Concussions, ahhhhh! They can cause brain damage and memory issues down the road. Should we be holding our athletes back from participating in sports with a high risk of concussions in order to save them from the repercussions later in life?
Now that concussions are front page news, many physical therapy clinics are offering specialized “Concussion Rehab” programs with specific protocols to get athletes back on the field. These specialized programs and protocols are great, however, the parents are still coming in with a million questions and the athletes are still very anxious to return to sport. How do we address these external factors?
Educating the parent and the athlete is important, but including the coach is key! The coach is the one who needs to understand the athlete’s limitations and the implications of pushing them too hard too soon. One of the things we have found to be helpful is providing the parent and the coach with an informational folder. This folder outlines the process from start to finish: what happens the moment you sustain a concussion, the internal healing process, the rehabilitation process and things to be mindful of in the future. Although concussions are a hot topic right now, that does not mean that people fully understand what it means to sustain a concussion. The education of the front line people in athletics, like coaches, is instrumental in keeping our athletes safe.
Now that we have educated the parents, athlete and coach it is important for us to understand our roles in the rehabilitation process. Many therapists in the outpatient world have shied away from treating the vestibular population, or maybe there is only one person in your clinic dedicated to seeing these types of patients. If your clinic is going to offer concussion rehabilitation, that clinician needs to make sure they are proficient in all types of vestibular rehab, not just the most common diagnosis of benign paroxysmal positional vertigo, or BPPV. Previously, the most commonly used screening tools after concussion were the Balance Error Scoring System (BESS) or the Sensory Organization Test (SOT). The problem with these tests is that they do not address dynamic aspects of the vestibular ocular system or the vestibulo-ocular control which may cause us to overlook other contributing factors. The newest tool, which encompasses both vestibular and ocular motor impairments, is the Vestibular/Ocular Motor Screening Assessment (VOMS).
If you are not familiar with the VOMS, you should be. This tool looks at 5 areas: smooth pursuit, horizontal and vertical saccade, convergence, horizontal vestibular ocular reflex (VOR) and visual motion sensitivity. These are all assessments we learned in school, but when was the last time most of us have used them in the clinic? It’s time to dust off the cobwebs! If you are looking to stay on top of cutting edge treatment of concussions, it is imperative that you are proficient in the assessment of these areas. Unless you can accurately assess and determine the area of the deficiency, how are you going to be able to properly treat the athlete? We owe it to our athletes and referring physicians to be on top of the research. This may mean signing up for a vestibular CEU, or attending a talk given by an ENT or otolaryngologist who specializes in concussions. If nothing else, start doing some reading. It will surprise you how much has changed since you took your board exams!