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Teens with Concussion May Benefit from Earlier Physical Therapy

“Multimodal PT interventions administered by licensed physical therapists may be feasible and safe even within the first few weeks after injury to help facilitate prompt recovery and mitigate the onset of secondary effects from delayed treatment,” write Catherine Quatman-Yates, DPT, PhD, of The Ohio State University, Columbus, and colleagues. The study is part of a JNPTspecial issue on “Rehabilitation Management of Concussion,” highlighting research-driven changes geared toward promoting return to activity in young patients with concussion.

Similar Outcomes for Teens with Concussion Undergoing Earlier or Later physical therapy

The researchers looked how the timing of physical therapy affected the course of concussion-related symptoms in 120 adolescents: 78 females and 42 males, median age 14 years. Physical therapy was classified as early (beginning 0 to 20 days after concussion) in 27.5 percent of patients, middle (21 to 41 days) in 32.5 percent, and late (42 days or after) in 40 percent.

The PT program consisted of progressive exercise; vestibular/oculomotor training (targeting inner ear/balance and visual symptoms); and cervical spine manual therapy, stretching, and strengthening exercises. This multimodal treatment was delivered by licensed physical therapists with special training in concussion treatment.

Whether started earlier or later, PT led to similar reductions in concussion-related symptoms. Recent research has led to new insights into medical management of concussion in children and adolescents. Past guidelines recommended complete physical and cognitive (mental) rest after concussion, until symptoms resolved. But recent studies have suggested that resting for more than a day or two has limited benefits, and may even be linked to increased concussive symptoms.

Today, concussion management is shifting toward a shorter period of rest, followed by gradual return to usual activities, guided by the patient’s symptoms. Physical therapy has been recommended for adolescents with persistent symptoms of concussion, generally after three weeks.

Other articles in the special issue include a neuroscience perspective on the role of rest versus physical activity in recovery for young people with concussion, along with new research on changes in vestibular/oculomotor function and the role of balance testing after concussion.

Physical therapists can play a critical role in evaluating and choosing targeted interventions most likely to result in the best outcomes for patients with concussion, according to a Guest Editorial by Karen L. McCulloch, PT, PhD, NCS, and Kathleen Gill-Body, PT, DPT, MS, NCS, FAPTA. They write, “We are in an ideal position to continue our process of returning people to activities and roles that they care about…because it is what we do.”