Michael Reeves PT, DPT, ATC, CSCS

What is Concussion Rehabilitation? What is a concussion? To answer that question I think it is important to first understand what a concussion is not. A concussion is not a structural injury, meaning that it will not show up using any of our traditional imaging techniques (MRI and CT scan). If you or someone you know initially went to the ER after suffering a head injury and imaging was ordered, it was not to “rule in” a concussion, it was to “rule out” other, more serious pathology such as a brain bleed. So if it is not a structural injury what is it? Rather than impact causing the injury, rapid movement causes shearing forces that cause damage to parts of our neural cells called “axons.” This disruption causes a change in ion concentration inside and outside the cell as well as a spike in glutamate, our body’s main excitatory neurotransmitter. Initially, this change causes many cells to fire in what is called “spreading depolarization” and a lot of energy is releas...

Vestibular Diagnosis and Treatment Components of Balance Visual Somatosensory Vestibular Vestibular System: Head motion and angular acceleration detected by the semicircular canals Posterior Canal Horizontal Canal Anterior Canal Head motion (acceleration) and head position (gravity) dependent on utricle and saccule  Utricle: horizontal  Saccule: vertical Inputs from vestibular organs, visual, proprioceptive and tactile inputs integrated in the central nervous system.  Forebrain perceives orientation  Spinal cord and cerebellum are responsible for postural control  Ocular system controls eye movements At the base of each semicircular canal sits an ampula; within each ampula sits a cupula  Cupula is gelatinous and has the same density as endolymph.  The cupula is attached to hair cells which are polarized  The cupula forms an impenetrable barrier between the ampula and the semicircular canals, so otocon...