Exploring Age and Sex Patterns for Rehabilitation Referrals After a Concussion: A Retrospective Analysis

Martini, Douglas N.; Wilhelm, Jennifer; Lee, Lindsey; Brumbach, Barbara H.; Chesnutt, J. C.; Skorseth, Paige; King, Laurie A.

doi:10.1016/j.arrct.2022.100183

Cited by 3 publications

(7 citation statements)

References 41 publications

(59 reference statements)

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“…However, there was no difference in the proportion of females and males between the ABF groups ( Table 1 ). Biological sex and gender are important psychosocial biological variables that can influence mTBI injury risk, symptom presentation, recovery patterns, and can even influence points of entry into the medical system as well as referral patterns ( 47 – 49 ). Given the role of biological sex and gender, our results should be interpreted in the context of our study sample and may not extend to other studies with different proportions of males and females.…”

Section: Discussionmentioning

confidence: 99%

The effects of augmenting traditional rehabilitation with audio biofeedback in people with persistent imbalance following mild traumatic brain injury

et al. 2022

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Complaints of non-resolving imbalance are common in individuals with chronic mild traumatic brain injury (mTBI). Vestibular rehabilitation therapy may be beneficial for this population. Additionally, wearable sensors can enable biofeedback, specifically audio biofeedback (ABF), and aid in retraining balance control mechanisms in people with balance impairments. In this study, we described the effectiveness of vestibular rehabilitation therapy with and without ABF to improve balance in people with chronic mTBI. Participants (n = 31; females = 22; mean age = 40.9 ± 11 y) with chronic (>3 months) mTBI symptoms of self-reported imbalance were randomized into vestibular rehabilitation with ABF (n = 16) or without ABF (n = 15). The intervention was a standard vestibular rehabilitation, with or without ABF, for 45 min biweekly for 6 weeks. The ABF intervention involved a smartphone that provided auditory feedback when postural sway was outside of predetermined equilibrium parameters. Participant's completed the Post-Concussion Symptom Scale (PCSS). Balance was assessed with the sensory organization test (SOT) and the Central Sensorimotor Integration test which measured sensory weighting, motor activation, and time delay with sway evoked by surface and/or visual surround tilts. Effect sizes (Hedge's G) were calculated on the change between pre-and post-rehabilitation scores. Both groups demonstrated similar medium effect-sized decreases in PCSS and large increases in SOT composite scores after rehabilitation. Effect sizes were minimal for increasing sensory weighting for both groups. The with ABF group showed a trend of larger effect sizes in increasing motor activation (with ABF = 0.75, without ABF = 0.22) and in decreasing time delay (with ABF = −0.77, without ABF = −0.52) relative to the without ABF group. Current clinical practice focuses primarily on sensory weighting. However, the evaluation and utilization of motor activation factors in vestibular rehabilitation, potentially with ABF, may provide a more complete assessment of recovery and improve outcomes.

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Section: Discussionmentioning

confidence: 99%

The effects of augmenting traditional rehabilitation with audio biofeedback in people with persistent imbalance following mild traumatic brain injury

et al. 2022

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“…Upon initial injury, most adult patients, who experience an mTBI and choose to seek medical treatment, present to the emergency department or an urgent care facility. However, it is estimated that approximately 46% present to outpatient clinics, such as sports medicine, neurology, and primary care, as their point of entry to the healthcare system 7,20 . After an initial evaluation where life-threatening intracranial complications have been ruled out with physical examination and in some cases neurological imaging, there is significant variability regarding the appropriate diagnosis, treatment, follow-up, and referrals for patients presenting with a work-related mTBI 20,21 .…”

Section: Treatment and Management Of Work-related Mtbi And Current Ro...mentioning

confidence: 99%

“…However, it is estimated that approximately 46% present to outpatient clinics, such as sports medicine, neurology, and primary care, as their point of entry to the healthcare system 7,20 . After an initial evaluation where life-threatening intracranial complications have been ruled out with physical examination and in some cases neurological imaging, there is significant variability regarding the appropriate diagnosis, treatment, follow-up, and referrals for patients presenting with a work-related mTBI 20,21 . Several guidelines for the diagnosis and treatment of mTBI exist, but they are not routinely used and are often institution and provider dependent 21,22 …”

Section: Treatment and Management Of Work-related Mtbi And Current Ro...mentioning

confidence: 99%

“…According to Martini et al, 20 referrals after an mTBI are largely dependent on where the patient received their initial evaluation. Patients evaluated in a sports medicine clinic were found to be much more likely to receive referrals to rehabilitation services when compared with patients who presented to primary care or the emergency department for their concussion 20 …”

Section: Treatment and Management Of Work-related Mtbi And Current Ro...mentioning

confidence: 99%

“…7,20 After an initial evaluation where life-threatening intracranial complications have been ruled out with physical examination and in some cases neurological imaging, there is significant variability regarding the appropriate diagnosis, treatment, follow-up, and referrals for patients presenting with a work-related mTBI. 20,21 Several guidelines for the diagnosis and treatment of mTBI exist, but they are not routinely used and are often institution and provider dependent. 21,22 Providers frequently involved in the follow-up care of these patients include, but are not limited to, primary care, neurology, orthopedics, neurosurgery, otolaryngology, ophthalmology, psychiatry, neuropsychology, and PM&R. Additional services, such as physical therapy, occupational therapy, and speech therapy, are also typically part of a patient's treatment regimen.…”

Section: Treatment and Management Of Work-related Mtbi And Current Ro...mentioning

confidence: 99%

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Treatment and Management of Work-Related Mild Traumatic Brain Injury in Physical Medicine and Rehabilitation

Andreae

Grafton

Hong

et al. 2022

Am J Phys Med Rehabil

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The purpose of this narrative review was to assess work-related mild traumatic brain injury treatment approaches and outcomes. Literature indicates that incidence of work-related mild traumatic brain injury is high. Ability to return to work after injury is variable, with differences identified across industry sector, mechanisms of injury, sex, and timely treatment and referral. Additional challenges exist in the context of secondary gains (e.g., financial) and the potential for symptom exaggeration. Emerging evidence from studies outside the United States demonstrate the benefits of proactive assessment and treatment at the time of injury. These benefits can be further augmented by early referral to multidisciplinary treatment teams led by physical medicine and rehabilitation physicians. Opportunities for ongoing research and development of strategies to improve treatment, management, and more timely return to work for patients with occupational mild traumatic brain injury are discussed. It is concluded that challenges persist in treatment and management of patients with work-related mild traumatic brain injury as they present unique challenges not seen in those with nonwork-related mild traumatic brain injuries. The unique position of physical medicine and rehabilitation and the skills of physiatrists render them poised to lead multidisciplinary treatment teams for these patients and contribute to the development of a new guideline for return to work, with an emphasis on functional recovery.

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Exercise Intolerance After Mild Traumatic Brain Injury Occurs in All Subtypes in the Adult Population

Antonellis

Campbell

Wilhelm

et al. 2024

Journal of Neurotrauma

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Exploring Age and Sex Patterns for Rehabilitation Referrals After a Concussion: A Retrospective Analysis

Cited by 3 publications

References 41 publications

The effects of augmenting traditional rehabilitation with audio biofeedback in people with persistent imbalance following mild traumatic brain injury

The effects of augmenting traditional rehabilitation with audio biofeedback in people with persistent imbalance following mild traumatic brain injury

Treatment and Management of Work-Related Mild Traumatic Brain Injury in Physical Medicine and Rehabilitation

Exercise Intolerance After Mild Traumatic Brain Injury Occurs in All Subtypes in the Adult Population

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