Unique physical therapy management of a young adult with post-concussion symptoms: a case report.
Purpose: Current research is controversial on initiation of exercise in individuals experiencing post-concussion symptoms at rest. There is also minimal evidence associated with exertion protocols and vision therapy in this population. The purpose of this report is 1) to evaluate the Buffalo Concussion Treadmill Test (BCTT) on an individual with post-concussion symptoms at rest and its implications for clinical decision making with treatment progression, and 2) to describe unique physical therapy management of post-concussion impairments in vision and activity tolerance. Measures and Interventions: 20-year-old male with persistent post-concussion symptoms presented with deficits in activity tolerance, gaze stability and oculomotor performance. He was seen once per week for 3 weeks; symptoms were documented at rest and during visual performance and exertion tests. BCTT was used to diagnose concussion symptoms and establish a safe exertion program. Treatment consisted of graded exercise and vision therapy focused on vergence and saccadic exercises. Outcomes: At discharge, the patient reported zero symptoms via the Post-Concussion Scale, indicating clinically significant improvement in post-concussion symptoms. He performed all provocative visual performance and exertion tests without symptoms. Conclusions: Customized vision therapy with a home exercise program may be beneficial in treating visual and vestibulo-ocular deficits after concussion. The BCTT with advanced exertion testing, appears to be effective in determining safe return to sport when managing individuals with physiologic dysfunction after concussion. Further research is needed to develop standardized exertion tests in addition to its safety and effects on individuals who present symptomatically at rest. Clinical Relevance: When to begin exercise with individuals suffering from concussion remains controversial, and one purpose of this report was to help fill this gap. This paper describes the effects of initiating exercise in an individual symptomatic at rest. No adverse effects were reported throughout treatment.
Key Words: post-concussion symptoms, exertion testing, vision therapy
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