Concussion and Mild TBI

Cristin Beazley, PT, DPT, CBIS

Concussion and Mild TBI

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Course Highlights

  • Analyze at least 5 different outcome measures used in concussion management and understand the implications they have on treatment
  • Effective assessment and treatment strategies for cervical spine impairments
  • Developing practical treatment plans and home exercise plans to improve patient progression and return to sport for athletes
  • Hands-on labs for vestibular and oculomotor review to help guide clinical decision making assessments and treatments plus a case study

Additional Info

It has been estimated in the general population that 1.7 million people sustain a concussion annually. It is also estimated that approximately 75% of all traumatic brain injuries (TBI) that occur each year are concussions or other mild forms of TBI. The US CDC Toolkit for Physicians (2007) estimates that between 2 and 3.8 million sports and recreation concussive injuries occur annually in the United States. Concussion management and recovery are focused on symptom management from beginning to end. Common symptoms of concussion have been identified and are tracked as predictors of outcomes and overall prognosis. It is extremely important that care be taken in the early stages of concussion recovery to monitor symptom progression, resolution and variability. Furthermore, the complex interaction between these categories of symptoms creates a challenge for the clinician, as symptom report alone is insufficient to determine the exact system contribution. Symptom reporting does not discriminate between physiologic contributions, cervicogenic symptoms, and vestibular symptoms. The treating provider must engage in specific examination techniques to determine the origin of these diverse symptoms. (Leddy,2014).

Sports related concussion has now been named the most complicated injury in sport medicine as noted at the 5th International Concussion conference in Berlin that publishednew guidelines for management in 2017. They present a challenge to the clinician because there are no absolute tests that are available to identify the concussion. One must rely on a good clinical history from the patient and a collection ofoutcome measures that examine a variety of areas of theinjury. To achieve positive outcomes with this population the clinician needs to be well-versed in all areas that can be impacted after injury and how they all interact in a variety of environments with a changing presentation. Concussion is often studied as a sports-related injury, however, it is an injury that affects all populations and across the lifespan.

This interactive, one-day course is designed to enhance the participant's knowledge and skill set with implementing evidence-based, comprehensive management for individuals with a concussion. It will include a myriad of didactic-based information on the pathophysiology, common impairments,and interventions used with this population. The role of thetherapist in management of this diagnosis will be the primary focus, with inclusion of information on the role of interdisciplinary care. Participants will have the opportunity topractice assessments and interventions during this course with guidance from the instructor. This course will help theclinician be able to develop a clinical decision-makingapproach to the injury to evaluate the symptoms and work to determine the best management and hierarchy of interventions for improved outcomes and recovery. There willbe a hands-on lab to review and practice outcome measures discussed. There will also be an interactive case studyreview where participants will be able to practice applying these clinical decision-making strategies to determine a treatment plan and overall best management for this population.

  1. Identify the current state of concussion research, statisticsand management.
  2. Interpret common red flags and impairments that warrant referral to alternative healthcare professionals.
  3. Evaluate common concussion assessment, goal settingand trajectories.
  4. Demonstrate assessment and treatment components of oculomotor and vestibular impairments.
  5. Demonstrate assessment and treatment components of cervical impairments.
  6. Identify the key components to a return to play/activityprotocol to fully test the vestibular system and ensure complete concussion recovery prior to return to play inathletic populations.
  1. The Current State of Concussion Research, Statistics, and Management
    1. Mechanism of injury and the role of rotational components vs. linear forces
    2. Common symptoms associated with concussion with early management
    3. Role of cognitive rest
    4. Risk factors that are associated with prolonged recoveryfrom concussion
    5. Comorbidities that contribute to variability within the injury
    6. Review and discussion of current sideline and baseline assessments
    7. Current practices and recommendations
  2. Creating an Effective Team: Interdisciplinary Team Members and Their Individual Roles
    1. When to refer and overall typical management
    2. Return to learn and return to play clearance considerations/decision making
  3. Assessment and Goal Setting for Patients with Concussion/ Mild TBI
    1. Current clinical trajectories found during concussion management
    2. Symptoms associated with trajectories
    3. Red flags
    4. Common patient complaints related to the trajectory
    5. Hands-On Lab
  4. Assessment and Treatment of Vestibular and Oculomotor Impairments and Concussion
    1. Purpose and role of the vestibular and oculomotor systems
    2. Examination of the systems
    3. Typical impairments seen post-concussion
    4. Treatment and HEP prescription
    5. Review and practice outcomes and some typical treatments of the vestibular and oculomotor systems
  5. Assessment and Treatment of Cervical Spine Impairments and Concussion
    1. Anatomy of the cervical spine
    2. Examination
    3. Relevance for contributions to symptoms
    4. Treatment and HEP prescription
  6. Effective Exercise Treatment Strategies and Return to Play
    1. Current guidelines and recommendations
    2. Role of vestibular testing and components in the protocol
    3. Cardiovascular changes and concerns that can be seen with return to activity and best management and testing
    4. Case studies and video examples of exercises
    5. Discussion/questions

Cristin Beazley graduated in 2006 with her Doctorate of Physical Therapy from the VCU Physical Therapy Program in Richmond, Virginia. She has worked for the last 12 years with emphasis on pediatrics and neurologic physical therapy. She's had a specific focus on concussion management over the last 7 years. She is the Clinical Lead for the Total Concussion Care program at Sheltering Arms Rehabilitation Center and is the lead author of a comprehensive clinical practice guideline that is used to guide treatment. Cristin is a Certified Brain Injury Specialist and is actively involved in clinical outcomes enhancement research and overall continued program refinement. She currently is the clinical leader for a team of 9 therapists that work out of two clinics and works closely with physicians, SLPs, and medical psychologists as part of her team as well. The sole patient population that she treats is those with a diagnosed concussion. She works with a variety of ages and populations from treating as young as 6 year olds and up through the lifespan, both athletes and non-athletes alike.She has presented at several conferences both locally and nationally on the topic of concussion management and to multiple levels of providers. She has presented posters on the role of Early PT intervention after concussion at the APTA combined section meeting as well as the AAN Sports Concussion Conference. Her goal is to improve the overall consistency of medical management and treatment of those with a concussion, starting with education and understanding of the complex nature of the injury.

DISCLOSURES

FINANCIAL: Cristin Beazley is compensated by Summit as an instructor.

NONFINANCIAL: Cristin Beazley does consulting work for BIONESS Inc. for which she receives BITS Technology.

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Content Level: Intermediate

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