TVTO Continuing Education | December 2018 | Concussion Management Workshop
Location: University of Toronto / Facilitator: Shannon McGuire, Physiotherapist
Report by Maxine Jelilyan
Last December I attended a concussion management workshop at the University of Toronto. The room was filled with Occupational Therapists (OT), Physio Therapists (PT) and one Vision Therapist, me!
The course was full of a good overview of material about how other professions assess a concussion versus how a PT or OT would assess (i.e. they would include balance, the vestibular system and oculomotor performance). However it is only physicians, nurse practitioners and neuropsychologists who can formally diagnose a brain injury. Did you know that post-injury MRI and CT imaging are usually “normal” so they can’t be used to diagnose a brain injury?
We discussed results of the CARE study, where it was discovered that athletes who were immediately removed from play recovered 3 days faster than those with a delayed removal from activity. We went over early management of concussions including rest during the first 24-48 hours and only to start activity when it could be tolerated (i.e. no symptoms (headache, dizziness, etc)). And we discussed the likelihood of sustaining a second concussion if you return to work or play too quickly.
After discussing at length about strategies and guidelines for returning to work/school/play, we talked about treatment plans including symptom reduction on how to get better sleep, how to tolerate noise and light and how to reintegrate activities of daily living to prepare the patient to get back to their daily routines as best as possible.
What’s interesting here, is that as the only vision therapist in the room, I was able to hear other professional’s perspectives on the treatment they provide, how it relates to vision rehabilitation and how we can work as a team to enhance patient outcomes. The course spent time talking about rehabilitating the visual system, including oculomotor control (controlling the muscles that move the eyes in unison), depth perception (3D vision), visual processing (how the brain processes the information taken in by the eyes), acuity (sharpness of vision), accommodative facility (the eye’s ability to make focal changes) and binocular coordination (how both eyes work together as a team). We also discussed balance, attention, memory, motion sensitivity, reading strategies (paper and screen), and body schema (“where am I in space”). All of these are looking at the visual system. The course reinforced the importance of the work we do as part of the interdisciplinary team of specialists in a concussion patient’s rehabilitation. Working and learning together can help close the gaps in a patient’s recovery.
At Toronto Vision Therapy and Optometry, we work with a lot of patients who have suffered brain injuries of all types, from playground and workplace accidents, to car accidents and everything in between. We work in conjunction with Physio Therapists, Occupational Therapists, Speech Language Therapists, Neurologists, Osteopaths, etc. This is only one of many courses attended by our team in order to give us the broadest knowledge to help our concussion patients in the best way possible. Twice now I’ve been the only vision therapist in the room (this time there were only about 100 attendees, last time were over 700!), and it makes me proud to know that our office is ahead of the curve where concussion rehabilitation is concerned. We are passionate about what we do and are thrilled for the opportunity to be part of some very successful teams of healthcare providers helping patients get back to living their best lives!