Guideline for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms
Ontario Neurotrauma Foundation. (2018).
Toronto, ON (Canada): Ontario Neurotrauma Foundation, i-244.
This update of a 2013 guideline provides recommendations for the management of mild traumatic brain injury (mTBI) and persistent post-concussive symptoms in adults. The target audience of this guideline includes all healthcare professionals involved in the management of mTBI, including speech-language pathologists and audiologists. Of particular interest to clinicians are the recommendations specific to the assessment and treatment of cognitive and vestibular disorders.
Ontario Neurotrauma Foundation (Canada)
Vestibular rehabilitation therapy is recommended for unilateral peripheral vestibular dysfunction in individuals with mTBI (Level A Evidence).
"Evidence-based neurorehabilitation strategies should be initiated if:
<ul>
<li>the individual exhibits persisting cognitive impairments on formal evaluation; and/or </li>
<li>to facilitate the resumption of functional activities, work, and school" (Grade A Evidence; p. 51).</li>
</ul>
Individuals with cognitive symptoms status post mild traumatic brain injury that have not resolved by 4 weeks post-injury should be referred for specialized cognitive assessment. The assessment can assist in treatment planning based on individual patient characteristics and conditions (Grade A Evidence).
The Dix-Hallpike maneuver should be used to assess symptoms of benign paroxysmal positional vertigo in individuals with mTBI once the cervical spine has been cleared (Level A Evidence).
"Evaluation by an experienced healthcare professional(s) with specialized training in the vestibular system, should include a thorough neurologic examination that emphasizes vision, vestibular, balance and coordination, and hearing. The evaluation should be conducted prior to 3 months post-injury" (Grade B Evidence; p. 53).
If the results of the Dix-Hallpike are positive for benign paroxysmal positional vertigo (BPPV) in individuals with mTBI, a canalith repositioning maneuver should be used in treatment. For both subjective and objective BPPV, the Epley maneuver should be used (Level A Evidence).
When a patient with mTBI identifies a problem with hearing, patient history should be reviewed and an otologic examination should be completed. Individual should be referred to audiology for hearing assessment if no other apparent cause is found (Level C Evidence).
Individuals with mTBI who screen positive for balance disorders should be considered for further balance assessment by a qualified health care professional (Level C Evidence).
Temporary work or school accommodations, modifications and/or assistance (e.g., use of schedules) should be implemented in individuals with persistent cognitive deficits secondary to mTBI (Grade C Evidence).
