Undergraduate Category: Health Sciences Degree Level: Bachelors of
Undergraduate/Graduate: Undergraduate Category: Health Sciences Degree Level: Bachelors of Science Abstract ID# 199
Introduction
Concussion rates are steadily increasing in the athleCc populaCon.1 The goal of this project was to explore the role of the vesCbular system in balance, how balance relates to concussion, and current balance assessments for pre-‐ and post-‐concussion. This project synthesizes the current evidence-‐based research to an athleCc populaCon in order to evaluate the implicaCons on physical therapy evaluaCon and management of athletes who sustained a concussion.
Results / Discussion
Research suggests that balance deficits may occur secondary to impairment of brain centers responsible for central integraCon of vesCbular, visual, and somatosensory sCmuli, damage to peripheral receptors causing erroneous senses of moCon, or concentraCon and aPenCon impairments that may exist post-‐ concussion.2-‐5 While the cause of postural instability and balance disturbance post-‐concussion may not be certain, it is certain that these deficits do exist, and like other concussion signs and symptoms, they are transient in nature.2-‐5 Further research regarding the relaConship between balance and concussions is necessary to ensure proper screening, preventaCve care, and rehabilitaCon protocol. The creaCon of a comprehensive balance assessment to be included in a standardized concussion management protocol is warranted. A newly evolving paradigm in research is a dual-‐task assessment that encompasses cogniCve and motor tasks simultaneously. Dual-‐task is especially relevant when studying athletes because sports require athletes to process cogniCve and sensory sCmuli simultaneously. 6,7 References
1. American Physical Therapy Association. APTA 2012 Position Paper: Concussion Management The Protecting Student Athletes from Concussions Act of 2011 (H.R. 469) 2. Guskiewicz K. Balance assessment in the management of sport-related concussion. Clinics In Sports Medicine. 2011;30(1):89-102. 3. Broglio SP, Ferrara MS, Shin S, Sosnoff JJ. Previous mild traumatic brain injury and postural control dynamics. Journal of Athletic Training. 2011; 46(1):85 4. Postural Stability Assessment Following Concussion: One Piece of the Puzzle Guskiewicz, Kevin M. Clinical Journal of Sport Medicine. 2001, Vol.11(3), pp.182-189. 5. Riemann BL, Guskiewicz KM. Effects of Mild Head Injury on Postural Stability as Measured Through Clinical Balance Testing. Journal of Athletic Training. 2000; 35(1):19 6. Broglio S, Tomporowski P, Ferrara M. Balance performance with a cognitive task: a dual-task testing paradigm. Medicine & Science In Sports & Exercise. 2005;37(4):689-695. 7. Resch J, May B, Tomporowski P, Ferrara M. Balance Performance With a Cognitive Task: A Continuation of the Dual-Task Testing Paradigm. Journal Of Athletic Training. 2011;46(2):170-175.
Example of Dual-Task Assessment
Future Research: Dual-Task Assessment
A dual-‐task paradigm has the ability to replicate an athlete’s performance in a “game-‐like situaCon” to evaluate mulCple systems concurrently.6 It would be beneficial to use pre-‐season athleCc screenings to idenCfy underlying impairments athletes may have that could increase their risk for injury, as well as to determine that person’s individual baseline score. It may also be a sensiCve tool to measure long term post-‐concussive balance deficits that are no longer profoundly present, but sCll exist clinically. Using dual-‐task to create a more consistent assessment for concussion diagnosis and management will decrease the risk of premature return to play.
Relevance to Physical Therapy
As of late, the incidence of sport-‐related concussions is increasing, therefore physical therapists will see this populaCon of paCents more frequently. Discovering pre-‐season or post-‐concussive balance impairments provides physical therapists with a unique opportunity to perform vesCbular rehabilitaCon with athletes. Motor Task: subject reaches foot in various direcCons while standing on one leg
Focusing on balance and vesCbular therapy can help to improve an athlete’s balance and propriocepCon to decrease predisposiCon to injuries, such as concussion. Balance and vesCbular rehabilitaCon may also be implemented post-‐concussion to decrease symptoms and increase body awareness and postural stability prior to an athlete’s return to play.
Cogni&ve Task: subject responds to auditory quesCon by raising blue or orange ball when appropriate *These tasks are performed simultaneously.
Proposed concussion management legislaCon emphasizes balance and vesCbular assessment and treatment as within the scope of physical therapy pracCce.1 This would necessitate incorporaCng more vesCbular content and concussion management informaCon into doctorate of physical therapy programs naConwide. This creates a new area for specializaCon and increases the variety of paCents seen by physical therapists.
Introduction
Concussion rates are steadily increasing in the athleCc populaCon.1 The goal of this project was to explore the role of the vesCbular system in balance, how balance relates to concussion, and current balance assessments for pre-‐ and post-‐concussion. This project synthesizes the current evidence-‐based research to an athleCc populaCon in order to evaluate the implicaCons on physical therapy evaluaCon and management of athletes who sustained a concussion.
Results / Discussion
Research suggests that balance deficits may occur secondary to impairment of brain centers responsible for central integraCon of vesCbular, visual, and somatosensory sCmuli, damage to peripheral receptors causing erroneous senses of moCon, or concentraCon and aPenCon impairments that may exist post-‐ concussion.2-‐5 While the cause of postural instability and balance disturbance post-‐concussion may not be certain, it is certain that these deficits do exist, and like other concussion signs and symptoms, they are transient in nature.2-‐5 Further research regarding the relaConship between balance and concussions is necessary to ensure proper screening, preventaCve care, and rehabilitaCon protocol. The creaCon of a comprehensive balance assessment to be included in a standardized concussion management protocol is warranted. A newly evolving paradigm in research is a dual-‐task assessment that encompasses cogniCve and motor tasks simultaneously. Dual-‐task is especially relevant when studying athletes because sports require athletes to process cogniCve and sensory sCmuli simultaneously. 6,7 References
1. American Physical Therapy Association. APTA 2012 Position Paper: Concussion Management The Protecting Student Athletes from Concussions Act of 2011 (H.R. 469) 2. Guskiewicz K. Balance assessment in the management of sport-related concussion. Clinics In Sports Medicine. 2011;30(1):89-102. 3. Broglio SP, Ferrara MS, Shin S, Sosnoff JJ. Previous mild traumatic brain injury and postural control dynamics. Journal of Athletic Training. 2011; 46(1):85 4. Postural Stability Assessment Following Concussion: One Piece of the Puzzle Guskiewicz, Kevin M. Clinical Journal of Sport Medicine. 2001, Vol.11(3), pp.182-189. 5. Riemann BL, Guskiewicz KM. Effects of Mild Head Injury on Postural Stability as Measured Through Clinical Balance Testing. Journal of Athletic Training. 2000; 35(1):19 6. Broglio S, Tomporowski P, Ferrara M. Balance performance with a cognitive task: a dual-task testing paradigm. Medicine & Science In Sports & Exercise. 2005;37(4):689-695. 7. Resch J, May B, Tomporowski P, Ferrara M. Balance Performance With a Cognitive Task: A Continuation of the Dual-Task Testing Paradigm. Journal Of Athletic Training. 2011;46(2):170-175.
Example of Dual-Task Assessment
Future Research: Dual-Task Assessment
A dual-‐task paradigm has the ability to replicate an athlete’s performance in a “game-‐like situaCon” to evaluate mulCple systems concurrently.6 It would be beneficial to use pre-‐season athleCc screenings to idenCfy underlying impairments athletes may have that could increase their risk for injury, as well as to determine that person’s individual baseline score. It may also be a sensiCve tool to measure long term post-‐concussive balance deficits that are no longer profoundly present, but sCll exist clinically. Using dual-‐task to create a more consistent assessment for concussion diagnosis and management will decrease the risk of premature return to play.
Relevance to Physical Therapy
As of late, the incidence of sport-‐related concussions is increasing, therefore physical therapists will see this populaCon of paCents more frequently. Discovering pre-‐season or post-‐concussive balance impairments provides physical therapists with a unique opportunity to perform vesCbular rehabilitaCon with athletes. Motor Task: subject reaches foot in various direcCons while standing on one leg
Focusing on balance and vesCbular therapy can help to improve an athlete’s balance and propriocepCon to decrease predisposiCon to injuries, such as concussion. Balance and vesCbular rehabilitaCon may also be implemented post-‐concussion to decrease symptoms and increase body awareness and postural stability prior to an athlete’s return to play.
Cogni&ve Task: subject responds to auditory quesCon by raising blue or orange ball when appropriate *These tasks are performed simultaneously.
Proposed concussion management legislaCon emphasizes balance and vesCbular assessment and treatment as within the scope of physical therapy pracCce.1 This would necessitate incorporaCng more vesCbular content and concussion management informaCon into doctorate of physical therapy programs naConwide. This creates a new area for specializaCon and increases the variety of paCents seen by physical therapists.
