10/24/2018 1 Exertion: Just Do It! Annie Doda, DPT TRIA Orthopedic Center October 26, 2018 Disclosures • No disclosures to report Objectives 1. Define exertion as it relates to concussion. 2. Discuss the value of exercise during acute and protracted recoveries during concussion treatment/management. 3. Demonstrate understanding of formal exertion therapy, various tools utilized for exertion assessment, and value of sport specificity. What is exertion? • Exertion Definition – the act or an instance of exerting; especially : a laborious or perceptible effort Exert • a : to put forth (strength, effort, etc.) • b : to put (oneself) into action or to tiring effort (https://www.merriam-webster.com/dictionary/exertion, 2018) https://corticalchauvinism.com/2013/03/20/key- players-in-autism-iii-brain-weight/ Which athletes should be exerted? • All Sports Concussion Athletes – Often overlooked • Graduated RTS Strategy (McCrory et al, 2017)
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Transcript
10/24/2018
1
Exertion: Just Do It!
Annie Doda, DPT
TRIA Orthopedic Center
October 26, 2018
Disclosures
• No disclosures to report
Objectives
1. Define exertion as it relates to concussion.
2. Discuss the value of exercise during acute and protracted
recoveries during concussion treatment/management.
3. Demonstrate understanding of formal exertion therapy,
various tools utilized for exertion assessment, and value of
sport specificity.
What is exertion?
• Exertion Definition
– the act or an instance of exerting; especially : a laborious or
perceptible effort
Exert
• a : to put forth (strength, effort, etc.)
• b : to put (oneself) into action or to tiring effort
– Football: contact, designed plays, position dependent
– Lacrosse: contact, position dependent, use of stick
*Typically most motivating to pts
Formal Exertion Therapy: PT sessions
• All PTs capable of performing all aspects of concussion
management
– Vestibular
– Cervical
– Exertion
• Clinic Athletic Trainers lead progression/sport specificity
Formal Exertion Therapy
• Breakdown to the various treatment aims
– Typically a combination
– Targeted limitations to be addressed:
• High Level Vestibular sensitivity with exertion emphasis
• Autonomic Dysregulation
• Deconditioning
• Anxiety/Fear
Treatment: High Level Vestibular sensitivity
with exertion emphasisTreatment: Autonomic Dysregulation
• (+) BCTT
Identify sub-maximal threshold
20 minutes subthreshold intensity (80% of HR achieved on BCTT)
5-6 days/week
Increased 5-10 bpm every 2 weeks
Physiologic resolution – voluntary exhaustion 85-90% HR for 20
mins w/o symptoms
(Leddy & Willer, 2013)
10/24/2018
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Treatment: Deconditioning
General Strength and
conditioning Exercises
Treatment: Anxiety/Fear
• 0-100% where are you at?
– What is that remaining 10%
• Often times contact/game intensity
Summary
• All concussed athletes need to pass RTS
– Includes exertion components!
• PT can help with RTS, further assessment of prolonged symptoms
– High level vestibular sensitivity
– Autonomic Dysregulation
– Deconditioning
– Anxiety/Fear
• Formal assessments tease sensitivities
– BCTT
– TRIA Active Assessment
• Sport specificity is key
• More research needed
Thank you!
References
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postconcussion syndrome. Rehab Res Pract. 2012;705309.
• Collins M, Kontos A, Okonkwo D, Almquist J, Bailes J, Barisa M, et al. Concussion is Treatable: Statements of Agreement form the Targeted Evaluation and Active
Management (TEAM) Approaches to Treating Concussion Meeting held in Pittsburgh, October 15-16, 2015. NeuroSurgery 2016 December; 79(6): 912-929.
doi:10.1227/NEU.0000000000001447.
• Cordingley D, Girardin R, Reimer K, et al. Graded aerobic treadmill testing in pediatric sports-related concussion: safety, clinical use, and patient outcomes. J Neurosurg
Pediatr 2016;18:693-702.
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ONE 13(4): e0196062. https://doi.org/10.1371/journal.pone.0196062.
• Leddy JJ, Baker J, Haider MN, Hinds A, Willer B. A Phsyiologic Approach to Prolonged Recovery from Sport-Related Concussion. Journal of Athletic Training
2017;52(3):299-308.
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• Leddy JJ, Kozlowski K, Donnelly JP, et al. A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. Clin. J. Sport Med.
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• Leddy JJ, Willer B. Use of Graded Exercise Testing in Concussion and Return-to-Activity Management. American College of Sports Medicine 2013; 12(6);370-376.
• Lumba-Brown A, Yeates K, Sarmiento K, Breiding M, Haegerich T, Gioia G, et al. Centers for Disease Control and Prevention Guideline on the Diagnosis and
Management of Mild Traumatic Brain injury Among Children. JAMA Pediatr 2018; doi:10.1001/jamapediatrics.2018.2853
• McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport – the 5th international conference on concussion in sport held in Berlin, October
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