March is National Brain Injury Awareness Month and a good time to reflect on the unique role PTs and PTAs play in treatment and recovery. In recognition of the month, here are some great APTA resources and a roundup of recent research articles worth exploring.
APTA's Concussion and Traumatic Brain Injury Webpage
Our webpage is a good jumping-off spot to investigate the topic. It includes links to a podcast, the APTA Academy of Neurologic Physical Therapy's Special Interest Group on brain injury, resources from other organizations, and more.
Clinical Practice Guideline: Physical Therapy Treatment After Concussion
This clinical practice guideline is a multi-APTA component effort that provides a set of evidence-based recommendations for the PT's management of patients who've experienced a concussive event. The CPG includes 43 recommendations that cover screening, diagnosis, examination, and interventions, and APTA’s CPG+ analysis adds further insight. (available to APTA members only).
Get Your Head in the Game: Basic Concussion Assessment and Management
This recording of a two-day lecture presented as part of the 2021 APTA Centennial Lecture Series provides 0.8 CEUs (8 contact hours) of content focused on the evaluation and management of postconcussion symptoms using clinical subtypes.
E-Learning Course on Symptom Management
APTA partnered with the International Federation of Orthopaedic Manipulative Physical Therapists, a subgroup of World Physiotherapy, to provide this up-to-date (and affordable) presentation on the management of postconcussion symptoms from Julia Treleaven, PhD, BPhty, a lecturer and researcher at the University of Queensland, Australia. A major focus of the presentation is the importance of PTs to perform a skilled exam to determine whether the cervical spine is implicated in any of the symptoms.
APTA's PTJ: Physical Therapy & Rehabilitation Journal has a search feature that can help you uncover relevant research and other resources — with free access for members. (Tip: For a more refined search use the "advanced search" option, then scroll to near the bottom of the page to set your search results to gather more recent articles — we recommend 2016 and later.)
Here's a sampling of recent brain injury-related research of particular interest to PTs and PTAs.
When's the best time to initiate physical therapy for patients with TBI? The sooner the better.
Researchers who analyzed data from 11,937 patients with and without TBI from an urban trauma center found that late physical therapy initiation times were associated with 76% lower odds of being discharged from home without services among the TBI group (60% lower odds among the non-TBI group). Late physical therapy was also associated with increased hospital length of stay and ICU length of stay for both groups. (Journal of Surgical Research; abstract only available for free)
Aerobic exercise beginning 14 to 24 days postconcussion is well-tolerated in young adults (but doesn't seem to speed up recovery).
A pilot program that assigned young adults to a one-week aerobic exercise program (stationary cycling) during the postacute phase of concussion found that compared with a group that received a placebo protocol of stretching and calisthenics, progress in recovery was not affected. Both groups showed similar rates of improvement, reaching performance levels similar to a nonconcussed group by three months postinjury. "Aerobic exercise does not appear to negatively impact recovery trajectories of neurobehavioral outcomes," authors write. "However, tolerability may be poorer for patients with high symptom burden."(HHS public access manuscript)
Older adults with acquired brain injury need better support in goal-setting and developing realistic expectations.
In this systematic review of qualitative research, authors found gaps in literature that explores the rehabilitation experiences of older adults with ABI. This lack of sufficient understanding often results in discrepancies between "older individuals' expectations and the reality of returning home," along with "the illusory wish to return to a perceived normality." The differences between expectation and reality can impact the individual's sense of well-being and need to be addressed through care that can "humanize and facilitate older individuals' adjustment to the new reality following ABI." (Journal of Advanced Nursing)
Translingual neurostimulation could help patients who've plateaued in balance recovery.
Authors of a study published in Neuromodulation Journal reported that among a group of 122 patients who had experienced mild-to-moderate TBI with balance deficit and had plateaued in recovery, the use of either high- or low-frequency TLNS plus physical therapy resulted in significant improvement in balance and gait, as well as fewer headaches and improved sleep quality.
The cost-effectiveness of compensatory cognitive training and supported employment is rooted more in societal benefit than in health care costs.
A study from Norway that tracked the progress of 116 individuals with TBI found that compared with usual care, a more involved treatment program that included cognitive training and employment support could be cost-effective in the long-run. While health care-related costs were higher than the usual-care pathway by a net monetary benefit of 561 Euros, the societal benefits of the cognitive and employment-related program resulted in a net monetary benefit of 1,566 Euros compared with usual care. Authors of the study argue that these benefits should be factored into cost-effectiveness estimates. (BMC Health Services Review)