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The Road to Recovery After a Concussion

Updated: Jan 20, 2023

BrainPlus™ is a comprehensive concussion management program unique to California Therapy Solutions and offered in conjunction with preferred partners and providers, select athletic organizations, and school systems in the Orange County area.

After a suspected concussion, clinicians at CTS can be accessed immediately for follow-up testing. This testing is completed in advance of seeing a physician and allows the clinician to compare post-injury data with baseline measures previously collected. This information is then shared with the physician to support diagnostic decision-making and the creation of an effective treatment plan. After the diagnosis is made, CTS will provide individualized care and rehabilitation for patients with concussions. Utilizing the latest clinical evidence, guidelines for best practices for physical therapy, and evidence-based technologies to provide a unique, world-class approach to the recovery process. CTS clinicians will also work closely with other providers to communicate progress and readiness for return to classroom activities and sports.

Some of the treatments your physical therapist may utilize in your recovery program include the following:

Cardiovascular Exertional Training: Our physical therapists will guide you through the Buffalo Concussion Treadmill (or Bike) Test to evaluate your cardiovascular threshold at time points linked to symptom increase. Throughout the test, your heart rate and concussion symptoms will be monitored. Every minute of the test, the patient will report their concussion symptoms on a scale of 1-10 with the four measured symptoms being headache, dizziness, fogginess, and nausea. The physical therapists will track your reported symptom level to determine what your sub-maximal cardiovascular threshold is and if/when the test should be terminated. The sub-maximal threshold is the maximum heart rate at which you may perform aerobic exercises to prevent over-exertion while still benefitting from cardiovascular training for your concussion recovery.

Cognitive Fatigue Monitoring and Accommodations: The prominence of this symptom dimension is measured via a questionnaire, and this defines its contribution relative to each of the symptom areas. Cognitive Fatigue is best monitored with a symptom log where the intensity of symptoms is rated on a scale of 1-10, and treated through cognitive loading in the clinic and at home. The most important guideline in this effort is to rest when a 3-point symptom increase occurs (i.e. from a 2 to a 5).

Vision Therapy and Training: 90% of the circuitry in the brain plays some role in vision. As such, deviations in visual tracking provide insight into the general well-being of the mind and the presence or absence of a concussion. With infra-red diagnostic equipment, we are able to detect deviations from normal eye-tracking performance. With this information, we can select the types of eye-tracking most affected by a given person's injury, and address them.

Vestibular System Habituation and Training: The Vestibular system consists of the Inner Ear as well as the brain structures with efferent (message sending) and afferent (message receiving) connections to the inner ear. This system is responsible for our sense of equilibrium, and immediate adjustments to loss of equilibrium. Dysfunction in the Vestibular System can commonly arise following concussion.

This can happen due to calcium crystals being dislodged within the inner ear, and or by the mechanism of neural-pathway disruption common to all concussions. To review the latter pathway, common concussive disruption is caused by shear forces exerted across the neural tissue in the brain. This shear force interrupts the functioning of neural membranes, and by extension, the neurons’ ability to transmit impulses. Poor neural transmission results in the myriad cognitive, visual, and proprioceptive deficits that are common to concussion.

Alternatively, if a patient’s vestibular dysfunction is rooted in calcium crystal dislodgement, the problem lies in excess stimulation to the inner ear’s semicircular canals. These canals are filled with liquid, and as our body moves this liquid moves across motion-sensitive hair cells in the canals. When calcium crystals break free in the semicircular canals, they rub against the hair cells and create an additional motion sensation. The term for this version of vestibular dysfunction is Benign Paroxysmal Positional Vertigo (BPPV) which is the dizziness symptom that many people experience during a concussion.

In either mechanism, Vestibular information about positioning in space becomes deceptive and causes a sense of dizziness or vertigo. In the case of BPPV, there is a simple maneuver where gravity is used to permanently guide the crystals out of the Inner Ear. Most commonly, this is called the Epley Maneuver; the fix can be as simple as training the patient's neuronal pathway.

Multi-Sensory Integration: The use of the Senaptec in your concussion rehabilitation program will enable you to train in the integration of multiple sensory inputs. You may be challenged to complete tasks that involve your balance, eye-tracking, problem-solving, auditory response, or a combination of the previous as a means of training your ability to integrate multiple sensory inputs. The Senaptec Sensory Station will train 10 different sensory parameters in one session and will track your progress. This allows for individualized care and provides an easy measurement of your progress.

Cervical Manual Therapy: This intervention is important in cases where the neck has been strained. The three basic ways this affects concussion are the generation of suboccipital tension, disruption of cervical proprioception, and generation of upper-quarter distress. The suboccipital muscles are small muscles at the back side of the neck that reside at the base of the skull. Tension in these muscles can come from whiplash and can cause headaches which may progress to migraine headaches.

Cervical whiplash during a concussive event can also disrupt proprioception. In the case of whiplash, the cervical joints, are stretched/sprained. The spraining of the ligaments results in less tension across cervical joints during a given amount of head motion. For instance, turning your head 30 degrees after a whiplash-related concussion might feel like 15 degrees. This not only creates a strange mismatch in the perception of movement but also can lead to dizziness and vertigo.

The last negative effect that whiplash can bring to concussion is increasing tension in all the muscles that extend between the shoulder blade and the neck. This is painful and results in pain with shoulder and neck movements. To alleviate these negative symptoms, the therapist may use their hands to release tension in the neck muscles, this method is called cervical manual therapy.

Sport-Specific Integration: As you progress toward the end of your program, your physical therapist can integrate some sport-specific activities to assess your concussion symptoms with activities that you may commonly do in your sport. This can include running, footwork drills, and more, depending on the patient's individual needs.

We provide concussion rehabilitation at four of our five locations: Costa Mesa, Newport Beach, Huntington Beach, and Irvine.

If you have a concussion and would like to start your road to recovery, you can request an appointment on our website!

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