Cargando…

Sequencing and Integration of Cervical Manual Therapy and Vestibulo-oculomotor Therapy for Concussion Symptoms: Retrospective Analysis

BACKGROUND: After concussion many people have cervicogenic headache, visual dysfunction, and vestibular deficits that can be attributed to brain injury, cervical injury, or both. While clinical practice guidelines outline treatments to address the symptoms that arise from the multiple involved syste...

Descripción completa

Detalles Bibliográficos
Autores principales: Wong, Christopher Kevin, Ziaks, Lauren, Vargas, Samantha, DeMattos, Tessia, Brown, Chelsea
Formato: Online Artículo Texto
Lenguaje:English
Publicado: NASMI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872443/
https://www.ncbi.nlm.nih.gov/pubmed/33604130
http://dx.doi.org/10.26603/001c.18825
_version_ 1783649186278801408
author Wong, Christopher Kevin
Ziaks, Lauren
Vargas, Samantha
DeMattos, Tessia
Brown, Chelsea
author_facet Wong, Christopher Kevin
Ziaks, Lauren
Vargas, Samantha
DeMattos, Tessia
Brown, Chelsea
author_sort Wong, Christopher Kevin
collection PubMed
description BACKGROUND: After concussion many people have cervicogenic headache, visual dysfunction, and vestibular deficits that can be attributed to brain injury, cervical injury, or both. While clinical practice guidelines outline treatments to address the symptoms that arise from the multiple involved systems, no preferred treatment sequence for post-concussion syndrome has emerged. PURPOSE: This study sought to describe the clinical and patient-reported outcomes for people with post-concussion symptoms after a protocol sequenced to address cervical dysfunction and benign paroxysmal positional vertigo within the first three weeks of injury, followed by integrated vision and vestibular therapy. STUDY DESIGN: Retrospective longitudinal cohort analysis METHODS: Records from a concussion clinic for 38 patients (25 male 13 female, aged 26.9±19.7 years) with post-concussion symptoms due to sports, falls, assaults, and motor vehicle accident injuries were analyzed. Musculoskeletal, vision, and vestibular system functions were assessed after pragmatic treatment including early cervical manual therapy and canalith repositioning treatment—when indicated—integrated with advanced vision and vestibular rehabilitation. Patient-reported outcomes included the Post-Concussion Symptom Scale (PCSS) for general symptoms; and for specific symptoms, the Dizziness Handicap Index (DHI), Convergence Insufficiency Symptom Scale (CISS), Activities-specific Balance Confidence scale (ABC), and the Brain Injury Vision Symptom Survey (BIVSS). Paired t-tests with Bonferroni correction to minimize familywise error (p<0.05) were used to analyze the clinical and patient-reported outcomes. RESULTS: After 10.4±4.8 sessions over 57.6±34.0 days, general symptoms improved on the PCSS (p=0.001, 95%CI=12.4-30.6); and specific symptoms on the DHI (p<0.001, 95%CI=14.5-33.2), CISS (p<0.002, 95%CI=7.1-18.3), ABC (p<0.024, 95%CI=-.3 - -.1), and BIVSS (p<0.001, 95%CI=13.4-28.0). Clinical measures improved including cervical range-of-motion (55.6% fully restored), benign paroxysmal positional vertigo symptoms (28/28, fully resolved), Brock string visual convergence (p<0.001, 95%CI=3.3-6.3), and score on the Balance Error Scoring System (p<0.001, 95%CI=5.5-11.6). CONCLUSION: A rehabilitation approach for post-concussion syndrome that sequenced cervical dysfunction and benign paroxysmal positional vertigo treatment within the first three weeks of injury followed by integrated vision and vestibular therapy improved clinical and patient-reported outcomes. Level of Evidence: 2b
format Online
Article
Text
id pubmed-7872443
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher NASMI
record_format MEDLINE/PubMed
spelling pubmed-78724432021-02-17 Sequencing and Integration of Cervical Manual Therapy and Vestibulo-oculomotor Therapy for Concussion Symptoms: Retrospective Analysis Wong, Christopher Kevin Ziaks, Lauren Vargas, Samantha DeMattos, Tessia Brown, Chelsea Int J Sports Phys Ther Original Research BACKGROUND: After concussion many people have cervicogenic headache, visual dysfunction, and vestibular deficits that can be attributed to brain injury, cervical injury, or both. While clinical practice guidelines outline treatments to address the symptoms that arise from the multiple involved systems, no preferred treatment sequence for post-concussion syndrome has emerged. PURPOSE: This study sought to describe the clinical and patient-reported outcomes for people with post-concussion symptoms after a protocol sequenced to address cervical dysfunction and benign paroxysmal positional vertigo within the first three weeks of injury, followed by integrated vision and vestibular therapy. STUDY DESIGN: Retrospective longitudinal cohort analysis METHODS: Records from a concussion clinic for 38 patients (25 male 13 female, aged 26.9±19.7 years) with post-concussion symptoms due to sports, falls, assaults, and motor vehicle accident injuries were analyzed. Musculoskeletal, vision, and vestibular system functions were assessed after pragmatic treatment including early cervical manual therapy and canalith repositioning treatment—when indicated—integrated with advanced vision and vestibular rehabilitation. Patient-reported outcomes included the Post-Concussion Symptom Scale (PCSS) for general symptoms; and for specific symptoms, the Dizziness Handicap Index (DHI), Convergence Insufficiency Symptom Scale (CISS), Activities-specific Balance Confidence scale (ABC), and the Brain Injury Vision Symptom Survey (BIVSS). Paired t-tests with Bonferroni correction to minimize familywise error (p<0.05) were used to analyze the clinical and patient-reported outcomes. RESULTS: After 10.4±4.8 sessions over 57.6±34.0 days, general symptoms improved on the PCSS (p=0.001, 95%CI=12.4-30.6); and specific symptoms on the DHI (p<0.001, 95%CI=14.5-33.2), CISS (p<0.002, 95%CI=7.1-18.3), ABC (p<0.024, 95%CI=-.3 - -.1), and BIVSS (p<0.001, 95%CI=13.4-28.0). Clinical measures improved including cervical range-of-motion (55.6% fully restored), benign paroxysmal positional vertigo symptoms (28/28, fully resolved), Brock string visual convergence (p<0.001, 95%CI=3.3-6.3), and score on the Balance Error Scoring System (p<0.001, 95%CI=5.5-11.6). CONCLUSION: A rehabilitation approach for post-concussion syndrome that sequenced cervical dysfunction and benign paroxysmal positional vertigo treatment within the first three weeks of injury followed by integrated vision and vestibular therapy improved clinical and patient-reported outcomes. Level of Evidence: 2b NASMI 2021-02-01 /pmc/articles/PMC7872443/ /pubmed/33604130 http://dx.doi.org/10.26603/001c.18825 Text en https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike License (4.0) (https://creativecommons.org/licenses/by-nc-sa/4.0/) which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited. If you remix, transform, or build upon this work, you must distribute your contributions under the same license as the original.
spellingShingle Original Research
Wong, Christopher Kevin
Ziaks, Lauren
Vargas, Samantha
DeMattos, Tessia
Brown, Chelsea
Sequencing and Integration of Cervical Manual Therapy and Vestibulo-oculomotor Therapy for Concussion Symptoms: Retrospective Analysis
title Sequencing and Integration of Cervical Manual Therapy and Vestibulo-oculomotor Therapy for Concussion Symptoms: Retrospective Analysis
title_full Sequencing and Integration of Cervical Manual Therapy and Vestibulo-oculomotor Therapy for Concussion Symptoms: Retrospective Analysis
title_fullStr Sequencing and Integration of Cervical Manual Therapy and Vestibulo-oculomotor Therapy for Concussion Symptoms: Retrospective Analysis
title_full_unstemmed Sequencing and Integration of Cervical Manual Therapy and Vestibulo-oculomotor Therapy for Concussion Symptoms: Retrospective Analysis
title_short Sequencing and Integration of Cervical Manual Therapy and Vestibulo-oculomotor Therapy for Concussion Symptoms: Retrospective Analysis
title_sort sequencing and integration of cervical manual therapy and vestibulo-oculomotor therapy for concussion symptoms: retrospective analysis
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872443/
https://www.ncbi.nlm.nih.gov/pubmed/33604130
http://dx.doi.org/10.26603/001c.18825
work_keys_str_mv AT wongchristopherkevin sequencingandintegrationofcervicalmanualtherapyandvestibulooculomotortherapyforconcussionsymptomsretrospectiveanalysis
AT ziakslauren sequencingandintegrationofcervicalmanualtherapyandvestibulooculomotortherapyforconcussionsymptomsretrospectiveanalysis
AT vargassamantha sequencingandintegrationofcervicalmanualtherapyandvestibulooculomotortherapyforconcussionsymptomsretrospectiveanalysis
AT demattostessia sequencingandintegrationofcervicalmanualtherapyandvestibulooculomotortherapyforconcussionsymptomsretrospectiveanalysis
AT brownchelsea sequencingandintegrationofcervicalmanualtherapyandvestibulooculomotortherapyforconcussionsymptomsretrospectiveanalysis