Concussions Continuing Education Course

Course Objectives

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Upon successful completion of this course the participant will be able to:

• Describe the pathophysiology and current management of sport-related concussion and the diagnosis of SRC to include evidenced-based recommendations from the 2016 Consensus Statement.
• Identify the clinical trajectories specific to SRC to improve impairment identification to guide treatment.
• Identify the 11 r’s associated with sport-related concussion.
• Identify outcome measures available to aid in diagnosis and objective measurement of ongoing symptoms to include: SCAT 5, Ocular (NPC, King-Devick, Cover/Uncover, Alternate Cover Test), Cervical JPE, Vestibular (DVAT, Head Thrust, VOR Cancellation, GST), Balance Tools.
• Perform an orthopedic evaluation to include cervical stability assessment, joint position error test, and postural contribution.
• Perform a Neurological exam of oculomotor and vestibular/balance dysfunction to include assessment of oculomotor ROM, smooth pursuits, saccades, convergence, VOR function, BPPV, ocular alignment and static and dynamic postural control.
• Perform a comprehensive concussion evaluation to include cervical examination, vestibular ocular examination, and exertional testing to quantify impairments commonly occurring with a concussion injury.
• Describe the post-traumatic headache differential diagnosis considerations.
• Perform clinical decision making when recommending guidelines and/or accommodations specific to identified impairments to facilitate return to activity to include return to learn considerations.
• Identify driving subtypes via clinical trajectories specific to individual patients in order to facilitate return to sport in a timely fashion when appropriate.
• Identify patient education resources for up to date concussion protocols.
• Identify physiological considerations in prescribing rest, and graduated return-to play protocols, based on the current literature and the 2016 consensus statement.
• Develop appropriate impairment-driven treatment strategies for Cervical, Ocular, Vestibular and Exertional intervention based on objective test results.
• Develop appropriate impairment-driven treatment strategies for multimodal sport specific interventions.
• Develop appropriate impairment-driven treatment strategies for higher level athletic activities that include sport specific training of identified impairments.
• Develop appropriate impairment-driven treatment strategies for use of multimodal and dual-task intervention to facilitate recovery.
• Identify and implement timeframes and activities for return- to-play protocols based upon the 2016 consensus statement.
• Develop clinical decision making on when to initiate RTP.
• Develop a communication pathway with other Healthcare providers and caregivers and identify the important role of each member of the multidisciplinary team.
• Refer patients to other members of the healthcare team for further assistance in postconcussive management.

Learn from the Expert Becky Bliss, PT, DPT, NCS

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Becky Bliss, PT, DPT, NCS is an Assistant Professor in the Doctor of Physical Therapy program at Wingate University and is a board certified in Neurological Physical Therapy. She holds her Certificate in Vestibular Rehabilitation from the APTA and is an Impact Trained Physical Therapist. Dr. Bliss graduated from Ithaca College Department of Physical Therapy with a combined undergraduate-graduate Master of Physical Therapy in 2001. She completed her Doctorate in Physical Therapy from Des Moines University in 2014 and is currently enrolled in the Doctorate of Health Science Program at the University of Indianapolis. Dr. Bliss has been actively practicing in the field of physical therapy for 16 years with specialization in concussion management. She has presented at both the state and national level meetings for both physical therapy and athletic training on topics to include the multi-disciplinary approach to concussion rehabilitation and management specific to sport related concussion. Her research interests include dysfunction of the vestibular ocular reflex following mild traumatic brain injury as well as early detection of impairments that lead to post-concussion syndrome. Dr. Bliss is active within the Academy of Neurological Physical Therapy and has served as chair of the Nominating Committee of the Vestibular Special Interest Group as well as on multidisciplinary committees for the state chapters of the Brain Injury Association.

Current Research, Definition of a Concussion, Common Signs and Symptoms and Specific Assessment tools

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• Latest research for concussions
• Defining a concussion
• Signs and symptoms and common features
• Biomarkers, PET scans
• Blood bile markers
• The metabolic crisis of a Concussion
• Isolated and multifactorial signs and symptoms
• Duration of Concussion symptoms
• The role of athletic trainers
• Understanding assessment tools
• Rate of recovery for children
• What is happening physiologically?
• Baseline testing recommendations
• Genetic testing and markers

Re-evaluation, Recovery and the Multimodal Approach

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• Recovery guidelines-gradual reintegration
• Post concussive symptom checklist
• Multimodal approach, When do we initiate rehab?

Clinical Trajectories, Clinical Subtypes and the Multidisciplinary Approach

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• Clinical trajectories
• Defining clinical subtypes that drive symptomatology
• Prioritizing treatment
• The Multidisciplinary Approach
• Oculomotor dysfunction
• Definitions and patient examples
• Cranial nerve function and the visual system

Oculomotor and Vestibular System

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• Understanding the Oculomotor system
• Learn about Ganglion cells
• The Parocellular–focal–ventral pathway
• The magnocellular–ambient–dorsal pathway
• Saccades
• The Convergence Test
• The smooth pursuit test
• The King Devick Test

Concussion Assessment for the Rehab Professional

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• Concussion assessment
• The most common symptoms of Concussions
• A comprehensive treatment approach detailed
• Understanding past medical history
• Learn the current assessment tools
• The role of rehabilitation
• Setting priorities
• Feasibility Study 2017
• How to train all the systems
• Exertional testing-objective measures
• The treadmill test
• Submaximal threshold
• How do you know if a test is complete
• The first signs of exacerbation
• Buffalo Concussion Treadmill Test
• Modifying exertional tests
• Sports specific drills
• Establishing Baselines

Patient Evaluation and Demonstrations

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• Concussion exam components
• Examination of the musculature around the neck
• Movement of joints above and below the targeted assessment.
• Cervical Evaluation
• Range of Motion
• Ligamentous stability
• Cervical Joint Proprioceptive Error Test
• Testing for spontaneous and fixed gaze nystagmus
• Ocular motor range of motion
• Saccades
• Reflexive saccade
• King-Devick Test
• Convergence
• Tropia
• Phoria Cover Test

Vestibular Testing

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• Vestibular Ocular Motor Screening Tool
• The VOR test
• Convergence
• Smooth pursuit
• Horizontal smooth pursuits
• Saccades
• Vertical saccades
• Visual motor speed
• Visual motor sensitivity
• Understanding the score to the screening tool

Treatment Exercises

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• Ocular alignment exercises
• Convergence training
• Ocular Motor Exercises for athletes
• Combining ocular and vestibular exercises
• Eye hand coordination
• Fine motor skills
• Gross motor skills
• Convergence
• Smooth pursuit
• VOR Cancellation
• Progressing the challenge with cognitive tasks
• Progress your athlete using critical thinking and judgement
• Adding in a balance component
• Multitasking dual tasking reaction time
• Multi visual systems
• Switching between magno and parvo-progressing
• Near far chart
• Saccadic motion exercises for the athlete
• Initiating vestibular-ocular exercises
• Progressing to higher function
• What if a patient can't regulate their hemodynamics?
• Instituting vestibular therapy when the patient has neck problems

Return to play Protocol

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• Graduated return to play protocol
• Guidelines of activity

Factors that May Trigger or Exacerbate Headaches

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• Understanding headaches
• Cervical spine injury
• Impaired sleep
• Higher level cognition
• Vision Hearing sensitivity
• The influence of Exercise

Patient Case Study Review

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• Cognitive fatigue patinet with cervical issues and ocular as the subdriving types
• Proper evaluation and building a comprehensive treatment program

Bonus Section: Dr Bliss Discusses Moderate to Severe TBI

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• More moderate to severe TBI
• Variability of recovery

Course Test - Evaluate your knowledge

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• Use the Healthclick proprietary online education system which provides the online student with:
• Worldwide access to high definition video, anatomical animations and images, and written information
• The highest quality film in the industry, you can see the difference!
• Stop and resume within a course, the Healthclick system will optimize your course based on your device, connection and remembers where you left off.
• Real-time course updates. We are always adding to each courses, updating content, adding animations, these are not static courses!
• Evaluate your knowledge with the course test on any device.
• Print your state course certificate for CE credit.
• Take the online test as many times as need in order to achieve a 70 % or greater score.