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Physical Therapy and Concussion

Published October 16, 2010
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Concussion: Part II

When there is a suspicion that an athlete sustained a concussion during a game or in practice, the following steps should be followed as recommended by the Centers for Disease Control and Prevention (CDC):

1. Remove the athlete from play
2. Have the athlete evaluated by an appropriate healthcare professional
3. Inform parents or guardians that the athlete sustained a possible concussion
4. Allow the athlete to return to play once cleared by a healthcare professional trained in evaluating and treating concussion

Being prepared to handle the situation is essential for proper management, treatment, and return to play of the athlete. The CDC has an excellent free program that is available online that helps educate athletes, coaches, and parents on prevention, preparation, and identification of concussion. Click on this link for more information:
http://www.cdc.gov/concussion/HeadsUp/online_training.html

At Specialized Physical Therapy, we are part of a multi-disciplinary team that is involved in the evaluation and treatment of children/adolescents and adults who have sustained a concussion. Most times, the patient is referred to us after having been evaluated by the appropriate medical physician. The physical therapy evaluation assesses a patient’s orientation to person, time, and place, cognition, balance, eye control, posture, cervical spine motion and muscle flexibility, and tolerance to physical activity (when appropriate). In addition, a thorough history is taken from the patient and parent/guardian so the mechanism of injury is understood and to assess if the appropriate steps were taken when the concussion occurred (see Steps 1-3 above).

Physical therapy treatment for concussion may involve patient and parent/guardian education, balance retraining, vestibular rehabilitation (for dizziness), manual physical therapy, aerobic conditioning, and sport specific training. As the patient progresses with treatment, there is an ongoing assessment of the patient’s condition to ensure that the patient’s symptoms and condition are improving and not worsening. Each patient is different, so their response to treatment is different as well. One of the best things a patient can do after a concussion is rest. As mentioned in our previous blog, proper rest allows the brain to heal, especially in a child/adolescent whose brain is still developing. Once proper rest has occurred and the symptoms have improved and stabilized, the patient is evaluated to begin supervised aerobic activity that closely monitors heart rate and the response of symptoms. Progressive aerobic activity facilitates a safe return to play. Return to actual competition can happen once the patient can perform progressive aerobic activity symptom free and practice their sport symptom free.

As part of a multi-disciplinary team, Specialized Physical Therapy closely communicates with the patient’s medical physician to make appropriate recommendations, based on the patient’s response in physical therapy, about the patient’s readiness to return to play.

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