Physical rehabilitation interventions for Post-mTBI symptoms lasting greater than 2 weeks: Systematic review

Abstract

Background. Heightened awareness of the lasting effects of mild traumatic brain injury (mTBI) has amplified interest in interventions that facilitate recovery from persistent post-mTBI symptoms. Purpose. The purpose of this study was to systematically review the literature to identify potential physical rehabilitation interventions that are safe, feasible, and appropriate for physical therapists to utilize with patients with persistent mTBI-related symptoms. Data Sources. The electronic databases PubMed, Cochrane Library, CINAHL, Scopus, SPORTDiscus, and Web of Science were systematically searched from database inception until June 2015. Study Selection. Studies were included if they utilized physical rehabilitation interventions and the study’s participants had a diagnosis of mTBI, a mean age of 8 years or older, and symptoms persisting an average of 2 weeks or longer. Exclusion criteria included blast injuries, diagnosis of moderate or severe TBI, or psychosis. Data Extraction. Data extraction and methodological risk of bias assessments were performed for each study. Data Synthesis. Eight studies with a range of study designs, intervention types, and outcome measures were included. The interventions investigated by the included studies were categorized into 3 types: physiological, vestibulo-ocular, and cervicogenic. Limitations. The identified studies had several significant limitations including: small sample sizes and low-level study designs. Conclusions. The results of this systematic review indicate that several physical rehabilitation options with minimal risk for negative outcomes are available for treating patients experiencing persistent post-mTBI symptoms. These options include: vestibular, manual, and progressive exercise interventions. Conclusions surrounding efficacy and ideal dosing parameters for these interventions are limited at this time due to the small number of studies, the range of interventional protocols, and lower levels of study design.