Concussion Rehabilitation

June 27, 2016

Concussion Management and Treatment in Edmonton

Post-concussion Syndrome (PCS)

Post-concussion syndrome (PCS) can develop after a single injury. Broadly defined, the hallmarks of PCSinclude prolonged fatigue, headache, dizziness, irritability, insomnia, and difficulty with concentration or memory, as well as intolerance to cardiovascular exercise.

The standard of care for PCS has been to rest, both from physical and cognitive activity, until symptoms are resolved. But recent research suggests rehabilitation as an effective way to address the potentially life-altering consequences of a concussion.

Rehabilitation Evaluations

Evaluations include a thorough assessment of the whole athlete, with special consideration given to aerobic exercise tolerance, whiplash-like cervical spine dysfunction and problems with vision and balance. Graded exercise testing combined with a thorough examination can help properly classify the impairments underlying PCS. Since no two patients are identical, classification allows for a refined approach to identifying each patient’s specific deficits and can lead to more appropriate treatment.

Treating Post-concussion Syndrome

Treatment is specific to each patient but often includes elements of closely monitored sub-symptom aerobic exercise, manual therapy and therapeutic exercise for spinal dysfunction, visuomotor retraining and balance impairment. Progressive aerobic exercise has been shown to be safe and effective in improving function in patients with PCS.

Most patients are prescribed an exercise program to be performed five to six days per week, with close monitoring of exercise intensity using a heart rate monitor. Exercise intensity is determined during the evaluation, and maintained at sub-symptom levels. Cervical range-of-motion, eye movement and balance exercises may be prescribed, as well.

As patients make progress, rehabilitation programs are fine-tuned to meet the demands of returning to full function in daily life and sport. Additionally, elements of injury prevention, such as cervical strengthening exercises, are incorporated as individuals return to pre-injury activities.

Concussion Testing

Concussions can occur in any sport, recreational activity or accident.  All coaches, parents, and athletes need to learn concussion signs and symptoms and what to do if a concussion occurs.  At Next Step physio and concussion clinic, we offer complete Baseline Concussion Testing and a Return to Play Protocol.  We are available to assist you in recognizing the signs and symptoms of concussion and guiding you in the proper treatment and care of your injury.  Our program is overseen by our talented team of health care professionals with extensive knowledge in the field.

Why Baseline Concussion Testing?

Baseline testing is when objective measures of balance, reaction time, memory, and cognitive function are established.

Every athlete’s baseline concussion scores are unique and cannot be compared to average population results. It is therefore important to have your own objective baseline measure established before an injury occurs.

If an injury occurs the baseline tests are repeated and the results are compared to your unique baseline scores.

Without this comparison, athletes are at risk of returning to regular activities prior to full recovery. This may prolong their recovery or possibly result in permanent neurological damage.

Baseline testing takes approximately 45 minutes. Arrangements for larger groups can be made (approximately 4 athletes per hour).

The online portion of the testing must be done in a quiet environmentwith no distractions – instructions will be given on how to complete this in an ideal environment (usually at home).

Please note that a baseline should be administered on an annual basis.

Why monitor Return-to-Play?

Should an athlete sustain an injury, it is important to implement the appropriate Return to Sport protocol (whether a baseline has been conducted or not). The player is put through a series of incremental tests, which are compared to their baseline test results to determine their level of recovery.

A common belief is that the absence of symptoms indicates a full recovery, when in-fact, being symptom free is only the first stage of recovery. This misconception results in many athletes returning to play far too early. Without a gradual and supervised protocol the athlete may experience a prolonged recovery and is in danger of suffering further and potentially life-long neurological impairment.

The stages of returning to play are:

  1. Complete physical and cognitive rest until symptoms resolve
  2. Light aerobic exercise, no resistance training
  3. Sport-specific exercise
  4. Non-contact training drills
  5. Full contact practice
  6. Return to play once the athlete has received medical clearance .

An athlete may only progress to the next level if they are asymptomatic for 24 hours at the current level. At Next Step Physio , our initial assessment uses standardized assessment protocols such as the ImPACT test and the SCAT-3 to identify how the disturbances in brain function caused by your concussion are affecting your athletic performance.

We look at:

  • Neck strength and biomechanics
  • Balance and position sense
  • Reflexes
  • Coordination
  • And other physical and neurological indicators of injury

After your assessment, we’ll work with you to develop a rehab plan to ensure you maintain your fitness and sport-specific skill set as you recover, and minimize your risk of re-injury.

Treatment and prevention includes:

  • Subsymptom threshold cardiovascular training
  • Neck strengthening
  • Balance and position sense retraining
  • Sport-specific awareness and education
  • Equipment review
  • Neuropsychological Assessment and training.

Concussions are complex injuries and are different for each athlete. It’s important to have a recovery plan specific to your needs. The team at Next Step Physio has the experience to work with you to maximize your recovery, and we look forward to working with you to get you feeling better and staying active.

Our Team:

  • Physiotherapist.
  • Chriopractor
  • Neuropscyhologist
  • Vestibular therapist.

About Dr. Kimberly BrodeurR.Psych

Clinical Psychologist | Neuropsychologist

  • Kimberly Brodeur is a Clinical Psychologist & Neuropsychologist working out of the Whyte Avenue Wellness Centre. After graduating with a B.Sc. from the University of Alberta, she obtained her Masters and Doctorate degrees at Pacific University in Portland, Orgeon with training at Legacy Good Samaritan Rehabilitation Hospital and Oregon Health and Sciences University (OHSU). She completed an accredited internship in the Faculty of Medicine at the University of Manitoba and became a registered member of the College of Alberta Psychologists.
  • Brodeur has seven years experience working at the Glenrose Rehabilitation Hospital where she provided neuropsychological assessment for individuals affected by brain injury or dysfunction. She helped develop and co-facilitate a biweekly cognitive rehabilitation group for stroke and brain injury survivors. She also provided psychotherapy to individuals adjusting to illness or injury, such as brain injury, stroke, amputation, chronic pain, and other medical and neurological disorders.
  • Brodeur specializes in neuropsychological assessment and rehabilitation psychology. She has experience working with individuals coping with psychiatric, medical, and neurological conditions, such as brain injury and concussion, Attention-Deficit/Hyperactivity Disorder (ADHD), dementia, learning disabilities, and Fetal Alcohol Spectrum Disorders (FASD).
  • Brodeur integrates various therapeutic techniques into her work, including cognitive-behavioral therapy and mindfulness training. She provides treatment for depression and anxiety, stress, anger, chronic pain, addiction, and adjustment to illness or injury. Always emphasized are individual strengths and improving overall health, quality of life and well-being.