Affilate Faculty, Doctor of Physical Therapy Program, Regis University, Denver, Colorado (N.M.); Marcus Institute for Brain Health, Aurora, Colorado (N.M.); University of Pennsylvania, Philadelphia (J.R.B.); Division of Cardiology, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania (J.R.B.); Physical Therapy Department Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (K.K.); and Dysautonomia International, East Moriches, New York (L.S.).
J Neurol Phys Ther. 2018 Jul;42(3):163-171. doi: 10.1097/NPT.0000000000000231.
BACKGROUND AND PURPOSE: Postural orthostatic tachycardia syndrome (POTS) is increasingly recognized as a complication affecting recovery from concussion. Individuals with POTS demonstrate refractory dizziness, lightheadedness, cognitive dysfunction, fatigue, headache, chronic pain, nausea and gastrointestinal dysmotility, activity and exercise intolerance, syncope, and tachycardia. Subtypes of POTS may include hypovolemia, hyperadrenergic states, autonomic neuropathy, and underlying autoimmunity, which may variably impact response to rehabilitation in varying ways. The subtle presentation of POTS postconcussion is often mistaken for underlying anxiety, conversion disorder, or lack of motivation for recovery. This article will present clinical features of POTS that may arise after concussion, and propose a role for physical therapists in the diagnosis and management of POTS during concussion recovery. SUMMARY OF KEY POINTS: Data recorded and entered into a database during clinic visits from a large pediatric institution indicate that 11.4% of individuals diagnosed with POTS report onset of symptoms within 3 months of sustaining a concussion. Activation of the sympathetic nervous system can result in lightheadedness, shortness of breath, chest pain, tachycardia, palpitations on standing or with exertion, and activity and exercise intolerance. Identified comorbidities in people with POTS such as joint hypermobility and autoimmune disorders can further influence recovery. RECOMMENDATIONS FOR CLINICAL PRACTICE: Physical therapists may identify signs and symptoms of POTS in a subset of individuals who remain refractory to typical interventions and who exhibit symptom exacerbation with orthostatic activity. Incorporation of an individualized POTS exercise program into current established concussion interventions may be useful, with emphasis on initial recumbent exercises and ongoing physical therapy assessment of exercise tolerance for dosing of activity intensity and duration.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A211).
背景与目的:体位性心动过速综合征(POTS)越来越被认为是影响脑震荡康复的并发症。患有 POTS 的人会出现顽固性头晕、头晕、认知功能障碍、疲劳、头痛、慢性疼痛、恶心和胃肠道动力障碍、活动和运动耐量下降、晕厥和心动过速。POTS 的亚型可能包括低血容量、高肾上腺素能状态、自主神经病变和潜在的自身免疫,这可能以不同的方式影响康复的反应。脑震荡后 POTS 的微妙表现常被误诊为潜在的焦虑、转换障碍或缺乏康复动力。本文将介绍脑震荡后可能出现的 POTS 的临床特征,并提出物理治疗师在脑震荡康复期间诊断和管理 POTS 的作用。
关键点摘要:从一家大型儿科机构的诊所就诊记录和输入数据库的数据表明,11.4%被诊断为 POTS 的患者报告在遭受脑震荡后 3 个月内出现症状。交感神经系统的激活可导致头晕、呼吸急促、胸痛、心动过速、站立或用力时心悸、活动和运动耐量下降。患有 POTS 的人存在关节过度活动和自身免疫性疾病等合并症,这可能会进一步影响康复。
临床实践建议:物理治疗师可能会在一组对典型干预措施仍然无反应且表现出直立活动时症状加重的患者中发现 POTS 的迹象和症状。将个体化的 POTS 运动方案纳入现有的脑震荡干预措施可能是有用的,强调初始卧位运动和持续的物理治疗评估运动耐量,以确定活动强度和持续时间的剂量。可观看视频摘要了解作者的更多见解(请访问补充数字内容 1,网址:http://links.lww.com/JNPT/A211)。
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