Concussion

A 22-year-old male Division I football wide receiver was diagnosed with a concussion following a helmet-to-helmet hit during a game 2 days ago. Initially following the injury, the athlete exhibited disequilibrium as he slowly walked to the sidelines. The sideline examination was performed by the team physical therapist. The therapist's assessment of concussion-related symptoms, postural control, and neurocognitive function was consistent with a concussion injury. The athlete was not allowed to return to play in the game. During the postgame injury clinic, the team physician confirmed the diagnosis of a concussion.

What are possible complications interfering with physical therapy?

What precautions should be taken during the physical therapy examination and interventions?

What are the most appropriate physical therapy goals?

• CONCUSSION: Complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Several common features include: (1) may be caused either by a direct blow to the head, face, neck, or elsewhere on the body with an “impulsive” force transmitted to the head; (2) typically results in rapid onset of short-lived impairment of neurologic function that resolves spontaneously; however, in some cases, symptoms and signs may evolve over a number of minutes to hours; (3) may result in neuropathological changes, but acute clinical symptoms largely reflect functional disturbance rather than structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies; (4) results in graded set of clinical symptoms that may or may not involve loss of consciousness; resolution of the clinical and cognitive symptoms typically follows sequential course, however, it is important to note that in some cases symptoms may be prolonged.1
• POST-CONCUSSIVE SYNDROME: Symptoms that occur following concussion; symptoms lasting ≥ 3 months following a concussion are classified as persistent post-concussive syndrome.2
• SECOND IMPACT SYNDROME: Condition that occurs within minutes of a concussion in someone who is still experiencing symptoms from a prior brain injury, which may have occurred earlier during the same event. Vascular engorgement leads to a massive increase in intracranial pressure and brain herniation, which can result in severe brain damage or death.2

1. Discuss appropriate components of the examination of the athlete with a potential concussion.

2. Describe potential complications during the early recovery period and over a longer period of time.

3. Identify reliable and valid outcome tools to measure an athlete's appropriateness for return to play.

4. Describe the phases of rehabilitation in concussion management.

PT considerations for management of the individual with a diagnosis of concussion:

• General physical therapy goals: Monitoring of the athlete for signs and symptoms that indicate any potential decline warranting further medical evaluation; rehabilitation progression based upon the individual athlete's symptom resolution
• Physical therapy interventions: Patient education regarding signs and symptoms of post-concussive syndrome; implementation of rehabilitation program beginning with physical and cognitive rest and progressing through aerobic exercise, resistance ...

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