1. Physical and Occupational
Therapy Intervention for
Concussion Patients
By: Alyssa Sanfilippo, Intern at RWJUH Outpatient Physical &
Occupational Therapy Department

2. According to the Centers for Disease
Control and Prevention (CDC)…
 In 2010, about 2.5 million million emergency
department visits, hospitalizations, or deaths were
associated with traumatic brain injury (TBI) in the
United States
 TBI was a diagnosis in more than 280,000
hospitalizations and 2.2 million emergency department
visits (CDC)
 In 2009, about 248,418 children (19 or younger) were
treated in EDs for sports and recreation-related injuries
that included a diagnosis of concussion or TBI (CDC)

3. What is a Concussion?
 “Mild traumatic brain injury that briefly impairs
neurological functions” (Schafer & Bull)
 Direct, sudden, powerful blows to the head
 Cause the brain to bounce inside the skull and can
damage brain tissue
 Nerve fibers tear and chemical reactions are altered
 Can cause brief unconsciousness

4. Common Causes
 Motor vehicle accidents
 Sports injuries
 Strikes and falls
 Penetrating injuries (gunshot wounds)
 Violent events (physical abuse)
 Direct, sudden, powerful blows to the head

5. Signs and Symptoms
The symptoms of concussion usually fall into 4 categories:
1) Thinking/Remembering
 Difficulty thinking clearly, feeling slowed down, difficulty
concentrating and remembering new information
2) Physical
 Headaches, fuzzy/blurry vision, nausea/vomiting, dizziness,
sensitivity to light and noise, balance problems, feeling
tired/having low energy
3) Emotional/Mood
 Irritability, sadness, more emotional, nervousness or anxiety
4) Sleep
 Sleeping more or less than usual, trouble falling asleep

6. Treatment
 Physical and/or occupational therapy is a way to
alleviate signs and symptoms
 Therapists evaluate patient’s using assessments that
focus on their history, subjective complaints, symptoms,
physical examination, gait and balance, and
occulomotor assessment
 Therapists design an individualized treatment program
specific to the patient’s needs
 Treatment may include: rest and recovery; restoring
strength and endurance; stopping dizziness and
improving balance; reducing headaches; returning to
normal activity/sport

7. A Study of Physical and Occupational Therapy
Intervention for Concussion Patients
 A Retrospective Study on Concussion Patients at
RWJUH Outpatient Physical & Occupational Therapy
Department
 Purpose:
 To measure and demonstrate the health and functional
benefits resulting from physical and occupational therapy
intervention through a retrospective study of concussion
patients
 Study the effectiveness of a fairly new program

8. Methodology
 A small-scale retrospective review of 8 concussion
patients, who received occupational or physical therapy
intervention within the past two years, was performed.
 The sample size cohort (n=8) consisted of 3 females
and 5 males, aged 7 to 18 years
 A review of each patient’s treatment, including tests
and exercises utilized, was performed
 Data was drawn from each patient’s initial evaluation
and re-evaluation and then was compared

9. Methodology Continued
 The two main outcome measurement tests the therapists
used for concussion patients:
 Dizziness Handicap Inventory (DHI) – a 25-item self-
assessment with the purpose to identify difficulties the patient
may be experiencing because of dizziness
• The score totals were used for the study
• The lower the number, the better
 Patient Specific Functional Scale (PSFS) – used to assess
the patient’s functional ability to complete three specific
activities that the patient chooses as their goals for therapy
• The scale is out of ten points
• The total averages of the three activities was used for the study
• The higher the number, the better

10. Outcomes
 Of the sample size cohort (n=8), 5 patients received physical
therapy and 3 patients received occupational therapy
 Every patient was provided with education and a home exercise
program by their therapist
 Most common activities/exercises used in treatment:
 Active range of motion activities:
• Cognitive skills development (OT)
• Neural mobilization techniques (OT)
• Proprioceptive activities
• Joint mobilization and protection techniques
 Vestibular rehabilitation:
• Aerobic conditioning
• Balance testing (Biodex Balance System) and training
• Vision testing and oculomotor remediation

11. Outcomes Continued
 Every patient demonstrated improvement in his/her DHI
and PSFS scores
 The average decrease in DHI total scores was 26.8
points
 ** The lower the score, the better
 The average increase in PSFS total average scores
was 4.7/10
 All 8 patients’ re-evaluation assessments described
progress that was demonstrated and a decrease of
symptoms after therapy intervention

12. 0
1
2
3
4
5
6
7
8
9
Patient 1 Patient2 Patient 3 Patient 4 Patient 5 Patient 6 Patient 7 Patient 8
Initial Average Score
Final Average Score
Patient Specific Functional Scale (PSFS) Total Average Scores

13. Evaluation
 This retrospective study demonstrates the
effectiveness of physical/occupational therapy
intervention for concussion patients
 The data that was compared from before and after
treatment demonstrated improvement for every
selected patient
 Limitations of the study:
 Some patients had poor attendance
 Multiple possible patients to be studied had to be omitted
because they stopped attending therapy before treatment
was completed (no re-evaluation)

14. Thank You!

15. References
 Centers for Disease Control and Prevention. (2016, January 22).
Retrieved April 07, 2016, from
http://www.cdc.gov/traumaticbraininjury/get_the_facts.html
 Raad, J. (2014, September 3). Rehab Measures – Dizziness
Handicap Inventory. Retrieved April 07, 2016, from
http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.as
px?ID=1041
 Raad, J. (2014, November 12). Rehab Measures - Patient Specific
Functional Scale. Retrieved April 07, 2016, from
http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.as
px?ID=890
 Schafer, E. P., & Bull, A. A. (2014). Concussion. Magill’S Medical
Guide (Online Edition).