Journal Club: Ortho/Neuro Edition

Today, the wheel of journal club topics falls on concussions!  Concussions and mild head injuries are being talked about a lot these days.  We hear it in sports analysis related to football head injury and subsequent CTE.  We see the effects of it in mild to moderate trauma cases like motor vehicle collisions.  The reality is that mild brain injury occurs frequently with wide ranging effects to the patient and their function.

That’s why I was intrigued when the most recent JOSPT journal published a massive review of evidence regarding concussion/mild traumatic brain injury.  Believe me, it is massive!  But the review is extremely helpful whether you are working with sport related athletes or a neuro therapist working with brain injury.  I appreciate that out of all the evidence reviewed by the authors, they were able created very useful clinical practice guidelines for the evaluation and treatment of these types of problems.

                                         Physical Therapy Evaluation and Treatment after Concussion/Mild TBI

Some of the highlights for me include the assessment of irritability and vestibular function.  I don’t always delve into those types of assessments but they can be helpful in formulating appropriate interventions and improving your rehab outcome of a patient with concussion/mild TBI.  Additionally, the authors concluded that a symptom-guided exertional tolerance test may be warranted to establish a baseline especially for those patients who indicate a desire to return to a high level of activity.

From a treatment standpoint, education is identified as a powerful intervention.  If that patient understands the etiology, tissue healing physiology, and recovery process, then the rehab will be very beneficial.  Additionally, posture exercises specific to the cervical and thoracic spine are recommended and vestibular rehab can be extremely beneficial, especially if the patient is dealing with dizziness.
  
Take some to digest this article.  I think you will find it extremely informative and helpful in either the ortho/sport world, the neurological world, or the trauma world.  What has been your experience in treating patients with concussion/mild TBI?  What really worked and what didn’t?  I would love to hear from you!

​Jason

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