Sports Concussions: An Evidence Based Course Designed to Maximize Results

Instructor:

Becky Bliss, PT, DPT, NCS is an Assistant Professor in the Doctor of Physical Therapy program at Wingate University and is a board certified in Neurological Physical Therapy. She holds her Certificate in Vestibular Rehabilitation from the APTA and is an Impact Trained Physical Therapist. Dr. Bliss graduated from Ithaca College Department of Physical Therapy with a combined undergraduate-graduate Master of Physical Therapy in 2001. She completed her Doctorate in Physical Therapy from Des Moines University in 2014 and is currently enrolled in the Doctor of Health Science Program at the University of Indianapolis. Dr. Bliss has been actively practicing in the field of physical therapy for 16 years with specialization in concussion management. She has presented at both the state and national level meetings for both physical therapy and athletic training on topics to include the multi-disciplinary approach to concussion rehabilitation and management specific to sport related concussion. Her research interests include dysfunction of the vestibular ocular reflex following mild traumatic brain injury as well as early detection of impairments that lead to post-concussion syndrome. Dr. Bliss is active within the Academy of Neurological Physical Therapy and has served as chair of the Nominating Committee of the Vestibular Special Interest Group as well as on multidisciplinary committees for the state chapters of the Brain Injury Association.

Course summary: 

This two-day advanced evidenced based course is specific to Sport Related Concussion in today’s health care environment. Course attendees will be equipped with a systematic evaluation of patients who have sustained a concussion and will be provided with tools to improve patient outcomes to return an athlete safely and efficiently to play. Current evidence supports a multi-modal approach to concussion management based on clinical trajectories. These trajectories include cervical, ocular, vestibular, post-traumatic migraine, cognitive/fatigue and anxiety/mood and when identified early can facilitate active rehabilitation and return to sport. This course will review history of treatment of concussions with most current “best” practices as well as pathophysiology and recent advances in diagnosis and management. In depth assessment through laboratory practice will be covered for each clinical trajectory with validated objective tests and measures as well as laboratory break out time to practice and become comfortable with administration and interpretation of results. Sport related clinical cases will be presented to aid in identification of driving subtypes so treatment strategies can be implemented, and impairment driven intervention covered. Utilization of a multi-modal approach relevant to rehabilitation professionals will be presented with treatment strategies specific to clinical symptomology. Course participants will utilize cervical, exertional, vestibular as well as visual rehabilitation strategies to be able to treat sport related concussion injuries effectively and ensure patients do not experience recurrent symptomology.

Objectives: 

Upon completion of this course participants will be able to:

• Describe pathophysiology of sport related concussion and current diagnostic and management strategies employed both on the field and in the clinic.

• Identify potential symptomology following concussion to include cognitive, orthopedic, neurological, physiological and psychological dysfunction.

• Compare and contrast differences between special populations to include child and elite athletes    in regard to concussion management.

• Discuss objective testing utilized in sport related concussion to include sideline assessment tools,            computerized neurocognitive testing, and specific measures for cervical, ocular, vestibular and exertional impairments.

• Perform a comprehensive concussion evaluation to include cervical examination, vestibular ocular     examination, and exertional testing to quantify impairments commonly occurring with concussion injury.

• Identify driving subtypes via clinical trajectories specific to individual patients in order to facilitate        return to sport in a timely fashion when appropriate.

• Compare and contrast current evidence on the role of rest versus guided active rehabilitation         strategies to include decision making on initiation of return to play protocol.

•Design appropriate impairment-based treatment plans based on clinical trajectories and driving subtypes that are multi-modal to ensure safe return to play.

•Employ sport specific drills that address post concussive impairments and ensure athlete is safe to return to sport and/or activity.

• Identify patients that need referral to neuropsychology, neurology or possible neuro-optometry for further assistance in post concussive management.

•Discuss patient and caregiver education on current evidence regarding residual effects and potential

sequelae from concussion injury.

•Describe current technology available for both diagnostic and intervention of sport related concussion.

•Design effective home exercise program to prevent reoccurrence of symptomology and facilitate functional athletic independence

Agenda:

DAY 1:

7:30 8:00 Registration

8:00 8:45 Pathophysiology and Current Management of Sport Related Concussion

• Safety considerations in residual effects and potential sequelae, what does research tell us

8:45 10:15 Clinical Symptomology and Objective Measures Utilized in SRC

• Utilization of outcome measures available to aid in diagnosis and objective measurement of ongoing symptoms

10:15 10:30 Break

10:30 11:00 Special Population Considerations

• Pre-existing conditions that may identify prolonged recovery

11:00 12:00 Outcome Measures in SRC

• Introduction to available clinical tests and decision-making tree on when to choose specific outcome measures in the management of SRC

12:00 12:45 Lunch (on your own)

12:45 2:30 Concussion Evaluation (Lab)

• Neurological exam of oculomotor and vestibular/balance dysfunction to include assessment of oculomotor ROM, smooth pursuits, saccades, convergence, VOR function, BPPV, ocular alignment and static and dynamic postural control

2:30 2:45 Break

2:45 4:00 Concussion Evaluation (Lab-Cont’d)

• Post Traumatic Headache Differential Diagnosis considerations.

4:00 5:00 Identification of Clinical Trajectories through Case Studies

• Guided assessment of patient case scenarios to identify driving subtypes to address specific impairments to aid in speed of recovery

5:00 5:45 Clinical Decision Making

• Patient education resources for up-to-date concussion protocols

DAY 2

7:30 8:15 Rest Versus Active Recovery

• Physiological considerations in prescribing rest post injury and when to initiate active recovery based on current literature

8:15 10:00 Impairment Driven Treatment Strategies (Lab)

 • Cervical, Ocular, Vestibular and Exertional interventional strategies based on objective test results

10:00 10:15 Break

10:15 11:00 Multi-modal Sport Specific Intervention Strategies (Lab)

• Use of multi-modal and dual task intervention to facilitate recovery

11:00 12:00 Return to Play Protocol

• Health care provider management and communication

12:00 1:00 Lunch (on your own)

1:00 2:00 Intervention Case Study Practice

 • Small group work of patient case scenarios to apply interventional strategies learned from previous information presented

2:00 2:30 Role of the Multidisciplinary Team

• Team approach-referral to specialists

2:30 3:00 Current Technology • Current available diagnostic and interventional technology in SRC

3:00 3:15 Course Wrap Up/Questions

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