The field of post-concussive care is actively evolving, as is evidenced by ongoing media presence, emerging medical evidence, and rule changes in sports, to name a few examples. What was a passive “rest is best” treatment approach has evolved into a much more active and engaged recovery process following the initial rest phase. Recent evidence suggests that rest beyond 2 days prolonged symptomatic recovery.1 That being said, understanding individualized treatment approach, symptom thresholds, and concussion clinical profiles is essential to safe and effective treatment in the post-concussive population.
While determining accurate clinical trajectories may be challenging, it is critical that a multidisciplinary approach to assessment and treatment is utilized. Various specialists are able to assess various physiologic, medical, and mechanical systems to identify impairments associated with the post-concussion sequelae. At Good Shepherd Rehabilitation Network, concussion team members include physiatrists, physical therapists, occupational therapists, vision therapists, speech therapists, neuro psychologists, and a neuro optometrist.
Vestibular rehabilitation (VR) improves balance control among elderly individuals with dizziness, but there isn’t a clear winner when it comes to whether physical therapists (PTs) should use a conventional or modified VR protocol, according to a new study.
The research, recently published online in The American Journal of Physical Medicine & Rehabilitation, aimed to find out not only if VR actually improved outcomes for older individuals with chronic dizziness due to vestibular disorders, but if one protocol was better than another. For purposes of this study, researchers compared the Conventional Cawthorne and Cooksey protocol (CCC), which authors write “consists basically of eye, head, and trunk exercises,” with a “multimodal” Cawthorne and Cooksey protocol (MCC), which they describe as an approach that adds “flexibility, cognition, sensory interaction, and muscle strength exercises” to the mix.
A total of 82 older individuals with chronic dizziness were divided into 2 groups that participated in 16 VR sessions over a 2-month period (2 50-minute sessions per week for 8 weeks). Both the CCC and MCC protocols consisted of 4 stages, with 1 week focused on exercises performed while lying down and the remaining 3 weeks focused on exercises performed while standing and walking. Participants also received educational information on VR and falls prevention, as well as instructions for daily home exercises.