Con­cus­sion aware­ness needed with fall sports

Phys­i­cal ther­a­pists of­fer ways to di­ag­nose, treat brain in­juries

Maryland Independent - - Front Page - By DAR­WIN WEIGEL dweigel@somd­ Twit­ter: @somd_bized­i­tor

Con­cus­sions in sports com­pe­ti­tions have been get­ting a lot more at­ten­tion in the last four or five years, and area phys­i­cal ther­apy clin­ics are com­ing up with ways to de­tect any phys­i­cal fall­out as­so­ci­ated with a brain in­jury and de­velop a treat­ment strat­egy.

“It’s a grow­ing thing, es­pe­cially as more and more peo­ple are con­cerned about con­cus­sions — with the movie ‘Con­cus­sion’ com­ing out last year” it spurred more in­ter­est, phys­i­cal ther­a­pist Mike O’Brien said about his Biodex Bal­ance Sys­tem test­ing de­vice, which tests bal­ance as one pre­dic­tor of a con­cus­sion. The ma­chine uses sen­sors to de­tect the slight­est move­ment while try­ing to stand still, both with eyes open and closed.

O’Brien, who’s been a phys­i­cal ther­a­pist for 19 years and cur­rently owns Free­dom Phys­i­cal Ther­apy in Me­chan­icsville, said per­form­ing a pre-con­cus­sion “base­line” assess­ment is im­por­tant for post-in­jury eval­u­a­tion and to pro­vide com­par­a­tive data dur­ing re­ha­bil­i­ta­tion so that ath­letes aren’t re­turned to play too soon. “Ath­letes re­turn­ing to play pre­ma­turely are at a higher risk of in­jury and a sec­ond con­cus­sion,” he said.

“It’s look­ing at your phys­i­cal abil­ity, your pos­ture and sway, and your bal­ance so we can get a base­line mea­sure­ment,” O’Brien said. “If you hap­pen to have a con­cus­sion, then we have a base­line mea­sure­ment to look at — we can retest you to see where you’re at and work on get­ting you back to your base­line. With­out the base­line, we’re ba­si­cally just guess­ing where you would be if we don’t have that ob­jec­tive in­for­ma­tion.”

He said cog­ni­tive test­ing, usu­ally done at the school or even right on the side­line, is an im­por­tant pre­dic­tor of a con­cus­sion and it’s pos­si­ble sever­ity. But the Biodex test — es­sen­tially a phys­i­cal bal­ance test — helps guide re­ha­bil­i­ta­tion by giv­ing an ob­jec­tive mea­sure­ment of phys­i­cal abil­ity. With­out a pre-con­cus­sion base­line test, the data is com­pared with hun­dreds of thou­sands of Biodex tests in a data­base to de­ter­mine where the ath­lete stands in re­la­tion to oth­ers in his or her age group.

“It’s nice hav­ing the ob­jec­tive mea­sure­ment with their phys­i­cal bal­ance” pre-con­cus­sion, O’Brien said. “If we do a be­fore, then we can retest. Once they’re back within a safe zone we can get them back [to their sports] and safely say they’re ready to re­turn.”

O’Brien said en­rolling in his con­cus­sion man­age­ment pro­gram, which cen­ters around the bal­ance test­ing, usu­ally costs $75, but he’s of­fer­ing it for $25 through the fall high school sports sea­son.

“It’s a re­ally easy test that’s rel­a­tively fun for the ath­letes to do,” he said. “It’s com­pletely pain free, non-in­va­sive — ba­si­cally it’s just stand­ing, work­ing on your bal­ance. It’s quick. It’s a great tool for par­ents to have for their kids. It’s kind of that miss­ing link that a lot of the con­cus­sion pro­grams don’t have — they have the cog­ni­tive part of it, but they don’t have the phys­i­cal side of it.”

The 250-pound ma­chine, which can also be used to eval­u­ate phys­i­cal prob­lems with hips, knees and an­kles, is mo­bile and O’Brien has trail­ered it to health fairs and nurs­ing homes.

“For older peo­ple, we can do a bal­ance screen,” he said. “It’s com­pared to nor­ma­tive data, so if you’re an 80-year-old it will show you where a nor­mal, male 80-year-old will test. It lets you know if you’re at risk, nor­mal or in the safe zone.”

Gateau Phys­i­cal Ther­apy, with of­fices in Cal­i­for­nia and Lusby, has re­cently signed on with the BrainyEX ther­apy pro­gram, an eight- to 12-week pro­gram that uses aer­o­bic ex­er­cise to im­prove cog­ni­tive brain func­tion and help re­ha­bil­i­ta­tion af­ter a con­cus­sion.

“It can be for any­body, whether they’re CEOs, it can be for kids, pre-con­cus­sion, post-con­cus­sion. It can be for any Alzheimer’s or de­men­tia pa­tient. Any­body who wants to in­crease their cog­ni­tive func­tion,” said Keri Ramey, man­ager and ex­er­cise phys­i­ol­o­gist at the clinic’s Med­i­cally Ori­ented Gym in Cal­i­for­nia. She’s now a “brain coach” in the new BrainyEX pro­gram.

The first ses­sion is used to as­sess men­tal abil­ity and pro­duce a base­line for com­par­i­son in fu­ture ses­sions. Each ses­sion is 30 min­utes on a piece of aer­o­bic ex­er­cise equip­ment, such as a tread­mill or sta­tion­ary cy­cle.

“Dur­ing the 30 min­utes they have a five minute warm-up when we’re telling them about the ed­u­ca­tion part,” Ramey said. “Then they go into their main ex­er­cise part get­ting their heart rate up — get­ting any­where from 56 to 61 per­cent of their max heart rate where they’re still able to talk to us. The last five min­utes are the brain­storms and brain chal­lenges.”

Dur­ing that last five min­utes, the client is asked ques­tions about the ed­u­ca­tional first five min­utes and their abil­ity to re­call in­for­ma­tion and the rate of re­call are com­pared against the base­line drawn from the first ses­sion. Ramey said a demon­stra­tion with col­leagues showed prom­ise for short-term im­prove­ments.

“I did a demo with a cou­ple of our em­ploy­ees in the Lusby of­fice and you could see that the oxy­gen was get­ting to their brain be­cause they were an­swer­ing ques­tions a lot quicker,” she said.

She said the pro­gram is re­ally meant to pro­mote life­style changes — more aer­o­bic ex­er­cise, bet­ter eat­ing, mon­i­tor­ing stress — to im­prove or re­tain cog­ni­tive func­tion over the long term.

The ben­e­fit is “not long term, like any ex­er­cise and any ben­e­fit, you’d have to con­tinue do­ing some­thing,” Ramey said. “You don’t have to keep do­ing BrainyEX af­ter BrainyEX af­ter BrainyEX, you just have to keep that life­style up and con­tinue do­ing aer­o­bic train­ing. It’s good ed­u­ca­tion for any­body. Not only does it pro­mote brain health, it pro­motes a healthy life­style.” The clinic is charg­ing $105 for ev­ery three ses­sions.

Clinic owner and phys­i­cal ther­a­pist Bon­nie Gateau, who started Gateau Phys­i­cal Ther­apy in Lusby in 1987, is a be­liever in bring­ing brain health into the phys­i­cal ther­apy equa­tion for those who’ve suf­fered con­cus­sions, have some form of de­men­tia or just want to im­prove their cog­ni­tive abil­ity.

“I’m go­ing to do the pro­gram my­self,” she said. “I’m re­ally ex­cited to of­fer it. It’s a re­ally awe­some tool.”


Gateau Phys­i­cal Ther­apy owner Bon­nie Gateau, left, and man­ager and ex­er­cise phys­i­ol­o­gist Keri Ramey pose with a BrainyEx sign in the Cal­i­for­nia of­fice’s Med­i­cally Ori­ented Gym. The ther­apy clinic also has an of­fice in Lusby.

Free­dom Phys­i­cal Ther­apy owner Mike O’Brien gives a demon­stra­tion of the Biodex Bal­ance Sys­tem that can de­ter­mine when some­one has had a con­cus­sion and ther­apy may be needed.

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