An active approach in the treatment of post-concussion syndrome -
Evidence-based practice in a collective case study
Abstract
Rational, Aims and Objectives: Prolonged symptoms after a mTBI, known as
Post-Concussion Syndrome (PCS), remains a challenging area of
rehabilitation. Evidence shows that an active approach can improve
prognosis, however PCS is a multifaceted condition with many
comorbidities and large variety in patient response. This study
investigated the use of submaximal aerobic exercise and body awareness
therapy, and the influence on symptoms in PCS cases, viewed through the
lens of evidence-based practice (EBP). Method: Four cases were separated
into two case studies. Cases in Study A received an aerobic exercise
protocol consisting of 8 individual sessions distributed twice a week
over 4 weeks, with additional cervical endurance training. Cases in
Study B received a body awareness therapy protocol consisting of 6
guided practices distributed twice a week over 3 weeks. Using method
triangulation, both quantitative and qualitative data were gathered
through the use of the Rivermead Post-Concussion Questionnaire (RPQ) and
semi-structured interviews, as well as the Craniocervical Flexion Test
(CCFT) in Study A, and the Short Form-36v2 (SF-36) questionnaire in
study B. Lastly, research evidence on PCS was included to contextualize
cases. Results: Both cases in Study A showed marked improvements in
their RPQ scores, but only one showed improvement in the CCFT. In Study
B, one case improved in RPQ score and in the mental component of
SF-36v2, while the other case did not experience any significant change.
All cases expressed positive associations with the interventions during
the interviews. Conclusion: These results illustrate how an active and
individualized approach can represent important qualities that can be
applied to further and larger studies. Based on the results and
discussion of this paper, relevant findings and suggestions are
summarized in a modified EBP model, which may be of help to
practitioners in dealing with PCS patients in the clinical practice.