Physical therapy for prolonged recovery after sports-related concussion: a case report [abstract] Abstract uri icon
  • BACKGROUND AND PURPOSE: Recovery times vary for sports-related concussion. Prolonged recovery can occur with a history of multiple concussions. Physical therapy can treat prolonged symptoms and functional limitations, but there are limited outcome studies. The purpose of this case study is to demonstrate successful physical therapy management of an athlete with repeated concussions and prolonged recovery. CASE DESCRIPTION: Patient was a 17-year-old male hockey player who presented to physical therapy 3 months after sustaining his fourth concussion. The patient lived 6.5 hours away and received several months of physical therapy near home for ongoing symptoms after his previous concussions. Patient felt like he never fully recovered after each concussion; with continued symptoms additional treatment was sought. He presented with headache, neck pain, difficulty concentrating and reading, environmental sensitivities, sleep disruption, and depressed mood. He had not returned to school since his injury due to symptom provocation. Medications included Gabapentin and Wellbutrin. Evaluation revealed Post-Concussion Symptom Score (PCSS) of 57, Dizziness Handicap Inventory (DHI) of 45%, and ImPACT neurocognitive testing scores well below baseline. Ocular motor exam (smooth pursuits, saccades, and convergence) was objectively normal, but provoked headache and dizziness. Vestibular exam (VOR × 1 and VOR cancellation) produced symptoms and challenge. Exertion testing (Balke protocol) increased symptoms. Upper-quarter exam showed weakness in deep neck flexors and middle/lower trapezius, forward head and shoulder posture and thoracic spine hypomobility. Treatment included education on an active recovery approach. Ocular motor exercises targeted decreasing sensitivity of the ocular motor system. Vestibular therapy focused on habituation, adaptation and tolerance of the central vestibular system and progressed into sport-specific head positions. Postural education and scapular stabilization were initiated for cervical pain. Patient was advised on a gradual return to school. OUTCOMES: After completing 4 visits over a 6-week period, the patient titrated off all medications, returned to full days of school with asymptomatic status, and began participating in symptom free baseball practice. Mood, sleep, and cognitive functioning were reportedly congruent with baseline. PCSS score was 8, DHI was 6%, and ImPACT scores were congruent with baseline. Ocular motor, vestibular and exertion testing were symptom free and within normal limits. In addition, his score on Neurocom (vestibular assessment) was normal. Neck pain was reduced and only noticeable with longer durations of poor posture, and deficits in upper-quarter exam had resolved. DISCUSSION: Physical therapy is an important part of comprehensive management for postconcussive syndrome and prolonged recovery. Successful physical therapy management in this case report utilized a multimodal approach consisting of education and supervised progression through vestibular, ocular motor, exertion, and cervical exercises.

  • publication date
  • 2017
  • Research
  • Brain
  • Injuries
  • Physical Therapy
  • Rehabilitation
  • Sports
  • Additional Document Info
  • 47
  • issue
  • 1