Traumatic Brain Injury and Concussions
This course is a two-day, advanced seminar focusing on effective identification and management of the physical symptom sequellae that may arise following a concussion or mild traumatic brain injury (mTBI). The emphasis of the course will be placed on knowledge of both neurological and orthopedic rehabilitation to effectively manage these clients, and the importance of a multidisciplinary team approach.
The primary physical symptoms following a mTBI are dizziness, balance complaints, headaches, and oculomotor dysfunctions. This course is designed to aid in the identification of these physical symptoms. We will also emphasize how the knowledge of the vestibular system, and effective pathology management, is paramount to the success of your treatment. The participant will learn common diagnosis’s following a concussion, expected recovery, outcomes and prognosis.
We will cover a variety of pathologies including diffuse axonal injury, skull fractures, complex cases of BPPV, vestibular loss, cranial nerve damage, fistulas, traumatic Meniere’s, whiplash, motion intolerance, exercise induced dizziness and balance dysfunctions. We will discuss current ‘return to play’ guidelines, their limitations and how balance plays an important role.
Complex case studies will be introduced so that participants will learn to systematically approach the examination, establish a working diagnosis and develop treatment plan and fi nally exercise prescription. Case studies will include several videos examples, focusing on key features to aid in interpretation of eye movement patterns and developing differential diagnosis from skills learned during lab.
This course is organized to build in complexity, through case presentations, guided lab and lectures to allow the learner to have a thorough understanding of how to manage this population without getting overwhelmed! Throughout the course evidence based practice is emphasized. Participants will be able to develop clear, concise treatment regimen, learn how to educate patient, families and coaches on when is the best time to ‘return to play’. Finally, participants will learn what is known in the literature, what is not known and how you as a health care provider can play a prominent role.
Upon completion of this course, participants will be able to:
- Describe the core features and overlap of symptoms from mild traumatic brain injury to post concussion syndrome protracted recovery, expected outcomes and literature updates.
- Identify possible barriers to rehabilitation following a concussion and how to address them to maximize outcomes in the most efficient, cost effective manner.
- Identify the areas of possible damage to the vestibular system following a mTBI or concussion.
- Develop advanced understanding and knowledge of how to choose the most appropriate tests to differentially diagnose vestibular and balance deficits following TBI.
- Describe the tools used for the balance and vestibular interview & evaluation and apply it to this complex population.
- Evaluate the visual system and identify abhorrent eye movement and what it means to rehab and outcomes.
- Describe how to effectively manage whiplash associated dizziness.
- Develop and perform appropriate examination and treatment options for a variety of pathologies including diffuse axonal injury, skull fractures, BPPV, vestibular loss, cranial nerve injuries, fistulas, traumatic Meniere’s, whiplash, motion intolerance, exercise induced dizziness and balance dysfunctions.
- Develop individualized treatment programs for peripheral, central vestibular and/or balance deficits following a head injury.
- Describe the importance of multi-sensory damage and interdisciplinary management.
- Develop programs that incorporate “return to play” guidelines in a more useful, clinically relevant manner.
- Describe how technological advances can help in your clinic, and how to utilize low cost evaluation and treatment tools.
Texas Children's Hospital
1102 Bates, 1st floor conference room
Houston, Texas 77030
15 contact hours or CCU’s through TPTA and AOTA
Karen Skop, PT, DPT, graduated in 2000 from University of Miami with her Master’s in Physical Therapy, 2008 from Temple University with her Doctorate in Physical Therapy. During her coursework at the University of Miami (UM), she studied under Dr. Susan Herdman, completing the fi rst of 4 “Vestibular Rehabilitation” competency course work while still a student. She was also able to have Dr. Herdman as her faculty advisor while completing research in providing visual feedback in individuals with vestibular dysfunction. It is through this mentorship she developed her love for working with individuals with vestibular dysfunction. Since graduation, Dr. Skop has continued her work in vestibular rehabilitation helping “dizzy” patients of all ages from high school athletes to geriatric population. She has worked under a variety of Neurologists, Neuro-opthamologists and Orthopedists leading the rehabilitation efforts for various clinics including Parkinson’s, stroke, vestibular disorders and sports clinics. She has published research on FIM data in stroke recovery, and currently is working on a variety of research/best practice for rehab in mild TBI, identifi cation of mTBI and its effect on the vestibular system. She currently practices for the Department of Veteran’s Affairs, National Polytrauma Center, managing rehabilitation for Veterans and active duty soldiers in a comprehensive concussion management program and vestibular disorders clinic. Dr. Skop has lectured for the Department of Defense and National Centers of Excellence regarding multisensory impairment following blast injuries in soldiers. She also lectures to residents and physicians to raise awareness and effective management of vestibular disorders. She serves as faculty for the VA’s ABPTS Neurological Residency program, lectures for the University of South Florida, and is active in the APTA.
7:30 8:00 Registration
8:00 9:30 Is This a Concussion or TBI?
- Mechanisms for Injury-blast/blunt traumas
- Co-morbidities that may impact care-PTSD, sleep, cognitive, migraine, pain, polypharmacy
- Literature update-concussions, management, neurophysiological/metabolic changes and impact on the
9:30 10:00 Anatomy and Physiology(Lecture)
- Review of CNS, CN, postural control reflexes, multiple sensory system impairments
10:00 10:15 Break
10:15 11:30 A Team Approach: Is it the Eyes, Ears, Neck or Brain? (Lecture)
- Eye movements what to look for and when to refer to a specialist
- Audiological testing- Interpretation from a rehab therapists perspective
- Whiplash associated disorders-association with neck pain, headaches and dizziness after head injury
- Multisensory & psychological considerations prioritizing treatments
11:30 12:00 Why Am I Dizzy? (Lecture/Demo)
- Key questions for differential diagnosis
- Group case study demonstrating importance of an accurate subjective exam-video analysis and discussion
12:00 1:00 Lunch (on your own)
1:00 3:45 Examination/Assessment Tools
- Basic and advanced exam skills including detailed assessment of visual, vestibular system differential diagnosis of central versus peripheral pathologies (CN
assessment, ocular misalignments, frenzel exam, aVOR, gaze stabilization, BPPV, balance testing, CTSIB, exertional testing)
- Guided lab and hands on testing including video analysis
3:45 4:00 Break
4:00 5:15 Is There a Problem with the Neck?
- Cervicogenic dizziness
- Literature update-Lecture, lab skills acquisition
- Cervical assessments-proprioception, orthopedic tests, head/neck differentiation, cervical flexion
5:15 6:15 Case Studies and Clinical Interpretation
- Guided analysis and interpretation of subjective and objective data
- Utilization of ICF model and EBM
Case studies to include: complex clinical presentation of multimodal pathologies following head trauma-single or multiple events
6:15 6:30 Wrap Up/Summary/Questions
8:00 9:00 Return to Play (Lecture/Lab)
- Learn current guidelines and ACSM/AAN recommendations
- Application and exercise prescription
9:00 10:15 Differential Diagnosis and
Exercise Prescription (Lec/Lab)
- Exercise paradigms rationale behind adaptation, substitution, habituation,vision rehabilitation
- Exercise prescription
- Management of co-morbidities during rehab
10:15 10:30 Break
10:30 12:00 Cervicogenic Problems (Lecture/Lab)
- Whiplash associated dizziness
- Proprioception and kinesthetic training
- Intrinsic muscle strengthening
- Mobilization for headaches
- Cervical dysfunction
12:00 12:45 Lunch (on your own)
12:45 2:30 Management of Central/Peripheral Pathologies (Lecture/Lab)
- Differential diagnosis-building an appropriate treatment plan from prior case studies
- Apply exercise prescription
- Prioritizing interventions
2:30 3:00 Clinical Tools and Clinical Integration
- Do it yourself sans technology
- There is an APP for that
- Wrap Up Questions
Wyndham Medical Center
Houston, Texas 77030
Nightly rate: $105.00 (price varies based on room availability)
Contact: Jade LeBeauf