Managing Persistent Post-Concussive Symptoms: Treatment Strategies After covering introduction and imaging of persistent post-concussive symptoms (PPCS), also termed post-concussion syndrome, we continue moving forward...
Managing Persistent Post-Concussive Symptoms: Treatment Strategies After covering introduction and imaging of persistent post-concussive symptoms (PPCS), also termed post-concussion syndrome, we continue moving forward to examine treatment strategies. The recommendations have been evolving over time and treatment for both acute and persistent concussive symptoms and has changed substantially from original strategies. Many providers will remember some advocating for waking the patient up every 1-2 hours in case there is a hemorrhage and goes unconscious.
Other dated recommendations included complete physical and cognitive rest with minimal stimulation until symptoms resolved. Treatment strategies will continue to evolve as more studies are undertaken and a more comprehensive team approach is becoming more common. Persistent symptoms related to concussion are a source of frustration for both the patient and provider.
The medical community has made strides in assessing and targeting treatment for PPCS in recent years. This begins with a detailed history that includes prior migraines and their patterns, ADHD or learning disability symptoms, depression or anxiety and how these have changed since their injury. Another aspect specific to females is any changes in menstrual cycle due to increased risk of abnormal patterns.
A thorough physical examination including a vestibular, oculomotor, neurologic (including balance assessment) and cervical examination should also be performed. Neuropsychiatric testing may also be done to monitor progress and recovery. Submaximal Exercise One of the most promising treatment strategies is submaximal exercise that does not exacerbate symptoms.
Patients with PPCS were shown to have shorter exercise duration, lower heart rate at test cessation and higher rating of perceived exertion (RPE) than matched controls (2-3). Aerobic treadmill testing has been used to evaluate and treat PPCS. The test most often used is the Buffalo Concussion Treadmill Test (BCTT) in which patients walk on a treadmill at increasing speed and grade and rate their symptoms and perceived exertion, all while undergoing heart rate monitoring.
If you are experiencing symptoms that may be related to persistent post-concussive symptoms (ppcs): treatment strategies, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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