KPTA Fall Conference, Manhattan 2013
Concussion Management for the Physical Therapist
Dan Lorenz, DPT, PT, ATC/L, CSCS
Ken Pringle, DPT, PT, ATC/L
Shannon Margherio, PT
Jon Schultz, MD
Meg Gibson, MD
Lucas Thompson, MD
Kellie Bartlow, MD
I. Introduction
A. Statement of the problem
B. New KSHAA rule
C. Operational Definitions
II. Pathophysiology of Concussion
III. On-Field Management/24-48 Hour Follow-Up
A. How to recognize a concussion
B. On-field Assessment
C. Sideline evaluation
a. Review of the SCAT3
D. Home management/Family education
E. Classroom issues
IV. Neuropsychological Testing
V. Physical Therapy Management
A. Review of relevant anatomy
B. Cervical biomechanics
C. Subjective history key points
D. Neuro screen
E. Cervical evaluation
F. Manual therapy interventions
G. Vestibular Testing and Rehab
VI. Graded Exercise Progression/Return to Play Management
A. Review of criteria to establish RTP protocol
B. Review of RTP Model Creighton et al, CJSM 2010
C. Graded exercise progression review
D. Exercise program outline
E. RTP progression once return to practice
VII. Cases
VIII. Q&A
REFERENCES:
1. Lincoln AE, et al. Trends in Concussion Incidence in High School Sports : A Prospective 11-Year Study. Am J Sports
Med. 2011; 39(5): 958-63.
2. Leddy JJ, et al. Reliability of a graded exercise test for assessing recovery from concussion. Clin J Sports Med.
2011; 21(2): 89-94.
3. Hossler P. Concussion: Carryover in the Classroom. NATA News. 2007; July. 32-36.
4. Harmon K, et al. American Medical Society for Sports Medicine Position Statement: Concussion in Sport. Clin J
Sports Med. 2013; 23: 1-18.
5. Kutcher JS. Management of the Complicated Sports Concussion Patient. Sports Health. 2010; 2(3): 197-202.
6. McCrory P et al. Consensus Statement on Concussion in Sport—the 4th International Conference on Concussion
in Sport Held in Zurich, November 2012. Clin J Sports Med. 2013; 23: 89-117.
7. Cripps A, Livingston S. The Value of Balance-Assessment Measurements
in Identifying and Monitoring Acute Postural Instability Among Concussed Athletes. J Sport Rehab. 2013; 22: 67-71.
8. Giza CG, DiFiori JP. Pathophysiology of Sports-Related Concussion: An Update on Basic Science and Translational
Research. Sports Health. 2011; 3(1): 46-51.
9. Leddy JJ et al. Rehabilitation of Concussion and Post-concussion Syndrome. Sports Health. 2012; 4(2): 147-154.
10. Broglio SP et al. Concussion in Sports: The Sideline Assessment. Sports Health. 2009; 1(5): 361-69.
11. McCrory P. Sport concussion and the risk of chronic neurological impairment. Clin J Sports Med. 2011; 21: 612.
12. ImPACT Concussion Course Manual, KU Med Center. July, 2013.
13. Alsalaheen BA, Mucha A, Morris LO, Whitney SL, Furman JM, Camiolo-Reddy CE, Collins MW, Lovell
MR, Sparto PJ. Vestibular rehabilitation for dizziness and balance disorders after concussion. J of Neuro
PT. 2010; 34:87-93
14. Brown KE, Whitney SL, Marchetti GF, Wrisley DM, Furman JM. Physical therapy for central vestibular
dysfunction. Archives of Physical Therapy and Rehabilitation, 2006; 87(1): 76-81.
15. Furman, JM., Whitney SL. Central Causes of Dizziness. Physical Therapy, 2000; 80 (2): 179-187
16. Herdman, SJ. Advances in the Treatment of Vestibular Disorders. Physical Therapy, 1997; 77:602618.
17. Herdman SJ. Vestibular Rehabilitation. 3rd Edition. F.A. Davis Co. Philadelphia PA. 2007.
18. Jacob, R. G., Woody, S. R., Clark, D. B., Lilienfeld, S. O., Hirsch, B. E., Kucera, G. D., Furman, J. M., &
Durrant, J. D. Discomfort with space and motion: a possible marker of vestibular dysfunction assessed by
the Situational Characteristics Questionnaire. Journal of Psychopathology and Behavioral Assessment,
1993; 15 (4), 299-324.
19. Peterka RJ. Sensorimotor Integration in Human Postural Control. J of NeuroPhysiol, 2002; 88 (3):
1097-1118 20. Umphred DA. Neurological Rehabilitation. 6th Edition. Elsevier Mosby. St. Louis MO. 2013.
21. Wrisley DM, Marchetti GF, Kuharsky DK, Whitney SL Reliability, internal consistency, and validity of
data obtained with the functional gait assessment. Phys Ther. 2004; 84(10): 906-918