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Risk factors and Prevalence

More likely to sustain a concussion

• Longer recovery periods

• Female sex

• Younger age

• History of concussion

• History of migraine

• Diagnosis of a learning disability or ADHD

More likely to have a longer recovery period

• Posttraumatic migraine

• Immediate dizziness

• Sub-acute fogginess

• Difficulty concentrating

• Vomiting

• General dizziness

• Cervicogenic dizziness

• Nausea

• Headache

• Slowness

• Imbalance

• Light or noise sensitivity

• Numbness

It is estimated that up to 40% of concussions will become post concussive

 

Diagnosis

• There is no test/image to 100% confirm, which is why baseline testing is important (lets us track symptoms and recovery)

• Neurocognitive testing such as ImPACT is great for getting baseline data to compare when concussion/PCS is suspected

 

Post-Concussion Syndrome “Tracts”

PCS is subdivided into several “tracts.” These tracts are determined by the type of symptoms/deficits you are experiencing and have specific treatments associated with each tract. Many times people will fall into more than one PCS Tract, and treatment should reflect all tracts

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Cognitive/Fatigue Tract

• Risk Factors: learning disorders, ADHD, ADD

• Common symptoms: difficulty with memory and concentration, difficulty following multi-step commands, fatigue, sleep disturbances

• Treatment approaches: behavioral strategies/accommodations, monitored active rehabilitation, pharmacological, cognitive behavior therapy

 

Vestibular Tract

• Risk factors: history of motion sickness

• Common symptoms: loss of balance, feeling of imbalance, motion sickness, nausea, dizziness, fogginess

• Treatment approaches: individually tailored vestibular therapy

 

Oculomotor Tract

• Risk factors: amblyopia (lazy eye), strabismus (cross eye), family history of both

• Common symptoms: eye pain/pressure behind the eyes, headache due to visual strain (reading/TV/computer or phone screen use), difficulty focusing (both physically and mentally), fatigue

• Treatment approaches: vestibular therapy focusing on the impaired oculomotor deficits

  • *Neuro-opthalmologist treatment may be necessary in more severe cases

 

Anxiety/Mood Tract

• Risk factors: history of mood disorders, family history of mood disorders

• Common symptoms: increased anxiety, ruminative thoughts, hyper vigilance, sadness, helplessness, feeling of being overwhelmed, headache, sleep disturbances, dizziness, fatigue, fogginess

• Treatment approaches: monitored active rehabilitation, regimented sleep schedule/diet/hydration/stress management, cognitive behavioral therapy, pharmacological

 

Post Traumatic Migraine Tract

• Risk factors: history of migraine, family history of migraine

• Common symptoms: chronic persistent headache, light sensitivity, noise sensitivity, nausea

• Treatment approaches: strict behavioral management (sleep/diet/stress), pharmacological, monitored cardiovascular training

 

Cervical Tract

• Risk factors: history of trauma to the neck (previous or at time of initial injury)

• Common symptoms: headache that is occipital (back of head) in origin which may radiate to temples and eyes, neck pain/stiffness, fatigue, fogginess

• Treatment approaches: cervical PT (manual therapy such as mobilization/manipulation/soft tissue release, AROM/PROM, stabilization training, and proprioceptive exercises

 

Physiological Tract

• Risk factors: none

• Common symptoms: headache, dizziness, fatigue, light sensitivity

  • These individuals will often have early symptom exacerbation with physical activity

• Treatment approaches: monitored endurance training and strengthening as appropriate/tolerated

 

What Does the Research Say For Treatment?

Concussions

• First 7-10 days it is important to rest and allow the brain to recover as much as possible, but to not completely eliminate all inputs into the brain

• Patients/athletes should limit their physical, mental, and emotional activities to moderate intensities (i.e., not too much, but not too little)

Post Concussion Syndrome

• Emerging evidence suggests that rest is only beneficial in the acute stages of injury, and may even be harmful if utilized for too long of a period

• Moderate activity is beneficial after the acute stages of injury, but over and under activity are both detrimental

 

General Treatment – WHAT YOU CAN DO

• Limiting physical, mental, and emotional stresses BUT not completely eliminating these entirely

• You want a balance of exertion and rest

• Your brain responds to the stresses applied to it à some stress is good; too much can cause delays in healing

 

WHY SEE A PHYSICAL THERAPIST?

• Determining which tracts of PCS you fall into

  • Cervical, vestibular, oculomotor, anxiety/mood, cognitive/fatigue, post-traumatic migraine, and physiological/exertional

• Creating and implementing individualized plans of care such based on your PCS Tracts and your specific symptoms

• EDUCATION! Helping you to understand your brain and how it responds to different stimuli and how to best manage your symptoms when they do happen