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Concussion Management Program

What is a concussion?

A concussion is a type of traumatic brain injury that can be caused by a bump or jolt to the head or body that causes the head and brain to move quickly back and forth. There may or may not be a loss of consciousness. This movement of the brain within the skull can cause chemical changes in the brain that can result in a variety of symptoms, including:

  • Dizziness
  • Memory loss
  • Fogginess
  • Anxiety
  • Headache
  • Neck pain
  • Visual disturbances

Concussions can affect people of all ages and result from a work, sport or recreational activity. Studies have shown that a multidisciplinary approach to managing symptoms of a concussion is most effective for a successful recovery.  Should you experience a concussion, the first priority is to stop activity, sport or work, and to seek evaluation by a qualified medical professional. If your symptoms persist for more than a few days, speak with your physician regarding whether physical therapy, occupational therapy, speech therapy or vision therapy may help in your rehabilitation.

 

Burke Rehabilitation Hospital provides the following services:

Physical Therapy:
Can assist with management of neck pain, headaches, dizziness, nausea, imbalance, fogginess, intolerance to exercise and fatigue.

Occupational Therapy:
Can assist with management of blurry vision, double vision, difficulty with functional visually related tasks such as reading or computer use, and compensatory strategies for returning to work, school, or day to day activities.

Speech Therapy:
Can assist with memory impairments, word finding difficulty, attention impairments, difficulty focusing, difficulty with complex reasoning and executive function dysfunction.

Physiatrists
Available for consultation and management of rehabilitation, including pain management and medication prescription if needed. Phone: 914-597-2332

 

You may need other services to treat your concussion. Our Burke team coordinates care with the following professionals as needed:

  • Neurologists
  • Neuropsychologists
  • Neuro-Optometrists

 

Outpatient Physical Therapy and Concussion

Following a concussion, patients will often have multiple symptoms, including neck pain, jaw pain, dizziness, headaches, fogginess, visual disturbances, balance impairments, and decreased tolerance to exercise. At Burke, we utilize a variety of specialized, evidence-based techniques to assist in screening the vestibular system, visual system, cervical (neck) component and activity tolerance.

Vestibular Therapy

When you hit your head or experience a rapid acceleration or deceleration of movement, the vestibular system can be affected. The vestibular system includes parts of the inner ear and brain that help to process information involved in controlling head and eye movements. When you injure parts of the vestibular system, it can cause dizziness, vertigo, motion sensitivity, visual issues, and balance impairments.  The VOR, or vestibular ocular reflex, is typically impaired following concussion. Someone who has a normal VOR is able to keep their eyes on a stationary target while their head moves, without symptom provocation or change in vision.  Vestibular therapy can involve the following types of exercises:

  • Static and dynamic balance exercises including eyes open and eyes closed
  • Eye and eye and head exercises
  • Habituation activities to allow brain to accommodate to light/noise/specific movements
  • Convergence/Divergence and gaze stabilization activities to address visual symptoms
  • BPPV treatment
  • Education to assist with sleep and fatigue symptoms post-concussion

 

Cervical Therapy

Cervical therapy addresses neck pain or range of motion deficits.  Typical exercises include the following:

  • Soft Tissue Mobilizations to address headache and cervical pain
  • Strengthening and stretching exercises to improve posture
  • Education on correct lifting techniques
  • Education on workplace set up to maximize recovery
  • Proprioception exercises to address head and neck position sense

Return to Exercise/Sport Protocol

An exertion assessment may be completed your first week or when your vestibular symptoms are stable. This may include treadmill testing and sport specific drills, all while monitoring your heart rate, blood pressure and symptom provocation.  You will carefully be progressed through the stages of the Berlin Return to Sport Protocol in collaboration with your physical therapist.

 

Outpatient Occupational Therapy and Concussion

After sustaining a concussion, people can experience a variety of symptoms or disruptions to many of life’s roles and routines. The symptoms of a concussion can impact a person’s ability to participate in self-care, work, school, or leisure activities. If a person has any of the below complaints or symptoms, he/she would benefit from occupational therapy:

  • Avoidance or decreased tolerance for activities the patient participated in prior to concussion
  • Difficulty or decreased tolerance for reading from a book or screen
  • Difficulty with school or work related tasks (keeping track of deadlines, note taking, organizing paperwork, remembering information from a meeting)
  • Difficulty or increase in symptoms going into the community (grocery store, restaurants, etc.)
  • Difficulty using computer, tablet or cell phone
  • Increased headaches, increased time, increased errors or poor attention when performing IADL tasks (paying bills, making a meal for family)
  • Eye strain
  • Light or noise sensitivity

An occupational therapist can help with the following:

  • Train compensatory strategies for ADLs, IADLs, return to work, school or leisure activities. These strategies may allow a patient to participate more fully in their day to day routine as well as return to these activities more quickly and with less symptoms.
  • Perform a visual assessment for skills such as smooth pursuits, saccades, convergence, and accommodation. The OT can provide restorative or compensatory treatments for dysfunction of these activities and link these skills to functional tasks.

Outpatient Speech Therapy and Concussion

Speech-Language Pathologists (SLPs) are responsible for evaluating and treating cognitive-communicative deficits with concussions. Initially, the SLP will complete a formal evaluation of speech and language, social communication skills, and cognitive/communicative skills. Following the evaluation, the SLP will develop a treatment plan and provide strategies to target individual deficits.   Speech therapy can help you recover from your symptoms as much as possible and help you to learn to effectively compensate when you are having difficulty.

Some common communication and cognitive symptoms associated with a concussion:

  • Difficulty finding the right word(s)
  • Difficulty following and responding quickly in conversations
  • Feeling dazed or “foggy”
  • Slowed thinking
  • Difficulty concentrating and remembering
  • Slurred speech
  • Difficulty reading
  • Fatigue

A Speech-Language Pathologist can help with the following:

  • Information processing
  • Comprehension of spoken or written language
  • Word retrieval and thought formulation
  • Inability or difficulty paying attention or staying on-task
  • Decrease in memory function
  • Lack of or decrease in executive functioning skills such as:  initiation and completion of tasks, self-regulation, sequencing, organizing, prioritizing, time management, or mental flexibility
  • Mathematical skills

 

Getting Started

To participate in the outpatient Concussion Management Program at Burke, you will need a prescription from your doctor.  The prescription should indicate PT, OT, and/or SLP and include “Concussion” as the diagnosis.  Please have the prescription and insurance card (front and back) faxed to the desired location.  Once they are received, Burke will verify your insurance benefits and contact you to schedule an evaluation with one of our vestibular therapists at one of our locations.  After the evaluation, you will be enrolled in a treatment program where your therapist will determine the frequency of visits based on your individualized needs.

The outpatient Concussion Management Program is available at:

White Plains (physical, occupational and speech therapy)
785 Mamaroneck Ave, Building 7
White Plains, NY 10605
Phone: 914-597-2122
Fax: 914-597-2763

Purchase (physical therapy)
3020 Westchester Ave
Purchase, NY 10577
Phone: 914-597-2133
Fax: 914-253-9372

Yonkers-Ridge Hill (physical therapy)
73 Market Street, Suite 178a
Yonkers, NY 10710
Phone: 914-597-2882
Fax: 914-233-5337     

Somers (physical and speech therapy)
352 Route 100, #106
Somers, NY 10710
Phone: 914-597-2890
Fax: 914-669-5061

Yonkers-Executive Plaza (physical therapy)
6 Executive Plaza, Suite 280
Yonkers, NY 10710
Phone: 914-597-3850
Fax: 914-969-3284

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