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Cutting edge management of post concussive syndrome

By Anthony Pribila, PT, DSc, CMPT, CMP, CEAS
Cutting edge management of post concussive syndromeIn the past several years concussions have recently started receiving the attention they deserve. Post Concussive Syndrome (PCS) is a clinical syndrome characterized by immediate and transient alteration in brain functioning. This may include altered mental status and level of consciousness, resulting from mechanical force or trauma, with or without impact to the head, neck and even the body. This may even be caused by a rapid deceleration injury not always resulting in a loss of consciousness.

Let’s face it, a concussion is a brain injury. While in most cases a single concussion may not result in permanent brain damage; a second concussion soon after does increase the chance of permanent brain damage. Concussions can cause severe headaches, visual or auditory sensitivity, affect memory, judgment, reflexes, speech, mood, cognitive performance, balance and muscle coordination. Sports most susceptible to concussions include: rugby, football, women’s ice hockey followed by men’s ice hockey, women’s soccer followed by men’s soccer.

The treatment of post concussive syndrome should initially begin with a thorough and ongoing evaluation of the client by medical professionals. Then an individualized program based on the client’s current status determined by symptoms, severity and progression can be prescribed.

At Therapeutic Rehab Specialists we use a unique 6 stage post-concussion syndrome (PCS) program based on the latest research and proven technology to optimize recovery.

Stage 1 consists of an initial physical and cognitive rest period where the individual is recommended to limit exercise, video games, television, computer use, social media and texting for up to 14 days. Sunglasses are recommended for photophobia and earplugs or noise cancelling headphones for phonophobia.

Medications such as NSAID’s, headache meds, sleep aids and selective serotonin reuptake inhibitors for depressive symptoms may be prescribed. In the case of potential intracranial bleeding, acute use of NSAID’s should avoided.

Stage 1 is associated with metabolic and physiologic changes occurring in the post concussive individual such as elevated heart rate with and without activity, higher sympathetic and lower parasympathetic activity, altered heart rate variability (HRV) which reflects the brain to heart sympathetic and parasympathetic nervous system balance. TRS offers treatment using Nu-Calm, a natural way to relieve anxiety, improve sleep, lower stress and cortisol levels and improve (HRV) by improving parasympathetic nervous system recovery and lowering sympathetic activity present during stress. Touch point therapy is initiated which is a bilateral alternating micro-vibration therapy device worn on each side of the body altering the body’s fight/flight response to restore and calm nervous system functioning. Retraining of proper breathing may also be indicated due to potential changes in diaphragmatic breathing leading to dysfunctional movement patterns. Balance and cognition continues to be assessed prior, during and post exercise.

Nutritional counselling is another important component of recovery. For example (PCS) clients often show a decline in their melatonin production therefore melatonin supplementation may be recommended as well as pulsing red LED light therapy to promote natural melatonin release. Fish oil has also shown to be effective in multiple studies starting with 2-20 grams a day and tapering off.

Stage 2 (week 2-4) is the post-acute phase using light exercise with heart rate variability (HRV) testing while keeping the pulse at below 60% of maximum heart rate (MHR). Cranial cryotherapy is performed at 20 minutes twice a day. Other treatments such as Nu-Calm, diaphragmatic breathing, touch points, and red LED light therapy are continued. Clients are evaluated and treated for vestibular dysfunction, balance, cognition and cervical spine mobility restrictions.
Cognitive deficits and balance are assessed and compared by testing with scales such as the BESS, SCAT2, dynamic gait index, mini-best and VOR assessment. Examination and treatment of the cervical spine and inner ear (BPPV) vertigo is continued as needed. Muscular dysfunction such as muscle length tension and the determination of muscular trigger points are assessed and treated.

Stage 3 (Week 4-6) allows for increased activity up to 80% of (MHR) levels while protecting the head from any impact. Exercise is stopped if heart rate exceeds 80% or if symptoms are exacerbated. Balance activity is also progressed incorporating visual training with single leg stance and on uneven surfaces.
Stage 4 (Week 6-8) will include non-contact coordination training, the initiation of strength training as well as high level endurance activity, measuring physiologic response up to 90% of MHR. Diaphragmatic breathing techniques are re-enforced, Nu-Calm treatment, light therapy and further nutritional counseling are continued. An infrared sauna can be used up to 20 minutes 2 x a day. Balance and cognition continue to be assessed prior, during and post exercise.

Stage 5 (Week 8 on) involves full contact sport practice and normal training activity with continued previous therapy.

Stage 6 (Week 10+) full return to play as the client should be rehabilitated while restoring confidence and assessing functional skills by coaching staff.
Therapeutic Rehab Specialists has three locations in the Brandon, Lakeland and Pinellas Park area. Call us at 813-876-8771 today for more information on our cutting-edge treatment approach for (PCS).

Brandon Physical Therapy Office

1129 Professional Park Drive
Brandon, FL 33511
813-876-8771

Lakeland Physical Therapy Office
1826 N. Crystal Lake Drive
Lakeland, FL 33801
813-876-8771

Pinellas Park Physical Therapy Office
6231 66th Street North
Pinellas Park, FL 33781
727-470-6070

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