Is Your Physical Therapy Clinic Ready to Meet Growing Demand for Concussion Rehab?
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1. Why does my clinic need a concussion rehab program?
According to the CDC, almost half a million children are treated in the Emergency Department across the United States each year for a head injury. Of these head injuries, 50% occur from falls - which is the #1 cause of concussions, followed by being struck in the head with an object, and car accidents. Since the majority of head injuries that occur are not related to sports, all clinics need to be prepared to manage concussions.
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2. What is physical therapy?
Physical Therapy (PT) is care that aims to return patients to functional independence. This means returning to the same level of activity a patient was at prior to an injury. Physical therapy addresses symptoms and functional deficits to return patients back to their normal routines.
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3. What is the difference between physical therapy and occupational therapy?
While there is some overlap in the scopes of practice between a physical therapist and an occupational therapist, the main difference is that physical therapy tends to focus on orthopedic injuries and movement whereas occupational therapy focuses on using fine motor and cognitive skills to perform activities of daily living (ADL).
The physical therapist may be involved in managing:
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- Cervical spine’s contribution to post concussion symptoms
- Vestibular dysfunction
- Ocular motor dysfunction
- Balance assessments
- Sports conditioning exercises
- Return to play exertional therapy
The occupational therapist may be involved in managing:
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- Ocular motor dysfunction
- Vestibular dysfunction
- Memory and concentration
- Functional vision activities
- Cognitive-behavioral therapy
- Environmental analysis / modification
- Return to work and activities of daily living
According to the CDC, almost half a million children are treated in the Emergency Department across the United States each year for a head injury. Of these head injuries, 50% occur from falls - which is the #1 cause of concussions, followed by being struck in the head with an object, and car accidents. Since the majority of head injuries that occur are not related to sports, all clinics need to be prepared to manage concussions.
Physical Therapy (PT) is care that aims to return patients to functional independence. This means returning to the same level of activity a patient was at prior to an injury. Physical therapy addresses symptoms and functional deficits to return patients back to their normal routines.
While there is some overlap in the scopes of practice between a physical therapist and an occupational therapist, the main difference is that physical therapy tends to focus on orthopedic injuries and movement whereas occupational therapy focuses on using fine motor and cognitive skills to perform activities of daily living (ADL).
The physical therapist may be involved in managing:
- Cervical spine’s contribution to post concussion symptoms
- Vestibular dysfunction
- Ocular motor dysfunction
- Balance assessments
- Sports conditioning exercises
- Return to play exertional therapy
The occupational therapist may be involved in managing:
- Ocular motor dysfunction
- Vestibular dysfunction
- Memory and concentration
- Functional vision activities
- Cognitive-behavioral therapy
- Environmental analysis / modification
- Return to work and activities of daily living
Setting Up a Physical Therapy Clinic:
Where do we start?
Step #1: Setting up your concussion rehab team
The first step is to look at who you have on your team already and determine which elements of concussion rehab you want to perform in-house and what therapies you’ll refer out for. No matter how you choose to staff your concussion rehab clinic, there should always be a multidisciplinary team involved in patients’ concussion care.
The concussion rehab team will work closely with the “point person” managing the patient’s concussion care. This is typically a physician, nurse practitioner, or physician assistant that has completed specialized training in concussion management.
The point person will determine if targeted rehab is necessary, and work closely with rehab professionals on the team to address specific deficits the patient is experiencing. In small clinics, the concussion rehab team may consist of just a physical therapist and occupational therapist, whereas larger clinics may also have dedicated resources for speech therapy, vestibular therapy, and vision therapy.
It’s recommended that a mental health professional also be involved in patients’ concussion care since anxiety and depression often accompany head injuries. If you don’t have this resource in house, build relationships with mental health professionals in your community.
Step #2: Choosing concussion care assessments
Having the right tools to identify patients’ deficits is critical for a successful concussion rehab clinic. While there are many assessments available, at a minimum you should have a tool for:
- Balance assessment. This may be done with a block of foam, walking tests, functional movement tests, or computerized tests.
- Ocular motor tools. This may be as simple as a vision chart or stick with letters on it.
- Cognitive assessment. This should be a computerized neurocognitive tool, such as ImPACT, that measures areas of cognition commonly affected by concussion.
In addition to having the right assessment tools, it’s also important to review international recommendations for concussion recovery and care as well as state guidelines for return to activity since the scopes of practice for concussion rehab professionals may vary state-by-state.
Step #3: Structuring your concussion rehab clinic
There is no “one size fits all” approach when it comes to structuring your concussion rehab clinic, but it is critical to determine what each discipline will be responsible for since there may be overlap in their scopes of practice. For example, addressing cognitive function could fall under the scope of practice for an occupational therapist, but it could also be addressed by speech therapists. Another example could be addressing vestibular dysfunction which could fall under the scope of practice for both a physical therapist or an occupational therapist. Having clear and defined roles for each discipline on your concussion rehab team will help avoid confusion, streamline processes, and create a more seamless patient experience.
Additionally, having open and frequent communication between disciplines is vital to get a more complete view of a patient. Understanding how a patient is progressing or not progressing throughout recovery and taking recommendations from other disciplines involved will help you tailor your treatment plan and ultimately get patients better faster. You’ll also want to have efficient communication with the “point person” who may be required to make the final return to activity decision depending on your state’s practice guidelines.
Step #4: Creating tailored concussion rehab plans
Concussion treatment plans should always be tailored to the patient's specific needs based on their symptoms, functional deficits, sports or activities, and lifestyle. It’s important to take into consideration both objective and subjective measures when creating comprehensive treatment plans. For example, a patients’ ImPACT clinical report provides insight into cognitive deficits they are experiencing, but patients’ reported symptoms are equally as important to take into consideration and address.
Home Exercise Programs (HEP) are especially important for concussion patients since their head injury causes simple, everyday tasks to be extremely taxing during recovery. The more a patient is able to perform the exercises prescribed to them by their therapist(s), the faster they’ll recover. HEPs should be created on a patient-by-patient basis and will evolve as the patient progresses.
It’s also important to take the mechanism of injury (MOI) into consideration and how that may have caused other injuries. For example, patients who were involved in a motor vehicle accident may also be experiencing cervical spine injuries.
Step #5: Getting reimbursed for concussion rehab services
Review ICD-10 codes and common occupational therapy and physical therapy CPT codes used to bill for concussion rehab services in this free online course.
Watch the webinar replay on this topic for additional takeaways.
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