Complexity of post-concussion syndrome assessment and management: a case for customizing rehabilitation
Abstract Background Post-concussion syndrome is a challenging condition to manage for even the most experienced chronic pain experts. Patients’ presentations are heterogeneous with symptoms spanning physical, cognitive and emotional domains. The symptoms reported are often non-specific, making it di...
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| Format: | Article |
| Language: | English |
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BMC
2025-04-01
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| Series: | BioMedical Engineering OnLine |
| Online Access: | https://doi.org/10.1186/s12938-025-01380-x |
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| author | Nicholas Moser Milos R. Popovic Sukhvinder Kalsi-Ryan |
| author_facet | Nicholas Moser Milos R. Popovic Sukhvinder Kalsi-Ryan |
| author_sort | Nicholas Moser |
| collection | DOAJ |
| description | Abstract Background Post-concussion syndrome is a challenging condition to manage for even the most experienced chronic pain experts. Patients’ presentations are heterogeneous with symptoms spanning physical, cognitive and emotional domains. The symptoms reported are often non-specific, making it difficult for health professionals to prescribe effective rehabilitation. The aim of the present study was to examine the effectiveness of a customized rehabilitation program based on subgroup determination following a standardized clinical exam in adults with post-concussion syndrome. Methods A total of 16 adults (mean age ± SD, 38.3 ± 12.5 years) with post-concussion syndrome participated in a 6-week rehabilitation program. Participants were recruited from external community concussion clinics around the greater Toronto area, Canada. Participants underwent a comprehensive standardized clinical exam to subgroup the ostensible symptom generators into either autonomic, cervical or vestibulo-ocular. Customized rehabilitation was then prescribed based on their subgroupings. The primary outcome measure was the Rivermead Post-Concussion Questionnaire (RPQ). Secondary outcome measures included the Patient Health Questionnaire-9 (PHQ-9), the Neck Disability Index (NDI), and exercise tolerance as assessed via the Buffalo Concussion Treadmill Test (BCTT). Results Following 6 weeks of customized rehabilitation, participants on average experienced a significant and clinically meaningful change with respect to the RPQ-3 and RPQ-13 (p < 0.001). We also observed a significant change in all secondary outcome measures including a reduction in PHQ-9 (p < 0.01), NDI (p < 0.001) and exercise tolerance, expressed as heart rate threshold (p < 0.001). Conclusion The standardized exam was feasible and useful in assisting the clinician in prescribing effective rehabilitation. The 6-week customized rehabilitation program demonstrated significant changes in patient-reported persistent post-concussion symptoms and exercise tolerance. The implementation of a customized program based on a standardized exam performed to subgroup the ostensible symptom generators may be key to successful management in this population. |
| format | Article |
| id | doaj-art-eade71c9155c4916af843b4d0c806546 |
| institution | Kabale University |
| issn | 1475-925X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BioMedical Engineering OnLine |
| spelling | doaj-art-eade71c9155c4916af843b4d0c8065462025-08-20T03:53:32ZengBMCBioMedical Engineering OnLine1475-925X2025-04-0124111510.1186/s12938-025-01380-xComplexity of post-concussion syndrome assessment and management: a case for customizing rehabilitationNicholas Moser0Milos R. Popovic1Sukhvinder Kalsi-Ryan2KITE Research Institute-University Health NetworkKITE Research Institute-University Health NetworkKITE Research Institute-University Health NetworkAbstract Background Post-concussion syndrome is a challenging condition to manage for even the most experienced chronic pain experts. Patients’ presentations are heterogeneous with symptoms spanning physical, cognitive and emotional domains. The symptoms reported are often non-specific, making it difficult for health professionals to prescribe effective rehabilitation. The aim of the present study was to examine the effectiveness of a customized rehabilitation program based on subgroup determination following a standardized clinical exam in adults with post-concussion syndrome. Methods A total of 16 adults (mean age ± SD, 38.3 ± 12.5 years) with post-concussion syndrome participated in a 6-week rehabilitation program. Participants were recruited from external community concussion clinics around the greater Toronto area, Canada. Participants underwent a comprehensive standardized clinical exam to subgroup the ostensible symptom generators into either autonomic, cervical or vestibulo-ocular. Customized rehabilitation was then prescribed based on their subgroupings. The primary outcome measure was the Rivermead Post-Concussion Questionnaire (RPQ). Secondary outcome measures included the Patient Health Questionnaire-9 (PHQ-9), the Neck Disability Index (NDI), and exercise tolerance as assessed via the Buffalo Concussion Treadmill Test (BCTT). Results Following 6 weeks of customized rehabilitation, participants on average experienced a significant and clinically meaningful change with respect to the RPQ-3 and RPQ-13 (p < 0.001). We also observed a significant change in all secondary outcome measures including a reduction in PHQ-9 (p < 0.01), NDI (p < 0.001) and exercise tolerance, expressed as heart rate threshold (p < 0.001). Conclusion The standardized exam was feasible and useful in assisting the clinician in prescribing effective rehabilitation. The 6-week customized rehabilitation program demonstrated significant changes in patient-reported persistent post-concussion symptoms and exercise tolerance. The implementation of a customized program based on a standardized exam performed to subgroup the ostensible symptom generators may be key to successful management in this population.https://doi.org/10.1186/s12938-025-01380-x |
| spellingShingle | Nicholas Moser Milos R. Popovic Sukhvinder Kalsi-Ryan Complexity of post-concussion syndrome assessment and management: a case for customizing rehabilitation BioMedical Engineering OnLine |
| title | Complexity of post-concussion syndrome assessment and management: a case for customizing rehabilitation |
| title_full | Complexity of post-concussion syndrome assessment and management: a case for customizing rehabilitation |
| title_fullStr | Complexity of post-concussion syndrome assessment and management: a case for customizing rehabilitation |
| title_full_unstemmed | Complexity of post-concussion syndrome assessment and management: a case for customizing rehabilitation |
| title_short | Complexity of post-concussion syndrome assessment and management: a case for customizing rehabilitation |
| title_sort | complexity of post concussion syndrome assessment and management a case for customizing rehabilitation |
| url | https://doi.org/10.1186/s12938-025-01380-x |
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