By Bridgett Wallace, PT, DPT, Concussion Health's Co-Founder & Director of Clinical Education
If you have not yet read last week’s New York Times article, “Effective Concussion Treatment Remains Frustratingly Elusive, Despite a Booming Industry,” I encourage you to do so. Even the title itself is revealing. As a health care provider who has been fortunate enough to work with leaders in the field of concussion management for almost 20 years, I consistently see patients who have seen a number of providers regarding their ongoing symptoms following head trauma, yet no effective treatment options were discussed.
It is encouraging to see the exponential growth of attention on the concerns and potential long term effects of concussions. However, we have only touched the tip of the iceberg in regards to best practices for concussion management.
Successful treatment begins with an accurate diagnosis. To date, there is no universally accepted means of diagnosing a concussion. We currently rely on a number of tools of which the clinical examination is extremely critical to identify functional impairments. There are a number of sophisticated tools to provide more objective information on cognitive, visual and vestibular function. Although there are recognizable common signs and symptoms associated with a concussion, it is critical for providers to understand each individual is unique in their clinical presentation and, above all, how they may recover. Not only can one individual differ significantly from another with a similar mechanism of injury but the individual themselves can differ on how they recover from repeated injuries.
As noted in the NYT article, more research is needed. It is likely that studies on the use of hyperbaric oxygen therapy (HBOT) will show benefits in post-concussion symptoms but, just as there is no one test to diagnose a concussion, there is no one treatment option.
I have heard from some patients that the use of HBOT alleviated their symptoms, and I have worked with patients in which it increased their symptoms. As a provider that specializes in vestibular disorders, there are certain injuries that can occur to the inner ear following head trauma and HBOT would be contraindicated.
Education is key. Technology will play a key role in bridging the gap in knowledge transfer by providing easily accessible education through mobile and web based tools as well as create the opportunity for “big data.” As we move more towards the “cloud” in our data collection, it creates the opportunity to leverage the use of clinical information for developing and continually improving best practices.
At a minimum, it is critical for providers to know once you have seen one concussion, you have seen one concussion. There are a number of current tools (clinical and computerized) to provide a comprehensive examination – an examination that would include assessment of symptoms, cognition, the oculomotor system and vestibular function. Such an examination allows for a customized treatment plan…yes, “treatment.” Concussions should be considered a manageable injury that incorporates the often underappreciated theory of neuroplasticity.
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