PTQ 028: Complete Concussion Management for the PT

Physical therapy can play an important role in concussion care. With appropriate training, licensed physical therapists can utilize their skill set to effectively manage concussion injuries. Dr. Cameron Marshall, Complete Concussion Management, joins PTQ.

Cam Marshall Headshot 2

Dr. Cameron Marshall is a Doctor of Chiropractic and sports injury specialist who holds a Fellowship through the Royal College of Chiropractic Sports Sciences in Canada. His primary research and clinic practice focuses on evidence-based treatment and management of concussion and post-concussion syndrome. Dr. Marshall is the founder and current president of Complete Concussion Management, a global network of sports medicine and rehabilitation clinics who provide evidence-based concussion care programs within their communities, and serves as an executive board member for Brain Injury Canada.

“When you look at all the therapies and treatments that are available for concussion patients, most of them are rehab.”

“Rehab professionals should be at the forefront of this particular injury, but a lot of therapists still aren’t really aware of the tremendous role that they can actually play.”

“It is such a huge area for therapists to get involved in and there are so many different ways in which we can help”

“The driving factor behind our programs is to empower therapists to help as many people as well possibly can.”

I asked Dr. Cameron Marshall about communication throughout the plan of care for someone with a concussion. Communication is always important, but conveying information effectively can be a challenge when the care team for someone with a concussion can be quite large. When it comes to keeping everyone up to speed, Complete Concussion Management has developed an application that provides a seamless way to keep everyone involved and up to date on the plan of care.

Education and training on the signs and symptoms of concussion are critical so that both healthcare professionals and lay people in the community are able to pick up on these injuries and know what their role is. Whether that be getting the patient to the right healthcare professional, or participating in the process of returning someone back to play or back to their prior level of function.

A coach, parent, or teacher doesn’t need to be an expert in the clinical management of someone with a concussion, but there are key signs and symptoms that everyone should know. Complete Concussion Management gives you appropriate resources, even if you’re not a healthcare professional.

A lot of courses in the past have presented good messages like “when in doubt, sit them out,” but Dr. Cameron Marshall and his team want you to know why you’re sitting someone out and what the potential implications are for that course of action down the road. It is critical to know the importance behind pulling someone out of play and also of following proper return to play strategy.

Research is constantly changing and Dr. Cameron Marshall has a system built to not only keep up with current research, but to also implement current changes into his teachings regularly. To do this, he updates his courses and modules monthly making sure he’s teaching the latest findings.

How does this work?

The process begins with a research team that analyzes the newest literature on a weekly basis. Subscribers that are part of the network get monthly research updates. Additionally, the entire course gets updated yearly. The idea behind this rigorous schedule is to provide people the most up to date information possible. By making current research easy for practitioners to apply, and essentially, easy to find, the quality of care provided can improve globally.

“Everything is so contradictory and I think that goes for all research. I think it’s important to go through it all because what you see published today will be completely refuted tomorrow, then the next day these concepts will often shift back the other way. If you were to read a couple studies here and there you could potentially believe something completely different than what is actually real.”

“What I think we need to consider is the fact that there’s always different sides of the story. We have to make sure we are reading everything and putting it all together so that we can develop the best clinical picture. Our goal isn’t to provide our ideas or what we think is appropriate, our goal is to provide a summary of the evidence. This gives people a good appreciation for what the current status of the literature is and also helps them to think critically about it and become a better clinician.”

Where is concussion treatment heading compared to what it looks like now?

“This idea of earlier return to activity is now going to be the way in which we start treating patients. How many physicians are sitting in their office with treadmills? Not very many. They’re going to outsource that to a trained physical therapist, so let’s get PTs informed because they are the ones who are going to be treating these patients.”

What if you are not around a patient population where concussions occur frequently? What are some things to look out for?

“The diagnostic criteria for concussion is minimal. There are up to 22 main symptoms, but the general diagnostic criteria for concussion is, was there a mechanism of injury?”

“Mechanism is acceleration of the head. This doesn’t necessarily mean they have to be hit directly in the head. Did they have a fall? Were they in a car accident? If someone was in a motor vehicle accident and their head didn’t hit the steering wheel, it is the head whipping back and forth causing the brain to move inside the skull.”

The bottom line is this:

“Was there an acceleration or deceleration force that occurred? Does your patient have any of the concussion signs and symptoms?  The Berlin Concussion Consensus statement is the most recent international document developed by leading experts in the field.”

“Another great tool is the SCAT 5 – Post Concussion Assessment Tool 5th edition. If you have a MOI and any one of the signs and symptoms than this is grounds for diagnosis. The problem is none of symptoms of concussion are very specific. Err on the side of caution and treat it as such.”

“If you’re a professional and you don’t necessarily feel 100% comfortable with concussion, you should probably be referring that patient on. If you’re giving the wrong advice that could create a lot of issues.”

How do you tease out comorbidities and polypharmacy in the geriatric population when it comes to concussions?

Here is a list of some good things to keep in mind when you suspect a concussion in the geriatric population. However, when you suspect a concussion is not the only time you should be considering the following. We just thought a list would be helpful.

Considerations for the Geriatric Population:

  • Higher prevalence of fractures
  • Brain bleeds
  • Brain swelling
  • Medications
  • Blood thinners
  • Are they on a new medication?
  • Medication side effects
  • Multidisciplinary communication is huge
  • Lifestyle habits
  • Do they have a spouse?
  • Do they have a Caregiver?
  • Do they have family in the area?
  • What’s their social network like?
  • One of the best indicators for recovery is a strong social network
  • Where do they live?
  • What are your resources?
  • Make sure you are understanding everything that’s going on.
  • Exercise can be beneficial, but what is their exercise capacity?
  • Do they have a heart condition?
  • Is there an increased risk for falls if they were to walk on a treadmill? (certain criteria via Buffalo Treadmill Test).
  • Higher probability to have a persistence of symptoms, some things that you would normally do with an athlete are a little bit more challenging with this population.

“There is a fear among people. I think that parents are afraid of pulling their kids out. I think that athletes, regardless of whether they are current or former, have a fear too. A lot of this stems from misinformation. As health care professionals, we have a duty to step in and provide therapy. We must also provide appropriate information to patients because we can stop a lot of this fear and make patients feel a lot better about their current health status.”

Are you interested in full clinical training regarding concussion management? How about becoming part of the Complete Concussion Management network? Visit Complete Concussion 

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