As we enter the month of October in the mountain state the rolling hills begin their transformation into gold and crimson shades, the cool mountain air begins to settle in the valleys, and we collectively celebrate the return of the fall season. With this seasonal change comes the return of fall sports and, unfortunately, athletic injuries. One injury that we could see an increased prevalence of this season is concussion and persistent concussion syndrome. As physical therapists we need to be prepared to help our communities and teams manage unwanted injuries. Are you ready to include managing concussion and persistent concussion syndrome in that task?
Concussion is now recognized as a brain injury. It is not a structural injury, but rather a functional injury. Though the exact pathophysiology of concussion requires continued research, we know that concussion can affect various systems throughout the human body. Because of this, concussion cannot always be detected with advanced medical imaging of the brain alone. When examining a patient post-concussion there are five primary domains that the physical therapist should consider: vestibular oculomotor; cervicogenic; cardiovascular; metabolic; and psychological. A clinical examination that incorporates these domains will help guide the clinician to the best matched treatment for the patient.
The physical therapist should consider the following tests and multi-disciplinary team members within each domain when examining a patient post-concussion: (See table)
|Domain of Concussion Symptom||Assessments for the Physical Therapist||Multidisciplinary Team Management|
|Vestibular Oculomotor||Vestibular Ocular Reflex (VOR) assessment in horizontal and vertical planes
Smooth Pursuit Test
|Cervicogenic||Cervical active range of motion assessment
Cervical flexion rotation test
Rotatory chair test
|Physiatry, Neurology, Orthopedics|
|Cardiovascular||Assessment of resting vital signs including heart rate, heart rate variability, blood pressure, and oxygen saturation
Assessment of vital signs and rate of perceived exertion with exertional aerobic activity
|Cardiology, Exercise Physiology|
|Metabolic||Screening dietary and nutritional habits
Screening recent lab work
Screening past medical history
|Endocrinologist, Registered Dietician, Functional Medicine Doctor
Timing is critical in the management of concussion! Prescribing the correct treatment plan based on the symptom manifestation can greatly help to accelerate the timeline of recovery. Recognize that not every patient will present with the same symptoms post-concussion and therefore careful examination is required. If you are a physical therapist working with an athlete post-concussion this fall, consider the above domains in the management of their care. I would additionally encourage the physical therapist to establish a relationship with other medical providers, such as those listed in the graphic above, because managing a patient post-concussion can require teamwork.