LEND Capstone. Kaley Ortiz

Transcription

1 LEND Capstone Kaley Ortiz

2 Youth Concussion Management Rest vs light activity Personal journey/significance Literature Review (no IRB) dual credit PT program Acknowledgements Sandra Heimerl, PT Tiffany Enache, PT KJPLR9Hs

3 In the United States alone, 1.6 to 3.8 million individuals experience a sport-related concussion, or minor traumatic brain injury, every year. Concussion Initial impact of concussion (coup) Secondary impact (contrecoup) Representing 8.9% of all high school athletic injuries

4 TBI is a leading cause of death and disability NORMAL AXON SHEARING OF AXON POST-TRAUMA CONDITION Myelin sheath ---- Nucleus in --=r::~..,----- cell Arter 2013 STUDIOS IN( Forces applied to brain cause axons to twist and tear Neuronal (brain cell) death results

5 In a national survey of 2,2012 American adults 9/10 respondents couldn t identify a concussion correctly 9/10 consider it a moderate to severe health concern 32% of parents live in fear that their child will sustain a concussion 1/4 parents forbid their children to play contact sports because of this fear

6 Concussion Symptoms (PCS) Physical Balance and vision changes Migraines/headache Pain in neck and shoulders Cognitive changes Poor concentration Psychosocial Depression / Sadness Emotional stress Anxiety, irritability Decreased self-image Disruption from school

7 Background WHO guidelines Cognitive Rest Attention, memory, concentration (schoolwork, video games, phone use) Physical Rest Avoid heavy lifting, housecleaning, working-out Avoid sport activity or re-injury possibilities Side-lining adolescents until the point of being asymptomatic Lack of evidence/ rat research Review body of evidence

8 Methods: Literature Review PubMed, CINAHL, Web of Knowledge, Cochrane, and The Journal of Pediatrics P I C O Patient Intervention Comparison Outcomes Adolescents age post acute concussion Light activity Absolute rest Duration/severity of symptoms Performance on neurocognitive testing IMPACT

9 Results 8 studies, 7 retrospective studies, 1 literature review Medical charts, self-reports activity and self reported symptoms impact and symptom severity scale Balance Reaction time Verbal and visual memory and learning Speed of information processed

10 Results Absolute rest did not show better outcomes Too much (moderate-heavy) activity is worse for outcomes 2 studies showed rest rx showed prolonged symptoms (>30 days) Light activity (jogging, walking) to symptom threshold showed faster recovery Concussion recovery is gendered Females prolonged recovery

11 Summary Conservative recommendations 1-2 days rest Initiation of light activity Personal opinions on graded return to play Bans on headers in certain age ranges

12 We need to get the message out, that exertion provided it's very well gauged, very well monitored, and injected at the proper sequence of the recovery phase can play a key role in returning people who've been concussed to full participation in their daily lives. Tim Rylander, PT

13 Relevance to LEND & learning experience Staying updated on current literature, questioning current best practice Role of clinicians in patient advocacy Roles/responsibilities in multi-disciplinary team

14 Resources Reis E. "Beyond Rest: Physical Therapists And Concussion Management". Apta.org. N.p., Web. 02 March Johnson RS, Provenzano MK, Shumaker LM, Valovich-McLeod TC, Bacon CE. The Effect of Cognitive Rest as Part of Post-Concussion Management for Adolescent Athletes: A Critically Appraised Topic. J Sport Rehabil Aug 24:1-17. Halstead ME, Eagan Brown B, McAvoy K. Br Cognitive rest following concussions: rethinking 'cognitive rest'. J Sports Med Sep 15. pii: bjsports doi: /bjsports Carroll LJ, WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med, 36 (43 Suppl) (2004), pp Annesi JJ. Correlations of depression and total mood disturbance with physical activity and self-concept in preadolescents enrolled in an after-school exercise program. Psychol Rep. 2005;96(3 Pt 2):