Physical Therapy Interventions Utilized in Concussion Management: A Case Report

Background: A concussion is a mild traumatic brain injury (TBI) that can result from a direct or indirect blow to the head or body. Symptoms of a concussion generally include headaches, confusion, dizziness, nausea, and memory disturbance. Although most people recover from a concussion within a few weeks, some individuals continue to experience ongoing symptoms known as post-concussion syndrome (PCS). Proper diagnosis and management are crucial for preventing long-term consequences of a concussion. The purpose of this case report is to outline current evidence-based interventions that may be beneficial for concussion management in an outpatient physical therapy setting. Case Description: A 25-year-old Caucasian female was diagnosed with a work-related traumatic brain injury. The patient slipped on the stairs at work and hit her head anteriorly. Initially, she felt okay, but the next day she experienced bouts of nausea, fatigue, sensitivity to light and noise, mental fogginess, headaches, emotional volatility, visual vertigo, and dizziness. She attempted to return to work as a registered behavioral technician and was head-butted by a patient, worsening her symptoms. She was diagnosed with a traumatic brain injury with residual vestibular and physiological deficits. The patient’s primary goal for physical therapy was to return to her previous level of function and work full-time with no restrictions. Intervention: Physical therapy focused on minimizing concussion-related symptoms to help the patient return to her full-duty full-time workload. The patient’s plan of care incorporated sub-symptom threshold aerobic exercise, optokinetic training, and vestibular rehabilitation. Outcome Measures: The primary measures considered for this patient were the Buffalo Concussion Test and patient-reported concussion-related symptoms. The patient’s performance improved from symptom reproduction at 3.2 mph at a 5% incline with 111 bpm on the BCTT to no symptom reproduction throughout the entire testing protocol, ending at 20 minutes at 5.2 mph at a 15% incline with 182 bpm. Discussion: This case report outlines the interventions utilized for concussion management in the outpatient physical therapy setting. The report shows a successful outcome with reduced symptoms, improved aerobic energy capabilities, and progress toward achieving goals.