Assessment & Management of Concussion & Mild Traumatic Brain Injury
Presented by lead researcher Dr Barry Willer (USA Psychologist) and Dr Julia Treleaven (Australian Physiotherapist), both have a wealth of research and clinical skill to help you understand the best methods to assess and manage clients post-concussion.
Introduction to the Physiology of Concussion
This opening session introduces the audience to the return to play guidelines of international consensus group and provides a brief description of the history behind the guidelines. Participants will learn that the guidelines indirectly provide a definition of recovery of a concussion that points to exercise tolerance as a key factor. The audience is then provided with evidence of dysregulation of the autonomic nervous system including elevated heart rate at rest and decreased cardiac output during exercise. Exercise intolerance is then linked to dysregulation of cerebral blood flow. The relevance of these physiologic changes to symptoms reported by patients will be explained.
- Participants will be able to describe the stages of the consensus guidelines on return to play.
- Participants will be able to identify sympathetic and parasympathetic autonomic nervous system changes that accompany a concussion.
- Participants will know the impact of physiologic changes on individual functioning including exercise tolerance and sleep pattern.
- Participants will be able to describe the key components of the metabolic cascade that accompanies a concussion.
Assessment of Exercise Tolerance and Development of a Treatment Plan
This session will provide participants with a description of the Buffalo Concussion Treadmill Test (BCTT). Video based case examples will be used to highlight the behavioural characteristics of symptom exacerbation. Participants will also hear how assessment can occur using a stationary bike, and learn how the stationary bike assessment differs from the BCTT. We will also describe how and why an exercise prescription is achieved using the symptom exacerbation threshold. Follow-up procedures to adjust the exercise prescription will also be described.
- Participants will be able to describe the process for evaluation of exercise tolerance using the BCTT.
- Participants will be able to identify the circumstances under which the BCTT is not recommended, and when to use a bike protocol.
- Participants will know the theory behind the use of aerobic exercise to speed recovery and how to prepare a safe prescription for exercise.
- Participants will be able to define full recovery from a concussion.
This short video is a good case study of the unique approach that you will learn.
Key Elements of a Physical Examination
This session focuses on the physical examination of the patient with a concussion. It is recommended that a medical doctor conducts the physical examination. It is suggested that a nurse or physical therapist conduct part of the exam including assessment of orthostatic imbalance. The physical examination itself should include three components: neck exam, oculomotor performance assessment and balance or vestibular assessment. Participants will see recent data on the diagnostic and prognostic usefulness of physical examination elements. The discussion will then focus on differential diagnosis using information from the test of exercise tolerance and the physical examination.
- Participants will be able to describe the relevance of orthostatic balance to disruption of the autonomic nervous system.
- Participants will be able to identify key elements of the initial examination including preliminary examination of cervicogenic, oculomotor and vestibular performance.
- Participants will know what physical examination elements might get worse with time.
- Participants will be able to describe the basic subtypes of post-concussion disorders: physiologic, cervicogenic, oculomotor and vestibular.
Assessment and Treatment of Cervicogenic, Oculomotor and Vestibular Disorders
The focus of this session is the screening, evaluation and treatment of the group of patients that the medical doctor perceives as having issues beyond physiologic concussion. This would include patients who have difficulty with their neck due to an accompanying whiplash, and/or issues with oculomotor performance, and/or vestibular dysfunction. We will present the theory on why these issues may accompany concussion but the emphasis will be on careful examination by a physical therapist. Video examples of assessment procedures will be presented. Treatment of each disorder type will also be described following the principle that given the complex interaction between these systems it is better to treat the most likely disorder first and treat other disorders if recovery is incomplete.
- Participants will be able to complete the assessment of cervicogenic proprioception.
- Participants will be able to identify key elements of the examination of vestibular performance.
- Participants will know how to assess oculomotor performance.
- Participants will be able to describe the neurological basis for coordination of cervicogenic proprioception, vestibular performance and oculomotor function.
FAQ and Wrap-up
This session will address a variety of issues associated with concussion assessment and treatment that are frequently raised in our seminars. We will discuss psychological and social issues that frequently accompany a concussion. We will talk about the value of preseason assessment, highlighting the issues associated with computerised neuropsychological assessment. Return to play will be discussed as part of the overall return to activity including the return to work, return to learn and return to duty. A frequently asked question is the relationship of concussion to mild traumatic brain injury, which we will discuss in terms of theory and practice. The perception of concussion as a physiologic disorder suggests that concussion is best managed in an interdisciplinary clinic with a medical doctor in the lead. We will discuss various aspects of clinic management and provide participants with useful forms for recording assessments.
- Participants will be able to describe the relationship of the physiological model to the overall management of assessment and treatment.
- Participants will be able to identify the essential components of baseline assessment.
- Participants will be able to describe various psychological effects that may interfere with recovery from a concussion.
- Participants will be able to knowingly discuss the critical factors in return to school following a concussion.
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