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Concussions: Classification and management

Updated: Dec 8, 2019

Concussions have garnered much attention in the past few years with many headlines about professional athletes who have suffered from post concussion syndrome and have had difficulty recovering. A concussion is a traumatic brain injury that is a result of having external forces placed on the head or body. Post concussive signs and symptoms typically resolve in a relatively short period of time with conservative management. However, on occasion, symptoms remain for weeks, months and even years.

In 2015, a group of researchers came up with an evidence-based classification system for three types of post concussive disorders. With the classification system also came some direction for managing these different types of post concussive symptoms.

Classification of Concussions

Physiologic Post Concussion Disorder

Definition: persistent symptoms caused by alterations in brain metabolism

Symptoms: headache made worse by physical and cognitive activity, nausea, photophobia/phonophobia, dizziness, fatigue, difficulty concentrating, slowed speech

Signs: Elevated resting HR, limited graded treadmill test*

Management: sub-symptom graded exercise program

*Graded treadmill test has been shown to be safe for adults with concussion symptoms persisting longer than 3 weeks.

HR and RPE are measured each minute; incline is increased until max exertion is achieved (18-20 RPE on Borg scale) or symptom onset or exacerbation.

Exercise is prescribed at same duration as achieved on the treadmill test at 80% of max HR achieved on test 1x/day 5-6x/week.

Vestibulo-ocular Post Concussion Disorder

Definition: symptoms caused by dysfunction of vestibulo-ocular system

Symptoms: dizziness, vertigo, gait instability, blurred or double vision, difficulty tracking objects, headache made worse with reading

Signs: balance and gait impairments, impairment in VOR, saccades, smooth pursuit

Management: vestibular rehabilitation, VOR retraining

Cervicogenic Post Concussion Disorder

Definition: symptoms caused by poor c/s proprioception

Symptoms: neck pain, occipital headaches, postural imbalance

Signs: restricted c/s ROM, PAVMs, muscle tightness, poor proprioception

Management: manual therapy, c/s proprioceptive retraining, VOR retraining

The management of concussions at Waterloo Sports Medicine Centre is a collaborative, multi-disciplinary approach involving sports medicine doctors, physiotherapists, registered massage therapists and naturopathic medicine. The goal of WSM is to ensure that every concussion patient has the highest probability of safe return to sport, play and normal daily activities.

The above information can be found in the following article

Ellis, M, Leddy, J, Willer, B (2015) Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: An evidence-based classification system with directions for treatment, Brain Injury, 29:2, 238-248.

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