Research Reports - Physical rehabilitation interventions for post-mTBI symptoms lasting greater than 2 weeks

Phys Ther. 2016 Nov;96(11):1753-1763. Epub 2016 May 19.

Quatman-Yates C(1), Cupp A(2), Gunsch C(3), Haley T(4), Vaculik S(5), Kujawa
D(6).

BACKGROUND: Heightened awareness of the lasting effects of mild traumatic brain
injury (mTBI) has amplified interest in interventions that facilitate recovery
from persistent post-mTBI symptoms.
PURPOSE: The purpose of this study was to systematically review the literature to
identify potential physical rehabilitation interventions that are safe, feasible,
and appropriate for physical therapists to utilize with patients with persistent
mTBI-related symptoms.
DATA SOURCES: The electronic databases PubMed, Cochrane Library, CINAHL, Scopus,
SPORTDiscus, and Web of Science were systematically searched from database
inception until June 2015.
STUDY SELECTION: Studies were included if they utilized physical rehabilitation
interventions and the study's participants had a diagnosis of mTBI, a mean age of
8 years or older, and symptoms persisting an average of 2 weeks or longer.
Exclusion criteria included blast injuries, diagnosis of moderate or severe TBI,
or psychosis.
DATA EXTRACTION: Data extraction and methodological risk of bias assessments were
performed for each study.
DATA SYNTHESIS: Eight studies with a range of study designs, intervention types,
and outcome measures were included. The interventions investigated by the
included studies were categorized into 3 types: physiological, vestibulo-ocular,
and cervicogenic.
LIMITATIONS: The identified studies had several significant limitations
including: small sample sizes and low-level study designs.
CONCLUSIONS: The results of this systematic review indicate that several physical
rehabilitation options with minimal risk for negative outcomes are available for
treating patients experiencing persistent post-mTBI symptoms. These options
include: vestibular, manual, and progressive exercise interventions. Conclusions
surrounding efficacy and ideal dosing parameters for these interventions are
limited at this time due to the small number of studies, the range of
interventional protocols, and lower levels of study design. 

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