What is Post-Concussive Syndrome?

Post-Concussive Syndrome is a complex set of symptoms that may include dizziness, headache, neck pain, fatigue, vision difficulties or changes, and balance impairments, cognitive fatigue/”brain fog”, among other symptoms.

What qualifications do physical therapists at CRC have?

At CRC, you will only work with a board certified doctor of physical therapy – we do not use PT assistants or aides. Our physical therapists specialize in neurologic/brain injury rehabilitation as their specific area of interest, and either hold or are working towards their NCS (board certified neurologic clinical specialist) certifications.

What makes this type of PT different from other PT I may have received?

Our approach to clients after concussion is unique because it focuses on addressing all of the “puzzle pieces” that may be contributing to your symptoms. Each person is more than a neck, a headache, or another symptom, and we aim to integrate each component into our treatment plan. Each treatment session will aim to specifically target your specific areas of breakdown and needs, within the activities that are most important to you. While exercise will likely be a part of your plan, integration of systems and application to daily activities are an important part of our rehab process. Our client-centered, functional approach aims to translate what you do in the clinic to the real world so that you can improve your function and get back to your life.

What will my PT evaluation be like?

Our physical therapists will first complete a detailed history of your current symptoms, as well as your prior level of function and activities you wish to return to. The PT evaluation will also include an assessment and screening of the many systems which may be involved after a concussion, including the cervical spine, vestibular system, oculomotor/visual system, sensory integration and balance, activity tolerance, and patient specific goals and activities.

How will you treat the symptoms I am having?

Following the evaluation, your PT will work with you to identify the problems that are contributing to your symptoms, and will develop a plan of care to address the goals that are important to you. Every individual is different, so your treatment plan will be unique to your needs. Treatment strategies that may be a part of your plan of care include:

• Manual therapy interventions (ie soft tissue work, mobilizations, stretching) to reduce pain or muscle spasm and improve joint mobility or muscle length

• Oculomotor retraining (ie exercises to improve coordination of eye movements, tolerance to more complicated visual environments, and reduction of visual fatigue)

• Vestibular rehab (ie exercises to improve tolerance to head movements, ability to maintain focus on a target while moving, and awareness of positioning in space. This may focus on specific positions and movements or be more general, depending on your needs)

• Therapeutic exercises working on stability, range of motion, strength, and muscle endurance

• Sensory integration training, including balance training, proprioception training for the neck, and coordination of eye and head movements

• Guided progression of cardiovascular/aerobic exercise, if symptoms limit physical activity

• Education on strategies for symptom management within daily activities, home exercise program, body mechanics, ergonomic setup, etc.

Most individuals will benefit from a blend of some or all of the above treatment strategies, sometimes in addition to others not listed here. You and your therapist will work together to decide if an intervention is working and will make changes as needed as you move through your plan. We are happy to hear about strategies that have or have not been helpful for you in the past in order to take the approach that will meet your needs best.

What about cognitive symptoms or “brain fog”? Does PT address that?

Some individuals experience a high level of cognitive fatigue or symptoms as a result of their concussion. In some cases, these symptoms resolve as your other symptoms improve with PT.  In other cases, individuals might find their cognitive symptoms become more noticeable as their physical symptoms decrease. In this case, we might recommend a referral to speech therapy. Our speech therapists work on developing systems and strategies to manage or improve cognitive symptoms following concussion. Many clients benefit from receiving both PT and ST in order to address all facets of their recovery.

How long will I need to come to therapy?

Every individual is different, and we want to make sure that you receive the right amount of therapy to reach your goals. In general, most post-concussive clients are seen 2x/week for 2-3 months before tapering down to 1x/week or every other week as they improve. Depending on your progress and needs, your plan may be shorter or longer. Your therapist will discuss their recommended frequency and plan with you both at the evaluation and as you continue to receive services.