Physical therapists and physical therapist assistants have a critical role to play in the care of people who've experienced traumatic brain injury and mild TBI, including concussion. In recognition of March as Brain Injury Awareness Month, here's a quick look at some of the brain injury-related resources available through apta.org, as well as quick roundup of notable recent research.
Resources Available Through apta.org
Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury
This clinical practice guideline provides a set of evidence-based recommendations for PT management of patients who have experienced a concussive event.
Traumatic Brain Injury in Civilian and Military Populations
APTA produced this clinical summary, which includes sections on classification, screening, examination, diagnosis, prognosis, and intervention.
Rivermead Post-Concussion Symptoms Questionnaire
This self-report or clinician-administered questionnaire measures severity of 16 postconcussive symptoms.
Sport Concussion Assessment Tool 3 and Child SCAT3
The SCAT3 is used to assess concussions in athletes 13 year or older; the Child SCAT3 is aimed at athletes five to 13 years old. The adolescent test measures across eight areas; the Child SCAT3 includes nine subcomponents.
Dizziness Handicap Inventory for Traumatic Brain Injury
This 25-item self-assessment is designed to measure self-perceived effects imposed by dizziness.
Recent Research
Does a SNF's Location Make a Difference in Discharge to Community After TBI?
This study looked at the progress of 61,000 Medicare beneficiaries with TBI who were discharged from hospitals to nearly 12,000 skilled nursing facilities across the country. Researchers found that rates of discharge from the SNF to the community within 100 days after SNF admission were about 52.1% for patients in rural settings, compared with 58.5% for patients in urban settings. Authors of the study call for "further research to explore interventions and improve SNF care and discharge planning" for SNF patients with TBI in rural settings. ("Rural/urban differences in discharge from rehabilitation in older adults with traumatic brain injury," Journal of the American Geriatrics Society, abstract only available for free)
Toward a Map of Clinical Reasoning for Selection of Assistive Walking Devices
Authors of this study say they've taken the first steps toward creating a "complete description" of the physical therapist clinical reasoning behind the choice of a particular walking assistive device to aid in rehab of patients with stroke and brain injury. Though the full description has yet to be developed, this study found a high level of complexity in the clinical reasoning process. That process factors in not only patient characteristics such as balance, cognition, and strength, but the therapist's own experiences and familiarity with objective goals. ("Every person is an individual: physical therapist clinical reasoning used in inpatient rehabilitation for walking assistive device prescription in patients with stroke and brain injury," Disability and Rehabilitation: Assistive Technology, abstract only available for free)
Using a Team Approach to Postconcussion Diagnoses and Care
More support for multidisciplinary approaches to care: An analysis of 57 pediatric patients seen for evaluation and management of postconcussion syndrome in a multidisciplinary care clinic found that patients tended to receive a high number of treatable diagnoses. The more robust diagnosis patterns led to increased access to appropriate interventions including physical therapy, and helped to speed up recovery, according to authors. Clinical evaluation included neurology, sports medicine, otolaryngology, optometry, ophthalmology, physical therapy, and psychology. ("Specialty-Specific Diagnoses in Pediatric Patients With Postconcussion Syndrome," Clinical Journal of Sport Medicine)
Evaluation of Potential Victims of "Directed Energy" Attacks
You may remember it from the news: In 2016, personnel working at the U.S. Embassy in Havana, Cuba, began reporting a variety of neurological ailments that couldn't be explained. Other government officials in Russia and China previously reported similar symptoms, which U.S. officials now believe were the result of microwave attacks. This article takes a deeper look at the effects of so-called "directed energy" attacks in order to provide guidance for conducting a vestibular physical therapist evaluation for potential victims of the attacks. The recommendations from the report include an emphasis on open-ended questions, attention to whether the peripheral vestibular apparatus have been affected, and attention to vestibular and central nerve pathways. ("Vestibular Physical Therapy Evaluation of Individuals Exposed to Directed Energy," Military Medicine)
The Cost of Concussion
What are the direct health care costs of treating a high school football player with a concussion? About $800, say authors of this article, which tracked 144 male high school football players diagnosed with concussion. The largest costs — $687—were associated with emergency department or urgent care evaluations, used by 27.8% of the athletes studied. Physical therapy was linked to an average per-patient cost of $481, but its was used by only 2.8% of the study group. ("The cost of a single concussion in American high school football: a retrospective cohort study," Concussion)
Tracking Adolescents' Self-Perceptions About Recovery From Concussion
"There is a significant gap between medical determination of recovery and what patients understand as recovery" — that's how authors of a qualitative study of seven adolescents describe what they found when they explored that adolescents' own perceptions of life after a concussion. Over the course of two semi-structured focus groups, researchers found that "Adolescents do not feel 'recovered' more than a year after they are clinically assessed as 'good to go.'" Their recommendation: increased "follow-up and support from a multidisciplinary health care team." ("Loss and recovery after concussion: Adolescent patients give voice to their concussion experience," Health Expectations)
