that most people have quick recovery
treatment considerations for concussion pts
environment (light sensitivity, noise, emotional liability, etc)
pacing of session (S&S irritability, recovery time, etc)
time of day
age
fall risk
