Research Reports - Physical therapy intervention strategies for patients with prolonged mild traumatic brain injury symptoms

Int J Sports Phys Ther. 2015 Oct;10(5):676-89.

Hugentobler JA(1), Vegh M(2), Janiszewski B(1), Quatman-Yates C.
BACKGROUND AND PURPOSE: Although most patients recover from a mild traumatic
brain injury (mTBI) within 7-14 days, 10-30% of people will experience prolonged
mTBI symptoms. Currently, there are no standardized treatment protocols to guide
physical therapy interventions for this population. The purpose of this case
series was to describe the unique, multimodal evaluation and treatment approaches
for each of the patients with post-concussion syndrome (PCS).
CASE DESCRIPTION: Six pediatric athletes with PCS who had participated in
physical therapy and fit the inclusion criteria for review were retrospectively
chosen for analysis. Patients received a cervical evaluation, an aerobic activity
assessment, an oculomotor screen, and postural control assessment. Each patient
participated in an individualized physical therapy treatment plan-of-care based
on their presentation during the evaluation.
OUTCOMES: Patients were treated for a mean of 6.8 treatment sessions over 9.8
weeks. Four of six patients returned to their pre-injury level of activity while
two returned to modified activity upon completion of physical therapy.
Improvements were observed in symptom scores, gaze stability, balance and
postural control measures, and patient self-management of symptoms. All patients
demonstrated adequate self-management of symptoms upon discharge from physical
therapy.
DISCUSSION/CONCLUSIONS: Physical therapy interventions for pediatric athletes
with PCS may facilitate recovery and improve function. Further research is needed
to validate effective tools for assessment of patients who experience prolonged
concussion symptoms as well as to establish support for specific post-mTBI
physical therapy interventions.
LEVEL OF EVIDENCE: Level 4. 

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