An Empirical Review of Treatment and Rehabilitation Approaches Used in the Acute, Sub-Acute, and Chronic Phases of Recovery Following Sports-Related Concussion

Elbin, R.J.; Schatz, Philip; Lowder, Harrison B; Kontos, Anthony P.

doi:10.1007/s11940-014-0320-7

Cited by 24 publications

(13 citation statements)

References 51 publications

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“…Many vestibular and oculomotor symptoms are evident only when provoked by stimuli or movements. 6 Therefore, vestibular symptoms may be exacerbated by busy environments, such as a shopping mall or crowded school hallway, and quick head movements, such as those involved in dynamic sports. Similarly, oculomotor symptoms may worsen during activities such as reading or taking notes in a classroom.…”

mentioning

confidence: 99%

Review of Vestibular and Oculomotor Screening and Concussion Rehabilitation

Kontos

Deitrick

Collins

et al. 2017

Journal of Athletic Training

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145

106

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Vestibular and oculomotor impairment and symptoms may be associated with worse outcomes after sport-related concussion (SRC), including prolonged recovery. In this review, we evaluate current findings on vestibular and oculomotor impairments as well as treatment approaches after SRC, and we highlight areas in which investigation is needed. Clinical researchers have intimated that recovery from SRC may follow certain clinical profiles that affect the vestibular and oculomotor pathways. Identifying clinical profiles may help to inform better treatment and earlier intervention to reduce recovery time after SRC. As such, screening for and subsequent monitoring of vestibular and oculomotor impairment and symptoms are critical to assessing and informing subsequent referral, treatment, and return to play. However, until recently, no brief-screening vestibular and oculomotor tools were available to evaluate this injury. In response, researchers and clinicians partnered to develop the Vestibular/Ocular-Motor Screening, which assesses pursuits, saccades, vestibular ocular reflex, visual motion sensitivity, and convergence via symptom provocation and measurement of near-point convergence. Other specialized tools, such as the King-Devick test for saccadic eye movements and the Dizziness Handicap Inventory for dizziness, may provide additional information regarding specific impairments and symptoms. Tools such as the Vestibular/Ocular-Motor Screening provide information to guide specialized referrals for additional assessment and targeted rehabilitation. Vestibular rehabilitation and visual-oculomotor therapies involve an active, expose-recover approach to reduce impairment and symptoms. Initial results support the effectiveness of both vestibular and visual-oculomotor therapies, especially those that target specific impairments. However, the evidence supporting rehabilitation strategies for both vestibular and oculomotor impairment and symptoms is limited and involves small sample sizes, combined therapies, nonrandomized treatment groups, and lack of controls. Additional studies on the effectiveness of screening tools and rehabilitation strategies for both vestibular and oculomotor impairment and symptoms after SRC are warranted.

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mentioning

confidence: 99%

Review of Vestibular and Oculomotor Screening and Concussion Rehabilitation

Kontos

Deitrick

Collins

et al. 2017

Journal of Athletic Training

Self Cite

145

106

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“…6,14,52,54 Although animal studies suggest that acute concussion is characterized by temporary alterations in neural activity, cellular metabolism, and cerebral blood flow (CBF), 8,21,22 the pathophysiological mechanisms mediating PCS remain unclear. Clinical studies suggest that clusters of PCS symptoms may be mediated by alterations in global brain metabolism or dysfunction within the vestibulo-ocular or cervical spine neurolog ical subsystems.…”

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confidence: 99%

Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome

Mutch

Ellis

Ryner

et al. 2016

JNS

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abbreviatioNs ASL = arterial spin labeling; AUC = area under the curve; BOLD = blood oxygen level-dependent; CBF = cerebral blood flow; CVR = cerebrovascular reactivity; dmIC = dorsal mid-insular cortex; DTI = diffusion tensor imaging; ET = end-tidal; GRE = gradient recalled echo planar; fMRI = functional MRI; MNI = Montreal Neurological Institute; MPET = model-based prospective end-tidal; MPRAGE = magnetization-prepared rapid gradient-echo; PaCO 2 = arterial partial pressure of carbon dioxide; pCASL= pseudo-continuous arterial spin labeling; PCD = postconcussion disorder; PCS = postconcussion syndrome; PCSS = Post-Concussion Symptom Scale; ROC = receiver operating characteristic; SPM = statistical parametric mapping; SRC = sports-related concussion; TBI = traumatic brain injury. obJective A neuroimaging assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO 2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls. methods This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO 2 challenge and blood oxygen level-dependent (BOLD) MRI. Post hoc processing was performed using statistical parametric mapping to determine voxel-by-voxel regional resting CBF and cerebrovascular responsiveness of the brain to the CO 2 stimulus (increase in BOLD signal) or the inverse (decrease in BOLD signal). Receiver operating characteristic (ROC) curves were generated to compare voxel counts categorized by control (0) or PCS (1). results Studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study participants. No differences in CO 2 stimuli were seen between the 2 participant groups. No group differences in global mean CBF were detected between PCS patients and healthy controls. Patient-specific differences in mean regional CBF and CO 2 BOLD responsiveness were observed in all PCS patients. The ROC curve analysis for brain regions manifesting a voxel response greater than and less than the control atlas (that is, abnormal voxel counts) produced an area under the curve of 0.87 (p < 0.0001) and 0.80 (p = 0.0003), respectively, consistent with a clinically useful predictive model. coNclusioNs Adolescent PCS is associated with patient-specific abnormalities in regional mean CBF and BOLD cerebrovascular responsiveness that occur in the setting of normal global resting CBF. Future prospective studies are warranted to examine the utility of brain MRI CO 2 stress testing in the longitudinal assessment of acute sports-related concussion and PCS.

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“…Relevant past medical history including age, gender, prior concussion history, and comorbid “concussion risk factors” 77,95,102,121 …”

Section: Summary Of the Current Approach To Treating Concussionsmentioning

confidence: 99%

“…155156,166 Patients experiencing psychological and behavioral effects following concussion such as anxiety 96,167 and depression 11,167,169 may benefit from cognitive behavioral therapy (CBT) and other psychotherapeutic and behavioral interventions. 121 Finally, cervical dysfunction and cervicogenic headaches occurring after concussion may be managed with manual therapy to the cervical spine and head/neck proprioceptive re-training. 115,132 …”

Section: Summary Of the Current Approach To Treating Concussionsmentioning

confidence: 99%

Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

et al. 2016

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Background Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. Objective To describe the current landscape of treatment for concussion and provide summary agreements related to treatment in order to assist clinicians in the treatment of concussion. Methods On October 14–16, 2015, the Targeted Evaluation & Active Management (TEAM) Approaches To Treating Concussion meeting was convened in Pittsburgh, Pennsylvania, USA. 37 concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research, and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. Results A total of 16 statements of agreement were supported covering: 1) Summary of the Current Approach to Treating Concussion, 2) Heterogeneity and Evolving Clinical Profiles of Concussion, 3) Targeted Evaluation and Active Management Approach to Concussion Treatment: Specific Strategies, and 4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97–100%. Conclusion Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies based on modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery following concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments.

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An Empirical Review of Treatment and Rehabilitation Approaches Used in the Acute, Sub-Acute, and Chronic Phases of Recovery Following Sports-Related Concussion

Cited by 24 publications

References 51 publications

Review of Vestibular and Oculomotor Screening and Concussion Rehabilitation

Review of Vestibular and Oculomotor Screening and Concussion Rehabilitation

Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome

Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

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