Completing the Loop: Management of the Adolescent Sports Injury. Marisa Frank PT, DPT, CSCS

Transcription

1 : Management of the Adolescent Sports Injury Marisa Frank PT, DPT, CSCS

2 OBJECTIVES Describe patients who are appropriate for physical therapy. Demonstrate an understanding of the phases of concussion rehabilitation. Describe proper exercise progression to ensure complete concussion recovery for return to play. Describe concussion risk reduction exercises.

3 Injury On-field management See MD (In ED or PCP) Rest and reduction of stimuli Full recovery Average resolution of symptoms: 7-14 days 80% of concussions*

4 Takes a combination of: Creating balanced routine of activity and rest Home and academic accommodations to assist with stimuli management Creating good sleeping habits. and if an individual continues to have trouble recovering, they may benefit from physical therapy.

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7 Symptom and stimuli management to produce most optimal healing environment for the brain

8 Education and communication on stimuli management and recovery Cervical management Vestibular/oculomotor training Balance training Exertion/sport-specific training Risk reduction exercises

9 Concussion Recovery Team: Student/Athlete Parents/Family Physician Teachers/School Faculty Physical therapist Coaches Athletic trainer (Friends) All should be involved & updated throughout the recovery process.

10 Promote them to take an active approach to their recovery Normalize a sleep schedule Staying hydrated Fueling their body with proper nutrition Take medications/vitamins same time every day Regular activity and rest should be scheduled, as tolerated.

11 Symptoms HA Cervical/thoracic pain Dizziness Assessment Soft tissue integrity ROM, MMT Proprioception Ligament stability Postural assessment Differential Diagnosis: Cervicogenic HA or dizziness Occipital neuralgia Migraines Treatment Joint mobility Stabilization (deep flexors) Periscapular strengthening

12 Symptoms Dizziness Lightheadedness Vision disturbances (diplopia, blurry vision etc.) Loss of balance Assessment: Smooth Pursuit VOR I Convergence Saccades Dix-hallpike test Optokinetic sensitivity Sway Balance app Treatment Habituation exercises Neuromuscular re-education Epley Manuver Functional vestibular and balance training

13 Smooth Pursuit Saccades VOR I Convergence

14 VOR Cancellation/ Optokinetic sensitivity Stationary/Dynamic Visual Acuity Test Benign Paroxysmal Positional Vertigo

15 Assessment BESS test Gait assessment Sway Balance App Treatment Proprioception training Core strengthening Vestibular/oculomotor training functional training

16 Cardio Start with min. stimuli with minimal positional change then progress as symptoms allow. (i.e. stationary bike > running) Continue to challenge balance, reaction times, endurance and progressively increase stimuli, oculomotor and vestibular involvement.

17 Non-contact, sport specific training Longer periods of high cardio exercise Be sure to stress oculomotor, vestibular and balance demands of the sport Usually transition to athletic trainers at this time

18 Postural muscle stability training Neck (deep flexors), back (periscapular) and core (transversus abdominus) strengthening Coordination and balance exercises

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21 Vestibular Rehab after concussion reported improvement in symptoms, balance and gait. (Alsalaheen, Mucha et al.) Vestibular and musculoskeletal treatment of the c- spine resulted in reported improved symptoms and sooner return to play (70%) (Schneider, Meeuwisse et al.) Pilot study for cervical strength in high school study (Collins, Cantu et al.) Pilot study of graded exercise in patients with post-concussion syndrome reported decreased symptoms and imaging demonstrated improved cerebral blood flow (Leddy, Cox et al.)

22 Questions?

23 Alsalaheen, Bara A. PT, MS; Mucha, Anne PT, MS, NCS; et al., Vestibular rehabilitation for dizziness and balance disorders after a concussion. Journal of Neurologic Physical Therapy. 34(2):87-93, June Christy L. Collins, et al., Neck Strength: A Protective Factor Reducing Risk for Concussion in High School Sports. J Primary Prevent. 15 June Covassin, T., P. Schatz, and C.B. Swanik, Sex Differences in Neuropsychological Function and Post-Concussion Symptoms of Concussed Collegiate Athletes. Neurosurgery, (2): Daneshvar, D.H., et al., The Epidemiology of Sports-Related Concussion. Clin Sports Med, (1): Guskiewicz, K.M., S.E. Ross, and S.W. Marshall, Postural Stability and Neuropsychological Deficits after Concussion in Collegiate Athletes. J Athl Train, (3): McCrory, P., et al., Consensus Statement on Concussion in Sport: The 3 rd International Conference on Concussion in Sport Held in Zurich, November J Athl Train (4): Meehan, W. Kids, Sports and Concussion: A guide for Coaches and Parents. Santa Barbra:Prager:2011. Mihalik, J.P., et al., Collision Type and Player Anticipation Affect Head Impact Severity Among Youth Ice Hockey Players. Pediatrics, (6): Tierney, R.T., et al., Gender Differences in Head-Neck Segment Dynamic StabilizationDuring Head Acceleration. Med Sci Sports Exerc, (2):