Multimodal impairment-based physical therapy for the treatment of patients with post-concussion syndrome: A retrospective analysis on safety and feasibility.
OBJECTIVE
Demonstrate implementation, safety and feasibility of multimodal, impairment-based physical therapy (PT) combining vestibular/oculomotor and cervical rehabilitation with sub-symptom threshold exercise for the treatment of patients with post-concussion syndrome (PCS).


METHODS
University hospital outpatient sports medicine facility.


METHODS
Twenty-five patients (12-20 years old) meeting World Health Organization criteria for PCS following sport-related concussion referred for supervised PT consisting of sub-symptom cardiovascular exercise, vestibular/oculomotor and cervical spine rehabilitation.


METHODS
Retrospective cohort.


METHODS
Post-Concussion Symptom Scale (PCSS) total score, maximum symptom-free heart rate (SFHR) during graded exercise testing (GXT), GXT duration, balance error scoring system (BESS) score, and number of adverse events.


RESULTS
Patients demonstrated a statistically significant decreasing trend (p < 0.01) for total PCSS scores (pre-PT M = 18.2 (SD = 14.2), post-PT M = 9.1 (SD = 10.8), n = 25). Maximum SFHR achieved on GXT increased 23% (p < 0.01, n = 14), and BESS errors decreased 52% (p < 0.01, n = 13). Two patients reported mild symptom exacerbation with aerobic exercise at home, attenuated by adjustment of the home exercise program.


CONCLUSIONS
Multimodal, impairment-based PT is safe and associated with diminishing PCS symptoms. This establishes feasibility for future clinical trials to determine viable treatment approaches to reduce symptoms and improve function while avoiding negative repercussions of physical inactivity and premature return to full activity.
University of Wisconsin Hospitals and Clinics, 621 Science Dr., Madison, WI 53711, United States; University of Wisconsin-La Crosse, Physical Therapy Program, 1725 State St., La Crosse, WI 54601, United States. Electronic address: pgrabowski@uwlax.edu.
Patrick
P
Grabowski
University of Wisconsin-Madison, School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, United States.
John
J
Wilson
University of Wisconsin-Madison, School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, United States.
Alyssa
A
Walker
University of Wisconsin Hospitals and Clinics, 621 Science Dr., Madison, WI 53711, United States.
Dan
D
Enz
University of Wisconsin-Madison, Department of Biostatistics, 600 Highland Ave., Madison, WI 53705, United States.
Sijian
S
Wang
D000293:Adolescent; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D061214:Patient Safety; D026741:Physical Therapy Modalities; D038223:Post-Concussion Syndrome / Q000534:rehabilitation*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
Cardiovascular exercise; Concussion; Mild traumatic brain injury; Physical therapy