What Kind of Physical Therapist Do I Need to Manage My Concussion?

For the first time in 8 years the American Academy of Pediatrics (AAP) revised the recommendations on pediatric sports-related concussions. This makes it important to find a healthcare professional who is up to date with updated concussion management guidelines. Concussions in children are a rapidly growing public health concern since over the past decade there has been a marked increase in the number of emergency department visits.

Concussions often occur along with other injuries, such as those to the neck and surrounding area, which should be managed by a licensed physical therapist. More serious brain injuries may also occur and require the immediate care of a medical doctor, such as a sports medicine doctor or neurosurgeon. It is important to seek medical treatment from a health care provider, such as a physical therapist, immediately following any head injury. Only health care providers have the knowledge and training to diagnose a concussion in the maze of symptoms that can occur following a head injury.

Concussion Symptoms:

A concussion is a brain injury; patients living with a brain injury often cannot articulate how they feel following the injury. Therefore, it is critical to work with a physical therapist who takes time to get to know you, your family, teammates, and/or coworkers who may notice any changes in you.

There are many symptoms related to concussion that can affect your physical, emotional, and mental health. Some symptoms show immediately, some after the injury, and some arise up months or years after a concussion.

Immediate and short-term symptoms

Physical symptoms of a concussion can include:

• Headache

• Dizziness

• Difficulty with balance and coordination

• Nausea/vomiting

• Fatigue

• Difficulty sleeping

• Increased sleepiness

• Double or blurred vision

• Sensitivity to light and sound

• Slurred speech

• Glassy-eyed stare

• Seizures

Cognitive (thinking) symptoms can include:

• Difficulty with short-term or long-term memory

• Confusion

• Slowed "processing" (eg, a decreased ability to think through problems)

• "Fogginess"

• Difficulty concentrating

• Worsening grades in school

Emotional symptoms can include:

• Irritability

• Restlessness

• Anxiety

• Depression

• Mood swings

• Aggression

• Decreased tolerance of stress

• Change in personality or behavior

Longer-term symptoms

• Loss of libido

• Loss of menses/menstruation

• Growth problems (children)

• Fatigue

• Weight gain

• Low blood pressure

• Muscle weakness

• Chronic headaches or dizziness

• Muscle spasticity

• Early dementia/chronic traumatic encephalopathy (brain disorder)

Some concussion symptoms do not go away in the expected time frame. These symptoms may need further testing and treatment by a team of health care providers, including a physical therapist.

Diagnosing

Concussion is most often diagnosed through careful testing by your health care provider, such as a physical therapist. Unfortunately, no single test or tool exists to diagnose a concussion. The diagnosis usually does not rely on hi-tech testing, such as an MRI or CT scan, because brain scans often do not show any brain abnormality, even when the person has symptoms of a concussion. The American Academy of Pediatrics’ recommends that Neurocognitive testing should not be the only tool used to make a return-to-play decision. Your physical therapist will ask you many questions to understand all of the symptoms that you are experiencing. They also will perform many tests to determine problems caused by a concussion, including muscle strength, coordination, balance, sight, smell, hearing, and memory tests.

• During treatment, your physical therapist will repeat the same questions and tests often to gauge your progress and help determine when you can return to work, school, sport, or recreational activities. Your physical therapist may also examine your neck for problems following a concussion. Neck injuries often occur at the same time as concussions, and can cause or escalate headaches and dizziness. If you lost consciousness during the concussion, the AAP recommends that health Providers should assume that an athlete who remains unconscious after a head injury also has suffered a neck injury.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:

• A physical therapist who is experienced in treating people with post-concussion issues. Some physical therapists have a practice with a neurological or vestibular rehabilitation focus.

• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship. This physical therapist has advanced education, experience, and training that may apply to your condition.

Physical therapists have a critical role in concussion prevention and management. Finding the right physical therapist is critical to your recovery from any injury.

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