Overview:

CONCUSSIONSA concussion is a type of traumatic brain injury caused by a bump, blow or jolt to the head that can change the way your brain normally works.1

Symptoms of a concussion can show up right after the injury or a few days/weeks after the injury. A concussion can affect the way an individual feels, thinks, experiences emotion and sleep/energy levels. If you suspect a concussion has occurred, seek out your medical provider or a physical therapist for specific testing.2

Concussion Symptoms5

Thinking/Remembering: Difficulty thinking clearly Felling slowed down Difficulty concentrating Difficulty remembering

new information

Physical: Headache, Fuzzy or

Blurry vision Nausea or Vomiting

(early on) Dizziness Sensitivity to noise or

light, Balance problems Feeling tired, having no

energy

Emotional/Mood: Irritability Sadness More emotional Nervousness or anxiety

Sleep: Sleeping more than

usual Sleep less than usual Trouble falling asleep

If you have a suspicion a concussion occurred, the individual should be removed from their sport and their behavior is assessed. If an individual develops neurological signs such as seizure activity, repeated vomiting, confusion, or slurred speech, immediate medical

Diagnosis:

needed to rule out a serious brain injury. Currently there is no diagnostic test for the presence of a concussion. A MRI or CT scan will help rule out a serious brain injury. A group of symptoms can diagnosis a concussion immediately after or arising a few weeks

to months after the injury. Acute symptoms can last 1-2 weeks. Symptoms lasting >3 weeks is considered as Post Concussion Syndrome. 3,4

1. Injury Prevention & Control: Tramuatic Brain Injury. Centers of Disease Control. http://www.cdc.gov/concussion/signs_symptoms.html. Accessed March 2015.

2. Miranda, N. Concussion: When Recovery Is Complicated By Vestibular Involvement and How Vestibular Rehabilitation Can Help. Vestibular Disorder Association. 2013.

3. Johnston KM, Bloom GA, Ramsay J, Kissick J, Montgomery D, Foley D, Chen JK, Ptito A. Current concepts in concussion rehabilitation. Current Sports Medicine Reports. 2004;3(6):316–323.

4. Harmon KG, Drezner JA, Gammons M, Guskiewicz KM, Halstead M, Herring SA, Kutcher JS, Pana A, Putukian M, Roberts WO. American Medical Society for Sports Medicine position statement: Concussion in sport. British Journal of Sports Medicine. 2013;47(1):15–26.

5. Concussion Management Guidelines. Colorado Department of Education. http://www.cde.state.co.us/healthandwellness/concussionguidelines11-6-14 . Accessed on March 2015.

6. Alsalaheen BA, Mucha A, Morris LO, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34:87–93.

7. Schneider K, Meeuwissee W, Nettel-Aguirre A, Barlow K, Boyd L, Kang J, Emery C. Cervicovestibular rehabilitation in sport-related concussion: a randomized controlled trail. Br J Sports Med. 2014: (48) 1294-1298.

8. Wells E, Goodkin H, Griesbach G. Challeneges in Determining the Role of Rest and Exercise in Management of Mild Traumatic Brain Injury. J Child Neuro. 2015: 1-7.

9. McCroy, P et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich., November 2012. Br J Sports Med. 2013: (47) 250-258.

Return to Play:A team of medical professions and school personnel determines the return to play and/or work of an individual. The individual can resume regular activities once they meet the following criteria:9

Symptom free at rest

Symptom free with physical and cognitive exertion

Intact cognitive functioning

Medication free for symptom resolution

Effective Physical Therapy Treatments

1. A physical therapist will evaluate and assess signs and symptoms of a concussion to design and individualized a return to play program.

2. Evidence shows that vestibular rehabilitation is an effective exercise based program targeted to reduce dizziness and improve walking and balance following a concussion. 6

3. A combination of cervical and vestibular physical therapy will decrease the time to medical clear a patient to return to play with persistent symptoms of dizziness neck pain and/or headaches due to sport-related concussions.7

4. Evidence indicates exercise can promote neuro-rehabilitation, particular with patients a concussion. A physical therapist will assist in a graded exercise program and determine when to implement cardiovascular exercise. 8

5. A physical therapy program can include gaze stability and visual motion sensitivity training, balance impairments and cervical spine management.

Acute Interventions: Limit physical activity

Limit “brain” activity with:o Phoneo Computero Musico TVo Textingo Gaming

Take time off or allow rest breaks throughout the day

Extend time to perform work task or homework assignments

Reduce repetition of work Share progress and difficulties