10. The Invisible Injury: Concussions w/ Mike Keenan and Steve Vandenberg - a podcast by Mike Quintans, PT, DPT, OCS, TPI

01:50 - Mike Keenan has worked in outpatient PT and sports performance since 2008. He specializes in vestibular conditions including sports concussions.

02:17 - Steve Vandenberg has worked in outpatient neurological rehabilitation over the past 6 years as a PT supervisor. Steve is an ImPACT trained PT specializing in concussions.

03:40 - What is a concussion? It’s a traumatic brain injury. They’re classified them on a spectrum from mild to severe.

04:30 - Symptoms of concussion: The first place to start is that no two concussions look the same. It can be challenging to assess which services should be appropriate because there are so many symptom combinations.

• Vestibular system (dizziness with head movement, blurriness)
  
  


• Ocular system (difficulty reading, tracking items)
  
  


• Cognitive (difficulty in school)
  
  


• Exertion (getting back to working out)
  
  


• Post-traumatic headaches
  
  


• Cervical spine
  
  


• Anxiety and mood (psychology services)
  
  

07:30 - Sometimes, patients don’t get to specialists until symptoms lessen. This can make concussions challenging to diagnose. Some providers still push rest. That’s great, but you have to see a specialist. Research is continuing to change.

10:40 - Concussions don’t always happen from a direct impact to the head. It can also happen through an impact to the body that affects the brain movement.

12:00 - Parents, teachers, coaches, and team doctors should take a close eye on their athletes, even if it’s a seemingly minor impact. An athletic trainer should spot some symptoms like unsteadiness, athletes looking confused, etc. They should do an on-field assessment and retest in about 5 minutes. Symptoms can be delayed so retesting is important! They should then be reassessed at 24 hours.

15:00 - Blinking of the eyes can also be a symptom. Usually, this is because of vision focusing or sensitivity to light.

19:30 - 70% of concussions will recover with relative rest within the first 24-48 hours and recover naturally with gradual re-exposure as tolerated. The other 20% — 30% are the patients we see in the clinic that did not recover naturally.

20:30 - If that 20%-30% gets their concussions diagnosed early, there’s research that with treatment, they can get back on the field sooner. For those in the 70% group, assessment won’t harm anything. Insurance can get in the way of seeing a sports medicine doctor with experience in concussions right away. The ATC should be able to give a recommendation.

27:40 - You have to be 24 hours symptom-free then do an exertional activity. If you gain symptoms from exertion, then you just have to repeat the cycle of 24 hours symptom-free.

40:00 - What should we be doing better with concussion management? One area we can improve on is “return to learn.” There are CDC guidelines for “return to play” and getting an athlete back on the field. Getting someone back to the classroom effectively is just as important, if not more important.

56:30 - Everyone involved in an athlete’s care needs to be informed. The PT should have direct communication with the athletic trainer.

1:06:00 - They guests don’t believe in concussion prevention. You can’t technically prevent a concussion. But there are things like peripheral vision and neck strength that can help reduce the risk of concussions. How to head the ball in soccer or tackle correctly can also help.

Further episodes of On Q Performance Therapy Podcast

Further podcasts by Mike Quintans, PT, DPT, OCS, TPI

Website of Mike Quintans, PT, DPT, OCS, TPI