Return to Meaningful Activities After a Multi-Modal Rehabilitation Programme among Individuals Who Experience Persistent Dizziness and Debility Longer Than 9 Months after Sustaining a Concussion: A Case Series

Adams, Joseph T.; Moore, Brian

doi:10.3138/ptc.2015-81ep

Cited by 14 publications

(19 citation statements)

References 48 publications

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“…19,20 Outcome measures such as those listed in Table 2 can be helpful for identifying specific problem areas either for treatment or for potential referral. 7,22,24 Patients are referred appropriately to other practitioners such as SLPs and neuropsychologists for language, cognitive, and/or emotional issues which are beyond physical therapy scope of practice. 8…”

Section: Physical Therapy For Individuals After Mtbimentioning

confidence: 99%

“…20 Deficits found during clinical oculomotor or vestibular examination then determine the course of treatment as neuroplasticity of the brain is exploited and exercises utilizing adaptation or habituation are undertaken to encourage ocular or vestibular compensation. 7,30 VOR creates stable gaze by causing the eyes to move in the equal and opposite direction to the head. 24,31 It is the primary means by which the body controls eye movement and gaze stability, and is especially important for individuals where speed and quick responses are necessary for work, family responsibilities, play, or avocations.…”

Section: Vestibulo-ocular Rehabilitationmentioning

confidence: 99%

“…31,33 Attending to the patient's symptoms, a PT will progress the treatment by having the patient maintain focus on a stationary object while moving the head vertically or horizontally. 7 As the patient improves, and only as tolerated, then the PT can do the following:…”

Section: Vestibulo-ocular Rehabilitationmentioning

confidence: 99%

“…Change to a moving target going the opposite direction to head movement (called gaze stability x2). 7,30,32 The above task can become even more difficult by decreasing the size of the target and adding in another task, thus making a dualtask exercise. Again, the goal of these activities is not to avoid symptoms altogether, but to provoke mild to moderately severe symptoms in order for the patient to handle progressively more complex activities and environments.…”

Section: Vestibulo-ocular Rehabilitationmentioning

confidence: 99%

“…6 Much of the research related to concussion focuses on those acquired through sports; however, many adults experience mTBI from injuries in activities other than sports. 7,8 As crucial as a return to sport is for an injured athlete, return to work, school, family responsibilities, and avocations is important to nonathletes with mTBI. 9 This paper summarizes how physical therapists (PTs) evaluate and treat adults after mTBI and collaborate with speech-language pathologist (SLP) in the care of these individuals.…”

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confidence: 99%

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Physical Therapy Management of Adults with Mild Traumatic Brain Injury

Kane

Diaz

Moore³

2019

Semin Speech Lang

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Rehabilitation for individuals after mild traumatic brain injury (mTBI) or concussion requires emphasis on both cognitive and physical rest, with a gradual return to activity including sports. As the client becomes more active, the rehabilitation professional should pay close attention to symptoms associated with mTBI, such as headache, dizziness, nausea, and difficulty concentrating. The systematic approach to return to play provided by the Berlin Consensus Statement on Concussion in Sport can apply to adults with mTBI. This protocol calls for gradually increasing the intensity of physical activity while attending to postconcussion symptoms. During the incident that led to an mTBI, the injured individual may incur injuries to the vestibular and balance system that are best addressed by professionals with specific training in vestibular rehabilitation, most commonly physical therapists. Benign paroxysmal positional vertigo is a condition in which otoconia particles in the inner ear dislodge into the semicircular canals, resulting in severe vertigo and imbalance. This condition frequently resolves in a few sessions with a vestibular physical therapist. In conditions such as gaze instability, motion sensitivity, impaired postural control, and cervicogenic dizziness, improvement is more gradual and requires longer follow-up with a physical therapist and a home exercise program. In all of the above-stated conditions, it is essential to consider that a patient with protracted symptoms of mTBI or postconcussion syndrome will recover more slowly than others and should be monitored for symptoms throughout the intervention.

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Section: Physical Therapy For Individuals After Mtbimentioning

confidence: 99%

Section: Vestibulo-ocular Rehabilitationmentioning

confidence: 99%

Section: Vestibulo-ocular Rehabilitationmentioning

confidence: 99%

Section: Vestibulo-ocular Rehabilitationmentioning

confidence: 99%

mentioning

confidence: 99%

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Physical Therapy Management of Adults with Mild Traumatic Brain Injury

Kane

Diaz

Moore³

2019

Semin Speech Lang

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Employment and Economic Outcomes of Participants With Mild Traumatic Brain Injury in the TRACK-TBI Study

et al. 2022

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IMPORTANCEMild traumatic brain injury (mTBI) may impair the ability to work. Strategies to facilitate return to work are understudied. OBJECTIVE To assess employment and economic outcomes for employed, working-age adults with mTBI in the 12 months after injury and the association between return to work and employer assistance. DESIGN, SETTING, AND PARTICIPANTS Using data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, a cohort study of patients with mTBI presenting to emergency departments of 11 level I US trauma centers was performed. Patients with mTBI enrolled in the TRACK-TBI cohort study from February 26, 2014, to May 4, 2016, were followed up at 2 weeks and 3, 6, and 12 months after injury. Work status and income decline of participants were documented in the first year after injury. Associations between work status, injury characteristics, and offer of employer assistance and associations between follow-up care and employer assistance were investigated. Results were adjusted for unobserved outcomes using inverse probability weighting. Data were extracted July 12, 2020; analyses were completed March 24, 2021. Analyses included 435 participants aged 18 to 64 years who were working before the injury, had a Glasgow Coma Scale score of 13 to 15, and completed all postinjury follow-up surveys. MAIN OUTCOMES AND MEASURES Primary outcomes were work status (working or not working) at each study follow-up milestone. Employer assistance included sick leave, reduced hours, modified schedule, transfer to different tasks, assistive technology, and coaching offered during the first 3 months after injury. RESULTSOf 435 participants (147 [34%] female; 320 [74%] White; mean [SD] age 37.3 [12.9] years), 258 (59%) reported not working at 2 weeks after injury and 74 (17%) reported not working at 12 months after injury. More than one-fifth (92 [21%]) experienced a decline in annual income. Work status at 12 months was significantly associated with postconcussion symptoms experienced at 3 months after injury (73% of patients with 3 or more symptoms reported working at 12 months after injury vs 89% of patients with 2 or fewer symptoms; P < .001) but not with other injury characteristics. Participants offered employer assistance in the first 3 months after injury were more likely to report working after injury than those not offered such assistance (at 6 months: 88% vs 78%; P = .02; at 12 months: 86% vs 72%; P = .005). CONCLUSIONS AND RELEVANCEIn this cohort study, mTBI was associated with substantial employment and economic consequences for some patients. Clinicians should systematically follow up with patients with mTBI and coordinate with employers to promote successful return to work.

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