Concussion Center faculty member Dr. Bara Alsalaheen was a co-author of new concussion management guidelines for the American Physical Therapy Association (APTA). This document will serve as a resource for physical therapists working with concussed patients across the country.

Alsalaheen was one of seven experts selected by the APTA to develop these guidelines. This group represented experts from the Academy of Pediatric Physical Therapy, the Academy of Orthopedic Physical Therapy, the Academy of Neurologic Physical Therapy, and the American Academy Sports Physical Therapy. The group spent the last five years reviewing literature for rehabilitation interventions in concussed individuals in order to develop guidelines and evidence-based recommendations for the assessment and treatment of concussion by physical therapists.

According to Alsalaheen, physical therapists were seeing an increased volume of post-concussion patients with varying injury mechanisms time from injury. Additionally, there was not a standard set of guidelines in place to guide treatments for individuals with concussion across their lifespan. The new APTA concussion guidelines were established to “guide clinicians to optimize treatment outcomes by adopting the best available evidence,” he said. “The goal is to provide a more cohesive, comprehensive plan of care by integrating approaches to assessment and treatment from various impairment domains that fall within the PT scope of practice.”

Alsalaheen highlighted three key takeaways from the guidelines.

The first takeaway emphasizes concussion as a broad concern with impairments that are not always reflected in diagnostic labels. “We’re making sure our therapists are digging deeper beyond the diagnostic label. The diagnosis of concussion remains a clinical diagnosis and it doesn’t always lend itself to developing a treatment plan for the patient,” Alsalaheen said. He explained that two patients can come in with the same concussion diagnosis, but present with vastly different set of impairments. The guidelines encourage physical therapists to comprehensively examine and target four PT-relevant categories that are commonly affected after concussion.

The second takeaway is to help therapists understand where they fit into the concussion landscape and the resources available to them. “We’re very successful in managing a subset of concussion patients,” he said. “Our success is far greater when we are aware of the role of other disciplines in solving the concussion puzzle. We are encouraging our clinicians to embrace this interdisciplinary mindset and familiarize themselves with existing resources such as consensus statements by the National Athletic Trainers Association and the International Concussion in Sport Group, as well as other concussion guidelines by the DoD, VA, and the Ontario Neurotrauma Foundation.”

The final takeaway is to ensure the guidelines are explicit about gaps in knowledge. “These are areas where we feel we should direct our research efforts, to hopefully generate higher levels of evidence by the next guidelines,” Alsalaheen said. This is the first iteration of the APTA Concussion Guidelines, which will be updated every five years. “They could be updated sooner if the recommendations are no longer supported by emerging evidence,” he continued.

Alsalaheen and his colleagues have been presenting these guidelines at a national and international level since they were published in April 2020. Additionally, Alsalaheen is working with other clinicians at U-M to implement these guidelines to see how the treatment outcomes change and use the U-M approach as an implementation science model. “What we learn by implementing the concussion guidelines hopefully can be translated into developing our capacity to implement other clinical practice guidelines within our institution, as well as implementing the concussion guidelines in other institutions,” he said.