Wong Christopher Kevin, Ziaks Lauren, Vargas Samantha, DeMattos Tessia, Brown Chelsea
Columbia University Irving Medical Center.
Park City Hospital, Intermountain Healthcare.
Int J Sports Phys Ther. 2021 Feb 1;16(1):12-20. doi: 10.26603/001c.18825.
After concussion many people have cervicogenic headache, visual dysfunction, and vestibular deficits that can be attributed to brain injury, cervical injury, or both. While clinical practice guidelines outline treatments to address the symptoms that arise from the multiple involved systems, no preferred treatment sequence for post-concussion syndrome has emerged.
This study sought to describe the clinical and patient-reported outcomes for people with post-concussion symptoms after a protocol sequenced to address cervical dysfunction and benign paroxysmal positional vertigo within the first three weeks of injury, followed by integrated vision and vestibular therapy.
Retrospective longitudinal cohort analysis.
Records from a concussion clinic for 38 patients (25 male 13 female, aged 26.9±19.7 years) with post-concussion symptoms due to sports, falls, assaults, and motor vehicle accident injuries were analyzed. Musculoskeletal, vision, and vestibular system functions were assessed after pragmatic treatment including early cervical manual therapy and canalith repositioning treatment-when indicated-integrated with advanced vision and vestibular rehabilitation. Patient-reported outcomes included the Post-Concussion Symptom Scale (PCSS) for general symptoms; and for specific symptoms, the Dizziness Handicap Index (DHI), Convergence Insufficiency Symptom Scale (CISS), Activities-specific Balance Confidence scale (ABC), and the Brain Injury Vision Symptom Survey (BIVSS). Paired t-tests with Bonferroni correction to minimize familywise error (p<0.05) were used to analyze the clinical and patient-reported outcomes.
After 10.4±4.8 sessions over 57.6±34.0 days, general symptoms improved on the PCSS (p=0.001, 95%CI=12.4-30.6); and specific symptoms on the DHI (p<0.001, 95%CI=14.5-33.2), CISS (p<0.002, 95%CI=7.1-18.3), ABC (p<0.024, 95%CI=-.3 - -.1), and BIVSS (p<0.001, 95%CI=13.4-28.0). Clinical measures improved including cervical range-of-motion (55.6% fully restored), benign paroxysmal positional vertigo symptoms (28/28, fully resolved), Brock string visual convergence (p<0.001, 95%CI=3.3-6.3), and score on the Balance Error Scoring System (p<0.001, 95%CI=5.5-11.6).
A rehabilitation approach for post-concussion syndrome that sequenced cervical dysfunction and benign paroxysmal positional vertigo treatment within the first three weeks of injury followed by integrated vision and vestibular therapy improved clinical and patient-reported outcomes. : 2b.
脑震荡后，许多人会出现颈源性头痛、视觉功能障碍和前庭功能缺陷，这些可能归因于脑损伤、颈椎损伤或两者皆有。虽然临床实践指南概述了针对多个受累系统出现的症状的治疗方法，但尚未出现针对脑震荡后综合征的首选治疗顺序。
本研究旨在描述在受伤后的前三周内按照处理颈椎功能障碍和良性阵发性位置性眩晕的方案进行治疗，随后进行综合视觉和前庭治疗后，有脑震荡后症状的患者的临床和患者报告的结果。
回顾性纵向队列分析。
分析了一家脑震荡诊所中38例（25例男性，13例女性，年龄26.9±19.7岁）因运动、跌倒、袭击和机动车事故受伤而出现脑震荡后症状的患者记录。在包括早期颈椎手法治疗和必要时的耳石复位治疗，并与高级视觉和前庭康复相结合的实用治疗后，评估肌肉骨骼、视觉和前庭系统功能。患者报告的结果包括用于评估一般症状的脑震荡后症状量表（PCSS）；以及用于评估特定症状的头晕残障指数（DHI）、集合不足症状量表（CISS）、特定活动平衡信心量表（ABC）和脑损伤视觉症状调查（BIVSS）。使用带有Bonferroni校正以最小化家族性错误（p<0.05）的配对t检验来分析临床和患者报告的结果。
在57.6±34.0天内进行了10.4±4.8次治疗后，PCSS上的一般症状有所改善（p=0.001，95%CI=12.4-30.6）；DHI（p<0.001，95%CI=14.5-33.2）、CISS（p<0.002，95%CI=7.1-18.3）、ABC（p<0.024，95%CI=-0.3--0.1）和BIVSS（p<0.001，95%CI=13.4-28.0）上的特定症状也有所改善。临床指标得到改善，包括颈椎活动范围（55.6%完全恢复）、良性阵发性位置性眩晕症状（28/28，完全缓解）、Brock线视觉集合（p<0.001，95%CI=3.3-6.3）以及平衡误差评分系统得分（p<0.
