Friday, 28 February 2020 06:49

Multi-faceted Approach to Concussion Rehabilitation

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Concussion is among the most commonly occurring sport and recreation related injuries in today's society. The majority of individuals recover in the initial time period following a concussion (typically between 7-10 days). However, in 20–30% of cases symptoms persist beyond the initial weeks following injury. Schneider (2019) have recently published a Masterclass is to outline evidence informed rehabilitation, including physiotherapy specific techniques, that may be of benefit individuals following concussion. 

Generally a period of rest for 24-48 hours is recommended before a gradual return to activities of daily living and a strategy of graded increase in both cognitive and physical exertion is initiated prior to returning to school/occupation and physical activity/sport.

Schneider(2019) have provided a graded strategy whereby, each step of strategy lasts 24 hours before progression on to the next phase. If symptoms recur while progressing through the protocol, the individual moves back to the previous step for an additional 24 hours.

The steps provided include:

  1. Symptom limited activities - ADLs that do not provoke symptoms
  2. Light aerobic exercise - Walking or stationery cycling at slow to medium pace
  3. Sport specific activities - Running or functional activities without head impact
  4. Non contact training drills - Gradually progress to training drills e.g. passing
  5. Full contact practice - With medical clearance, participate in normal training
  6. Return to play - Normal game play

Schneider (2019) proposed that return to school activities can coincide with return to play progression outlined above through gradual introduction of cognitive demands starting with activities that do not aggravate symptoms e.g. reading, writing etc. This can then be progressed to graduated return to school with the patient completing reduced hours or alternate days and then progressing to full time studies.

Considering that concussion is a complex heterogenous presentation, it is unlikely that any single intervention can be useful in managing various aspects of this presentation. Therefore,
a thorough interdisciplinary and multifaceted assessment is an important first step in identifying appropriate management strategies for individuals who do not recover in the initial weeks following concussion.

Subsequently, Schneider (2019) proceed to highlight the evidence for management of various aspects of concussion including:

  1. Headache - Use of behaviour therapies, physical therapy, education on sleep hygiene and management of stress.
  2. Cervical spine rehabilitation - Combination of manual therapy (either mobilisation or manipulation) and exercise is more effective than passive modalities, interventions that focus on function are more effective than those that do not, additional sensorimotor exercises (including eye fixation and proprioceptive training) can be of benefit, and that specific training appears to be more effective than general training.
  3. Vestibular rehabilitation - Canalith repositioning maneouvers are safe and effective in treating BPPV in as few as one treatment, with the majority of individuals having resolution of symptoms within the 1–3 treatments. Other considerations include adaptation exercises, habituation exercises, balance exercises and low level aerobic exercise.

Schneider (2019) then end the article by providing some implications for practice. This masterclass is second of the series with the first one focussing on assessment and diagnostic procedures.


The full article can be accessed here

Read 2248 times Last modified on Friday, 28 February 2020 06:52

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