Physical Therapy Roles in Concussion Intervention – It’s Not Just about Sports Injury
Faculty: Karen McCulloch, PT, PhD, MS, FAPTA Board Certified in Neurologic Physical Therapy (Emeritus) Professor, Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, UNC-Chapel Hill, Chapel Hill, NC
Concussion is an injury that has captured the attention of the media as it relates to sports (and military service), driving the development of measures to ensure that concussion, which is a mild brain injury, is recognized when it happens and an injured athlete (or service member) is protected from additional injury allowing recovery to occur. This has focused attention on adolescents and young adults, where much of our understanding of post-concussion impairment is derived. What is not well recognized is that many more non-sports related concussions occur every year as a result of various causes to individuals across the lifespan. Physical therapists are an in ideal position to identify possible concussion, in situations where it may not be diagnosed, and to treat many of the common physical complaints that occur after this injury. As members of an interdisciplinary team, we also play a role in referring patients appropriately for conditions that are not part of our practice. This course uses a recently developed APTA Concussion CPG as the foundation for considering the role of the physical therapist. The course will be divided into units that include an introduction to the injury, and overview of acute management focused on the role of initial rest with gradual return to activity, followed by units that address key elements of PT care: screening for a possible concussion, identifying physical impairments that are consistent with PT practice including cervical, vestibulo-ocular, exertional and functional mobility impairments. Throughout the units, case examples will provide illustration of key concepts, addressing all levels of the International Classification of Function, Disability and Health. Although the evidence for assessment and intervention in this area is developing, case examples will illustrate the use of outcome measures to identify impairments with sequencing of multi-modal intervention to improve functional abilities consistent with life roles. Factors related to return to learn, work, typical activity and play will be addressed, emphasizing the importance of appropriately grading intervention to account for symptom irritability and injury chronicity.
At the conclusion of this course, participants will be able to:
Describe the incidence and prevalence of concussion in the US, including prognostic indicators, risk factors and common injury mechanisms based on stage of the lifespan.
Describe the neurometabolic cascade identified post-concussion relating this to rest and gradual return to activity as appropriate.
Contrast the sports-medicine approach of baseline testing and “return to baseline” as a driver for decision making with the typical PT referral where assessment occurs without baseline measures.
Based on case history, identify individuals who would benefit from screening to rule out concussion and describe questions and examinations to aid in this screening.
Identify clinical signs of and effective interventions for common complaints post-concussion including headache, dizziness, vestibulo-ocular complaints, exertional intolerance, and functional mobility limitations.
Identify appropriate self-report measures, evaluation tools and outcome measures to common complaints post-concussion.
Identify evidence-based treatment strategies to address the impairments in people with concussion including: cervical, vestibulo-ocular, exertional and functional mobility.
Design physical therapy delivery plans for case examples of people with concussion in acute and outpatient settings, taking into account injury chronicity as it relates to prognosis and necessary referrals.
Describe gaps in knowledge related to concussion management that are important to address in PT research.
The online course will be launched in Aug, 2019
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