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Cervical and Exertion Assessment in Concussion

presented by Anne Mucha, DPT, MS, NCS and Susan Whitney, DPT, PhD, NCS, ATC, FAPTA

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Disclosure Statement:

Financial: Susan Whitney and Anne Mucha receive compensation from MedBridge for this course. Susan Whitney is a consultant for two Department of Defense grants related to concussion with IAI, Inc. She also teaches a continuing education course with Michael Schubert, PT, PhD. Anne Mucha is a provider of continuing education for APTA and other entities.

Non-Financial: Susan Whitney is vice president of the International Neurological Physiotherapy Group of WCPT. Anne Mucha has no competing non-financial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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Video Runtime: 96 Minutes, Learning Assessments: 36 Minutes

One of the roles of physical and occupational therapists in concussion management is to return individuals back to their preconcussion activities. For asymptomatic athletes, progressive exertion is an important component of return-to-play assessments. In addition, exertion therapy is being implemented more frequently to facilitate recovery for individuals who are symptomatic after a concussion. While the evidence regarding exertion therapy is continuing to evolve, the latest information related to who can benefit from exertion, possible exercise paradigms, and appropriate timing for exertion are discussed.

Neck pain may be an associated feature of concussion, requiring management by therapists. Dizziness, a common symptom attributed to concussion, may also be due to impairments in the cervical spine. Key cervical examination elements will be demonstrated via video, and ideas for management in the acute, subacute, and chronic phases will be discussed.

The course will conclude with information related to serious negative consequences that have been associated with concussion. Facts about second-impact syndrome (SIS) and chronic traumatic encephalopathy (CTE) will be discussed to assist therapists in providing the latest evidence-based information to their patients and families who are concerned about these issues.

Meet Your Instructors

Anne Mucha, DPT, MS, NCS

Anne Mucha is the coordinator of vestibular rehabilitation for the University of Pittsburgh Medical Center Sports Medicine Concussion Program and Centers for Rehab Services. She is a board-certified clinical specialist in neurologic physical therapy with advanced certification in vestibular rehabilitation. With more than 20 years of experience treating individuals with neurologic conditions, she is also…

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Susan Whitney, DPT, PhD, NCS, ATC, FAPTA

Susan L. Whitney received her PhD in motor development/motor learning from the University of Pittsburgh, her professional physical therapy education from Temple University in Philadelphia, and her DPT from MGH Institute of the Health Professions. Currently, she is a professor in physical therapy in the School of Health and Rehabilitation Sciences and treats clinically for…

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Chapters & Learning Objectives

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1. Exertion Concepts in Concussion Assessment

Progressive exertion programs are recommended as part of the return-to-play process for asymptomatic athletes. However, in the past, rest was recommended as the primary treatment for symptomatic patients. More recent evidence has shown the detrimental effects of excessive rest on recovery. This chapter reviews research related to rest and activity following a concussion, as well as indications for exertion therapy.

2. Exertion Therapy for Concussion Rehab

In addition to progressive exertion for return-to-play protocols, exertion therapy appears to be beneficial for patients who are symptomatic following a concussion. This chapter will discuss the current evidence related to patients who may benefit from exertion therapy, along with type and timing of intervention.

3. Cervical Spine Considerations in Concussion

Cervical spine dysfunction is an important underlying issue in the management of patients after a concussion. This chapter discusses key cervical considerations, including tests and measures, and whether dizziness may be due to cervical influences.

4. Negative Outcomes: Second-Impact Syndrome (SIS) and Chronic Traumatic Encephalopathy (CTE)

Much media attention has been focused around serious conditions connected to concussion. This chapter provides evidence-based information related to CTE and SIS, with discussion of gaps in the current literature.

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