Concussion MSK Cervico-Vestibular Rehabilitation
Dr. Quesnele utilizes current best practice guidelines and research in post-injury assessment and effective tailored rehabilitation techniques in concussion care. Post-concussion is often complex and involve multiple body systems. For this reason Dr. Quesnele works very closely with medical doctors, and nurse practitioners, registered kinesiologists in an interdisciplinary care model. He frequently collaborates with other medical specialists, and health care providers such as physiotherapists, optometrists, neuropsychologists, psychologists, occupational therapists, speech and language pathologists, athletic therapists, etc. to ensure comprehensive and targeted individualized rehabilitation.
Dr. Quesnele takes the time to identify the sometimes subtle, yet important, functional deficits. This important information allows him to tailor rehabilitation strategies, including specific exercises, that help break through the cycle of persistent symptoms and help avoid prolonged recoveries.
Education remains the hallmark of any visit. Often Dr. Quesnele implements various exercises (cervico-ocular, vestibulo-spinal, vestibulo-ocular and balance/proprioceptive rehabilitation), along with soft tissue based therapies, spinal stabilization and neuromuscular control exercises, acupuncture and spinal mobilization/manipulation (depending on the case).
Dr. Quesnele, along with physician Dr. Tara Baldisera (MD) and Nurse Practitioner Shannon Kenrick-Rochon (NP), lead an interdisciplinary comprehensive concussion management program in Sudbury ON called Sudbury Sport and Exercise Medicine - Concussion Program*. Please speak with your physician or nurse practitioner about being referred to this program.
Dr. Quesnele takes the time to identify the sometimes subtle, yet important, functional deficits. This important information allows him to tailor rehabilitation strategies, including specific exercises, that help break through the cycle of persistent symptoms and help avoid prolonged recoveries.
Education remains the hallmark of any visit. Often Dr. Quesnele implements various exercises (cervico-ocular, vestibulo-spinal, vestibulo-ocular and balance/proprioceptive rehabilitation), along with soft tissue based therapies, spinal stabilization and neuromuscular control exercises, acupuncture and spinal mobilization/manipulation (depending on the case).
Dr. Quesnele, along with physician Dr. Tara Baldisera (MD) and Nurse Practitioner Shannon Kenrick-Rochon (NP), lead an interdisciplinary comprehensive concussion management program in Sudbury ON called Sudbury Sport and Exercise Medicine - Concussion Program*. Please speak with your physician or nurse practitioner about being referred to this program.
A Concussion UPDATE!
Awareness on concussion management and rehabilitation has been on the rise recently. No longer is 'getting your bell rung' a sufficient response to a head injury. The literature is clear on concussions, better termed mild traumatic brain injury (mTBI). They often resolve in weeks however, recent literature and current Berlin 2017 Guidelines have drawn attention to recurrence of symptoms and delayed recovery for longer periods of time. Once a concussion has been medically evaluated, 'red flags' or warning signs have been rule out (see resources for more information) and symptoms are abating or reducing patients may start rehabilitation.
The Berlin 2017 Consensus Concussion Guidelines have emphasized the need for targeted individualized rehabilitation with particular focus on the cervical spine and vestibular rehabilitation.
Early active rehabilitation and early exercise are emerging as important factors in speedy, uncomplicated recoveries both in acute concussion and also in more chronic or post concussion scenarios. Ensuring proper targeted rehabilitation including exercise prescription is best done in an interdisciplinary fashion. Dr. Quesnele is part of a research team that is examining the interprofessional management of concussion at a varsity athletic level in Northern Ontario and also examing efficient pathways to care in the community. He continually learns from those around him and is often reading scientific literature and attending courses/workshops to stay abreast to important changes that may influence his practice.
The Berlin 2017 Guidelines (PDF) draw special attention to 11R's that help in the management of sports related concussion.
A brief review (Please read the guideline for detailed information):
1. Recognize:
The recognition of suspected sports related concussion (SRC) is best approached using multidimensional testing. The SCAT5 currently represents the most well-established and rigorously developed instrument available for sideline assessment.
2. Remove: When in doubt sit it out!
3. Re-evaluate:
Evaluation should be performed at the emergency room or at a doctor’s office as a point of first contact
4. Rest:
Complete rest is not BEST, a brief 24-48hr period of relative rest is and then activate to tolerance
5. Rehabilitation:
The data support interventions including psychological, cervical and vestibular rehabilitation along with closely monitored active rehabilitation programmes involving controlled sub-symptom-threshold, submaximal exercise.
6.Refer:
Patients with symptoms persisting should be referred for individualised and target-specific medical, physical and psychosocial assessment/treatment. There is preliminary evidence supporting the use of:
- an individualised symptom-limited aerobic exercise programme in patients with persistent post-concussive symptoms associated with autonomic instability or physical deconditioning, and
- a targeted physical therapy programme in patients with cervical spine or vestibular dysfunction, and
- a collaborative approach including cognitive behavioural therapy to deal with any persistent mood or behavioural issues.
Higher symptom scores, pre-existing health conditions (mental health diagnoses, migraines diagnoses, learning disabilities), younger children and adolescents and girls typically can expect longer recovery times. Paying special attention and accommodating these prognostic factors is very important. Emphasis has been put on RETURN TO SCHOOL and also as with other previous guidelines return to sport for adolescents. Tailoring accommodations and modifications in a gradual manner has been recommended.
8. Return to Sport:
The process of recovery and then return to sport participation after an SRC follows a graduated stepwise rehabilitation strategy. See Guideline
9. Reconsider:
Children and adolescents should not return to sport until they have successfully returned to school.
10. Residual Effects and Sequelae:
The literature on neurobehavioral sequelae and long-term consequences of exposure to recurrent head trauma is inconsistent. See Guideline.
11. Risk Reduction:
While it is impossible to eliminate all concussion in sport, concussion-prevention strategies can reduce the number and severity of concussions in many sports...The strongest and most consistent evidence evaluating policy is related to body checking in youth ice hockey (ie, disallowing body checking under age 13), which demonstrates a consistent protective effect in reducing the risk of SRC.
Reference:
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 2016. Br J Sports Med Published Online First: 26 April 2017. doi: 10.1136/bjsports-2017-097699
*non-partnership