Concussion Protocols for Physical Therapists

Concussion protocol for physical therapists

What is a concussion?  

A concussion is a form of a traumatic brain injury (TBI) caused by a direct trauma to the head. This trauma could be from a fall, a hit, or whiplash (i.e., from a car accident) injuries. This force causes the brain to move rapidly back and forth within the skull, causing injury to the brain tissue. This injury can result in immediate or delayed loss of normal brain function.   

Concussion symptoms are typically temporary. Severe concussions or multiple concussions may cause lasting long-term effects on the chemical balance and overall function of the brain.   

According to the CDC, 1.6 to 3.8 million sports related TBIs occur annually in the United States. In 2014, the CDC recorded 2.87 million TBI-related hospital visits in the US. Over 800,000 of the events occurred amongst children.   

This number may not account for the true number of concussions in the US, as many cases do not get reported.  

Related course: Concussion Management: A Comprehensive Evidence-Based Approach for the Physical Therapist  

Signs and symptoms  

While concussion symptoms vary, they significantly affect a patient’s well-being. They can impair motor skills, emotional health, and mental capabilities. These symptoms can appear immediately or present months after a concussion occurs.   

Whether symptoms are present immediately or not, individuals should seek medical attention immediately following head trauma.   

Common symptoms include:  

  • Dizziness or balance impairments  
  • Blurry or double vision  
  • Light sensitivity  
  • Headache  
  • Nausea/vomiting  
  • Speech impairments  
  • Confusion or memory loss  
  • Difficulty concentrating  
  • Slow executive processing  
  • Mood swings or change in behavior  

How physical therapy can help with concussions  

Physical therapists are trained to examine each body system and identify all concussion symptoms. This allows PTs to tailor an individualized routine to best address the needs of the patient.   

Treatment can include things such as restoring strength or balance, improving endurance, and reducing headaches or dizziness. The goal is for the patient to be able to return to normal daily activities and/or exercise.  

Concussion protocols for physical therapists 

There are various concussion protocols for physical therapists. The International Journal of Sports Physical Therapy breaks down the rehabilitation process into 5 different treatment phases:  

First phase: Rest  

  • Goals of treatment: Rest and prevent symptom exacerbation  
  • Physical therapy intervention: Activities of daily living (such as getting dressed or light housework) as tolerated by patient  

Second phase: Gradual Exercise Introduction   

  • Goals of treatment: Introduce exercise to prevent excessive deconditioning  
  • Physical therapy intervention: Gradual progression of aerobic exercise to increase heart rate (e.g., light walking)  

Third phase: Exercise Progression/Neurological Recovery  

  • Goals of treatment: Progress rehabilitation with harder movements to stimulate neuroplasticity for long term recovery  
  • Physical therapy intervention: Aerobic exercise to increase head movement (running, swimming, etc.). Challenge the patient with different exercise environments (outside or busy workout room, etc.)  

Fourth phase: Transitional/Complex Activities  

  • Goal of treatment: Reintroduce sports activity and maximize full functional recovery  
  • Physical therapy intervention: Incorporate cognitive activities and dual task practice (example-counting backwards while walking or running). Begin sports specific activities (i.e., shooting or passing drills).  

Fifth phase: Return to Sport  

  • Goal of treatment: Full return of prior level of function and full return to sport  
  • Intervention: Sport-specific activities  

Every patient will recover from a concussion at their own pace. This pace will be based off their prior level of function, severity of head injury and history of prior concussions.   

Physical therapists are trained to center the plan of care and progression of activity around the patient’s tolerance and symptoms.   

How to find the right PT  

While all physical therapists are educated to treat various injuries, post-concussion rehabilitation is considered a niche practice with the profession. Many of these physical therapists have extensive experience treating post-concussion symptoms.  

Additionally, some of these physical therapists are neurological or vestibular specialists.   

When looking for the right physical therapist to assist in a patient’s rehabilitation journey, here are a couple tips:  

  • Contact local physical therapy clinics and ask if they have someone who specializes in post-concussion rehabilitation  
  • Search online for therapists who have these credentials. The APTA has a helpful directory called Find a PT  
  • Get recommendations from online PT groups or others who have experienced similar injuries