Physical therapy evaluation and treatment after concussion/mild traumatic brain injury

This guideline was developed jointly by four APTA academies (orthopaedic, sports, neurologic and pediatric) and published in JOSPT. It addresses how physical therapists should screen, examine and treat the wide range of people who have had a concussion or other mild traumatic brain injury.

On screening, it calls for checking every patient for signs of emergency conditions, undiagnosed concussion and mental health or cognitive concerns, and referring when needed. The examination is organized around four domains: cervical musculoskeletal function, vestibular and oculomotor function, autonomic function and exertional tolerance, and motor function. Testing is sequenced according to how irritable the symptoms are.

For treatment, it emphasizes education about relative rather than strict rest and a gradual return to activity, with reassurance that most people recover. Care is matched to the impairments found: neck exercise and manual therapy, canalith repositioning for BPPV, vestibular and oculomotor rehabilitation, symptom-guided aerobic exercise, and balance and motor training.