Our research has indicated that concussions can involve different clinical profiles or subtypes that require a comprehensive multidomain evaluation and targeted approach to treatment. Each of these clinical profiles is characterized by specific symptoms and impairment that can be matched with the appropriate treatments. Additionally, these injuries can typically involve multiple, often overlapping affected domains including but not limited to anxiety/mood, vestibular, migraine/headache, ocular, cognitive, and sleep. Early identification of individual's clinical profile(s) allows for clinicians to prescribe matched active therapies and rehabilitation techniques that focus on the cause rather than the symptom to aid in reduced recovery times.
Targeted Mulitdomain Interventions (TMD)
Active and targeted approaches to concussion management is at the center of the UPMC Sports Medicine Concussion Program treatment model. Previously, prescriptions of rest and restriction of activity, physical and mental, were a cornerstone of concussion management. However, research has found that this can cause increases in symptom burden, exercise intolerance, and worse changes in mood (e.g., anxiety and depression). Instead, matching active treatments to an individual's clinical profile can be shown to improve recovery following a concussion. Along with standard behavioral management strategies (sleep, nutrition, non-contact exercise, etc.), individuals can be prescribed rehabilitation techniques associated with their profile, such as vestibular therapy for dizziness and balance issues or psychotherapy for problems with increases in anxiety or depression. While there is agreement for the use of targeted rehabilitation techniques, more research is required to identify effects on therapy combinations and optimal timing and dosage.
TMD in Older Adults
Although concussion is a common occurrence in older adults, we know little about the injury in this at-risk population. Certain management tools that might be appropriate for adolescent and young adult populations may not be appropriate for use in older adults who may have sensory, cognitive, and neuro-motor limitations. Our lab aims to help to develop initial evidence for targeted treatments for concussion in older adults.