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Pleva DJ, Hanson JC, Greer B. Management of concussion symptoms utilizing Mechanical Diagnosis and Therapy: a case series. J Man Manip Ther 2024:1-6. [PMID: 38949207 DOI: 10.1080/10669817.2024.2368923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/07/2024] [Indexed: 07/02/2024] Open
Abstract
OBJECTIVE Concussions are a common condition in athletes leading to symptoms including headache, dizziness, and sometimes vestibular deficits. Concussion management typically involves rest and a gradual return to activity among other interventions. This case series includes three patients who were evaluated using Mechanical Diagnosis and Therapy (MDT) after sport-related injuries involving concussion-like symptoms. MDT is a system of evaluating patients using repeated movements and sustained positions to assess symptomatic and mechanical changes. RESULTS Patients in this case series demonstrated rapid reduction of symptoms using variations of repeated cervical movements and sustained positions, which enabled them to return to play with a lasting resolution of symptoms. DISCUSSION/CONCLUSION This highlights the importance of a classification system for the appropriate treatment of these cases who did not require management using concussion protocol, as they were classified as cervical derangement.
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Affiliation(s)
| | | | - Brian Greer
- Physical Therapy and Sports Medicine Centers, Glastonbury, CT, USA
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2
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Farrell G, Chapple C, Kennedy E, Reily-Bell M, Sampath K, Gisselman AS, Cook C, Katare R, Tumilty S. Autonomic nervous system and endocrine system response to upper or lower cervical spine mobilization in males with persistent post-concussion symptoms: a proof-of-concept trial. J Man Manip Ther 2024:1-17. [PMID: 38904298 DOI: 10.1080/10669817.2024.2363018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/29/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION The peripheral stress response, consisting of the autonomic nervous system (ANS) and hypothalamic pituitary adrenal-axis (HPA-axis), functions to maintain homeostasis in response to stressors. Cervical spine manual therapy has been shown to differentially modulate the stress response in healthy populations. No study has investigated whether cervical spine mobilizations can differentially modulate the stress response in individuals with persistent post-concussion symptoms (PPCS), a population characterized by a dysfunctional stress response. METHODS A randomized, controlled, parallel design trial was performed to investigate whether upper or lower cervical spine mobilization can differentially modulate components of the stress response in individuals with PPCS. The outcomes were salivary cortisol (sCOR) concentration (primary) and the HRV metric, rMSSD, measured with a smartphone application (secondary). Nineteen males diagnosed with PPCS, aged 19-35, were included. Participants were randomly assigned into either intervention group, upper (n = 10) or lower (n = 9) cervical spine mobilization. Each outcome was collected at different time points, pre- and post-intervention. Statistical analyses were performed using the Friedman's Two-Way ANOVA, Mann-Whitney U test, and Wilcoxon Signed Rank Test. RESULTS There was a statistically significant within-group reduction in sCOR concentration 30 minutes following lower cervical spine mobilizations and statistically significant within-group increase in rMSSD 30 minutes following upper cervical spine mobilizations. CONCLUSION The results of this trial provide preliminary evidence for cervical spine mobilizations to differentially modulate components of the stress response at specific time points. Understanding the mechanisms of the effect of cervical spine mobilizations on the stress response provides a novel rationale for selecting cervical spine mobilizations to rehabilitate individuals with PPCS.
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Affiliation(s)
- Gerard Farrell
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, Dunedin, New Zealand
| | - Cathy Chapple
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, Dunedin, New Zealand
| | - Ewan Kennedy
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, Dunedin, New Zealand
| | - Matthew Reily-Bell
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Kesava Sampath
- Centre for Health and Social Practice, Waikato Institute of Technology-Rotokauri Campus, Hamilton, Waikato, New Zealand
| | | | - Chad Cook
- Doctor of Physical Therapy Program, Duke University, Durham, NC, USA
| | - Rajesh Katare
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, Dunedin, New Zealand
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Langevin P, Frémont P, Fait P, Dubé MO, Roy JS. Moving from the clinic to telehealth during the COVID-19 pandemic - a pilot clinical trial comparing in-clinic rehabilitation versus telerehabilitation for persisting symptoms following a mild Traumatic brain injury. Disabil Rehabil 2024; 46:2880-2889. [PMID: 37466379 DOI: 10.1080/09638288.2023.2236016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE The objective of this study was to compare the effects of an in-clinic cervicovestibular rehabilitation program (education, home exercises, manual techniques, sub-symptom threshold aerobic exercise [STAE] program) to a similar program (education, home-exercises, STAE program), but without manual techniques, provided in a telerehabilitation format in adults with persisting post-concussion symptoms (PCS). MATERIALS AND METHODS DESIGN In this parallel-group non-randomized clinical trial, 41 adults with persisting PCS were allocated to the in-clinic (n = 30) or telerehabilitation (n = 11) program. The outcome measures, which included the Post-Concussion Symptom Scale (PCSS; primary outcome), Numerical Pain Rating Scale (NPRS) for neck pain and headache and three disability questionnaires, were collected at baseline, weeks 6, 12, and 26. Non-parametric analysis for longitudinal data (NparLD) was used. RESULTS For the PCSS, there was a group-by-time interaction (p = 0.05) with significant between-group differences at week 6, 12, and 26 (p < 0.05) for the in-clinic group. There were also group-by-time interactions for NPRS neck pain and headache (p < 0.05) for the in-clinic group. CONCLUSION The study suggests that a telehealth format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement. These results must be interpreted with caution given the limited number of participants. ClinicalTrials.gov Identifier: NCT03677661.IMPLICATION FOR REHABILITATIONThe telerehabilitation format for adults with persisting post-concussion symptoms was widely implemented in the COVID-19 pandemic without any evidence of efficacy over the more traditional in-clinic rehabilitation format.The study suggests that a telerehabilitation format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement.Clinicians should try to incorporate some in-clinic appointments when a telerehabilitation format is required such as for patients in underserved area.
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Affiliation(s)
- Pierre Langevin
- Clinique Cortex and Physio Interactive, Québec, Canada
- Department of Rehabilitation, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), Quebec City, Canada
| | - Pierre Frémont
- Department of Rehabilitation, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Philippe Fait
- Clinique Cortex and Physio Interactive, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), Quebec City, Canada
- Department of Human Kinetics, University of Quebec at Trois-Rivières, Trois-Rivières, Canada
- Research Center in Neuropsychology and Cognition (CERNEC), Montréal, Canada'
| | - Marc-Olivier Dubé
- Clinique Cortex and Physio Interactive, Québec, Canada
- Department of Rehabilitation, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), Quebec City, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), Quebec City, Canada
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Postconcussion Symptom Catastrophizing Scale: Preliminary Reliability and Validity Analysis of Cross-sectional Data. Am J Phys Med Rehabil 2023; 102:105-109. [PMID: 35473889 DOI: 10.1097/phm.0000000000002040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of the study was to describe cross-sectional relationships between postconcussion symptom catastrophizing and patient-level factors in a postconcussion cohort. DESIGN This cross-sectional study was conducted in an outpatient rehabilitation hospital concussion clinic and consisted of adults undergoing a neuropsychological evaluation. Cronbach α assessed internal consistency for Post-Concussion Symptom Catastrophizing Scale total scores. Pearson r correlation coefficients assessed construct validity among emotional function measures and Post-Concussion Symptom Catastrophizing Scale total scores at initial evaluation. Hierarchical regression models were used to assess criterion validity. RESULTS Excellent internal consistency was observed for Post-Concussion Symptom Catastrophizing Scale total scores (α = 0.953). The Post-Concussion Symptom Catastrophizing Scale was significantly correlated with cause of injury ( r = -0.223, P < 0.01), litigation consideration ( r = 0.309, P < 0.05), and history of psychiatric illness ( r = 0.198, P < 0.01). The Post-Concussion Symptom Catastrophizing Scale was significantly correlated with emotional functioning (Patient Health Questionnaire [ r = 0.600, P < 0.05]; Generalized Anxiety Disorder [ r = 0.602, P < 0.05]), symptom rating (Sports Concussion Assessment Tool [Fifth Edition, r = 0.477, P < 0.05]), and cognitive functioning (Repeatable Battery for the Assessment of Neuropsychological Status [ r = -0.238, P < 0.05]) measures. The final regression model explained 64.7% variance in Post-Concussion Symptom Catastrophizing Scale total scores and included the Generalized Anxiety Disorder ( b = 1.038, β = 0.466, P = 0.001) as a unique predictor. CONCLUSIONS Results indicate strong, positive relationships between anxiety and catastrophizing at initial neuropsychological evaluation in a postconcussion sample.
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Glendon K, Desai A, Blenkinsop G, Belli A, Pain M. Recovery of symptoms, neurocognitive and vestibular-ocular-motor function and academic ability after sports-related concussion (SRC) in university-aged student-athletes: a systematic review. Brain Inj 2022; 36:455-468. [PMID: 35377822 DOI: 10.1080/02699052.2022.2051740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Physiological differences between a maturing and matured brain alters how Sports-Related Concussion (SRC) affects different age groups; therefore, a review specific to university-aged student-athletes is needed. OBJECTIVES Determine time to recovery for symptom burden, neurocognitive and Vestibular-Ocular-Motor (VOM) function and academic impact in university-aged student-athletes. METHODS Searches were conducted in PubMed, SpringerLink, PsycINFO, Science Direct, Scopus, Cochrane, Web of Science and EMBASE. Articles were included if they contained original data collected within 30 days in university-aged student-athletes, analysed SRC associated symptoms, neurocognitive or VOM function or academic ability and published in English. Two reviewers independently reviewed sources, using the Oxford Classification of Evidence-Based Medicine (CEBM) and the Downs and Black checklist, and independently extracting data before achieving consensus. RESULTS 58 articles met the inclusion criteria. Recovery of symptoms occurred by 7 and 3-5.3 days for neurocognition. The evidence base did not allow for a conclusion on recovery time for VOM function or academic ability. Few papers investigated recovery times at specified re-assessment time-points and have used vastly differing methodologies. CONCLUSIONS To fully understand the implication of SRC on the university-aged student-athlete' studies using a multi-faceted approach at specific re-assessments time points are required.Systematic review registration number: CRD42019130685.
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Affiliation(s)
- K Glendon
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Desai
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - G Blenkinsop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Belli
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, UK
| | - M Pain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Langevin P, Fremont P, Fait P, Dubé MO, Bertrand-Charette M, Roy JS. Cervicovestibular Rehabilitation in Adults with Mild Traumatic Brain Injury: A Randomised Clinical Trial. J Neurotrauma 2022; 39:487-496. [PMID: 35102743 DOI: 10.1089/neu.2021.0508] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to compare the effects of a cervicovestibular rehabilitation program combined with symptom-limited aerobic exercise (SLAE) program to a SLAE program alone in adults with persistent symptoms following mild traumatic brain injury (mTBI) on severity of symptoms and other indicators of clinical recovery. In this single-blind, parallel-group randomised clinical trial, 60 adults with persistent symptoms following mTBI were randomly assigned to: 1) a 6-week SLAE program or 2) a 6-week cervicovestibular rehabilitation program combined with SLAE program. All participants took part in 4 evaluation sessions (baseline, week 6, 12 and 26) performed by a blinded evaluator. The primary outcome was the Post-Concussion Symptoms Scale (PCSS). The secondary outcomes were Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), Headache Disability Inventory (HDI), Dizziness Handicap Inventory (DHI), time to return to function, and physical cervical and vestibular measures. Nonparametric analysis for longitudinal data was used to evaluate the effect of interventions on outcomes. For PCSS, NPRS, NDI, HDI, DHI and return to function, there were no group-by-time interactions at any time-points follow-up (p>0.05); clinically significant time effects were however observed (p0.05). There were group-by-time interactions at weeks 6 and 12 for vestibulo-ocular reflex (p0.003) and the cranio-vertebral mobility (p0.001) measures in favor of the cervicovestibular rehabilitation group. The study indicates that a cervicovestibular rehabilitation program combined with SLAE was not superior to a SLAE program alone in term of symptoms and functional level improvement but resulted in improved physical cervical and vestibular function. Keywords: mild traumatic brain injury, rehabilitation, neck pain, dizziness, headache.
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Affiliation(s)
- Pierre Langevin
- Université Laval Faculté de médecine, 12369, Quebec, Quebec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 560498, Quebec City, Quebec, Canada;
| | - Pierre Fremont
- Université Laval, 4440, Department of Rehabilitation, Quebec, Quebec, Canada;
| | - Philippe Fait
- Université du Québec à Trois-Rivières UQTR, Departement of Physical Activity Science, Trois-Rivières, Quebec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 560498, Quebec City, Quebec, Canada;
| | - Marc-Olivier Dubé
- Université Laval Faculté de médecine, 12369, Quebec City, Quebec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 560498, Quebec City, Quebec, Canada;
| | - Michael Bertrand-Charette
- Université Laval Faculté de médecine, 12369, Quebec City, Quebec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 560498, Quebec City, Quebec, Canada;
| | - Jean-Sébastien Roy
- Université Laval Faculté de médecine, 12369, Quebec City, Quebec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 560498, Quebec City, Quebec, Canada;
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Kennedy E, Chapple C, Quinn D, Tumilty S. Can the neck contribute to persistent symptoms post concussion? Long-term follow up from a prospective descriptive case series. J Man Manip Ther 2021; 29:318-331. [PMID: 34279185 PMCID: PMC8491693 DOI: 10.1080/10669817.2021.1920276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To describe individual long-term outcomes of people with persistent symptoms following a concussion who received neck treatment as part of multidisciplinary concussion care. A secondary objective is to report on how participants describe the outcomes of neck treatmentMethods: Long-term follow-up for a subgroup of participants in a prospective case series (n = 11). Data were collected at initial assessment, completion of neck treatment, 6 and 12 months including standard questionnaires (Rivermead post-concussion symptoms questionnaire, neck disability index, dizziness handicap inventory); patient-reported measures of headache, dizziness and neck pain and participant descriptions of the effects of neck treatmentResults: Grouped measures of post-concussion symptoms were further improved or sustained at 6 and 12 months. Ten of the 11 participants reported neck treatment as a beneficial part of their care and described the effects on the neck, multiple symptoms and their overall recovery. However, seven participants experienced recurrent headache, neck pain or dizziness at 6- or 12-month follow-up. CONCLUSION Long-term follow-up of individuals receiving neck treatment shows improvement across a range of patient reported outcomes, yet highlights frequent recurrence of symptoms. Neck treatment can play a valuable role in people's recovery that extends beyond local effects on the neck.
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Affiliation(s)
- Ewan Kennedy
- School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Cathy Chapple
- School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | | | - Steve Tumilty
- School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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8
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Glendon K, Blenkinsop G, Belli A, Pain M. Does Vestibular-Ocular-Motor (VOM) Impairment Affect Time to Return to Play, Symptom Severity, Neurocognition and Academic Ability in Student-Athletes following acute Concussion? Brain Inj 2021; 35:788-797. [PMID: 33896286 DOI: 10.1080/02699052.2021.1911001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Research indicates Sports-Related Concussion (SRC) impairs Vestibular-Ocular-Motor (VOM) function. The aim was to explore if VOM impairment correlates with longer Return To Play (RTP), symptom burden, neurocognitive performance and academic capability.Participants: 40 (61.4% male) Loughborough University, UK, rugby union student-athletes who sustained 42 SRCs.Methods: Student-athletes completed an assessment battery during pre-season (baseline), 2, 4, 8 and 14 days post-SRC and prior to RTP and were managed according to the rugby Football Union' community pathway.Outcome measures: Vestibular Ocular-Motor Screening (VOMS), Immediate Post-Concussion Assessment and Cognitive Test, Post-Concussion Symptom Scale, Perceived Academic Impairment Tool questionnaire and percentage of academic activities specifically missed due to SRC.Results: VOMS scores were significantly (p < 0.005) greater than baseline at all time points except RTP. Presence of VOM dysfunction at 14 days post-SRC significantly correlated with a longer RTP, greater symptom burden and increased odds ratio at 2, 4 and 8 days and academic time loss at 2, 4 and 8 days post-SRC.Conclusion: VOM impairment is associated with an increased symptom burden and impaired academic capability, and a longer time to RTP when present at 14 days post-SRC.
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Affiliation(s)
- K Glendon
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - G Blenkinsop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Belli
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - M Pain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Feddermann-Demont N, Chiampas G, Cowie CM, Meyer T, Nordström A, Putukian M, Straumann D, Kramer E. Recommendations for initial examination, differential diagnosis, and management of concussion and other head injuries in high-level football. Scand J Med Sci Sports 2020; 30:1846-1858. [PMID: 32557913 PMCID: PMC9290574 DOI: 10.1111/sms.13750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/09/2020] [Accepted: 06/04/2020] [Indexed: 12/22/2022]
Abstract
Head injuries can result in substantially different outcomes, ranging from no detectable effect to transient functional impairments to life‐threatening structural lesions. In high‐level international football (soccer) tournaments, on average, one head injury occurs in every third match. Making the diagnosis and determining the severity of a head injury immediately on‐pitch or off‐field is a major challenge for team physicians, especially because clinical signs of a brain injury can develop over several minutes, hours, or even days after the injury. A standardized approach is useful to support team physicians in their decision whether the player should be allowed to continue to play or should be removed from play after head injury. A systematic, football‐specific procedure for examination and management during the first 72 hours after head injuries and a graduated Return‐to‐Football program for high‐level players have been developed by an international group of experts based on current national and international guidelines for the management of acute head injuries. The procedure includes seven stages from the initial on‐pitch examination to the graduated Return‐to‐Football program. Details of the assessments and the consequences of different outcomes are described for each stage. Criteria for emergency management (red flags), removal from play (orange flags), and referral to specialists for further diagnosis and treatment (persistent orange flags) are provided. The guidelines for return to sport after concussion‐type head injury are specified for football. Thus, the present paper presents a comprehensive procedure for team physicians after a head injury in high‐level football.
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Affiliation(s)
- Nina Feddermann-Demont
- University Hospital and University of Zurich, Zurich, Switzerland.,Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Georges Chiampas
- US Soccer Federation, Chicago, IL, USA.,Departments of Emergency and Orthopedics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbruecken, Germany
| | - Anna Nordström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Margot Putukian
- University Health Services, Princeton University, Princeton, NJ, USA.,Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dominik Straumann
- University Hospital and University of Zurich, Zurich, Switzerland.,Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Efraim Kramer
- Division of Sports Medicine, University of Pretoria, Pretoria, South Africa
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10
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Mucci V, Meier C, Bizzini M, Romano F, Agostino D, Ventura A, Bertolini G, Feddermann-Demont N. Combined Optokinetic Treatment and Vestibular Rehabilitation to Reduce Visually Induced Dizziness in a Professional Ice Hockey Player After Concussion: A Clinical Case. Front Neurol 2019; 10:1200. [PMID: 31849804 PMCID: PMC6896248 DOI: 10.3389/fneur.2019.01200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/28/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The appropriate detection and therapy of concussion symptoms are of great importance to avoid long-term impairment and absence from pre-concussive activities, such as sport, school or work. Post-traumatic headache and dizziness are known as risk factors of persistent symptoms after a concussion. Dizziness has even been classified as a predictor for symptom persistence. One type of dizziness, which has never been considered is visually induced dizziness (VID) often develops as a consequence of vestibular impairment. This manuscript presents the clinical case of a 25-year-old male, professional ice hockey player, whereby a therapeutic approach to VID after concussion is demonstrated. Case: A detailed interdisciplinary clinical and laboratory-assisted neurological, neurovestibular and ocular-motor examination was performed 20 days post-concussion, which indicated VID symptoms. Thus, the player qualified for a 5-day combined vestibular, balance and optokinetic therapy, which aimed to reduce the player's increased sensitivity to visual information. Each treatment day consisted of two sessions: vestibular/ocular-motor training and exposure to optokinetic stimuli combined with postural control exercises. The optokinetic stimulus was delivered in the form of a rotating disk. VID symptoms were recorded daily via posturography and a visual analog scale prior to the optokinetic sessions. The player improved over the course of each treatment day and was able to return to ice hockey 15 days after the final treatment session. Three months later the player reported no symptoms in the follow up questionnaire. Conclusion: The combination of vestibular, balance and optokinetic therapy led to remission of VID symptoms in a professional ice hockey player after multiple concussions, within a short time frame after his last concussion. Thus, this case study highlights the significant benefit of treating post-concussive VID symptoms utilizing a multi-modal approach.
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Affiliation(s)
- Viviana Mucci
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland.,Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Cornelia Meier
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Mario Bizzini
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland.,Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
| | - Fausto Romano
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland.,Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Daniel Agostino
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | | | - Giovanni Bertolini
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland.,Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Nina Feddermann-Demont
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland.,Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
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11
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Falla D, Jull G. Introduction to the special issue on concussion. Musculoskelet Sci Pract 2019; 42:138-139. [PMID: 31155451 DOI: 10.1016/j.msksp.2019.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom; Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom; NIHR Surgical Reconstruction & Microbiology Research Centre, Queen Elizabeth Medical Centre, Birmingham, B15 2TH, United Kingdom.
| | - Gwendolen Jull
- Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Australia
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