Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: an evidence-based classification system with directions for treatment

Abstract

Primary objective: To present a novel pathophysiological approach to acute concussion and post-concussion syndrome (PCS).

Research design: Review of the literature.

Methods and procedures: PubMed searches were performed to identify articles related to the pathophysiology and treatment of concussion and PCS. Relevant articles that contributed to the primary objective of the paper were included.

Main outcome and results: This paper presents an evidence-based approach to acute concussion and PCS that focuses on the identification of specific post-concussion disorders (PCDs) caused by impairments in global brain metabolism (Physiologic PCD) or neurological sub-system dysfunction (Vestibulo-ocular PCD and Cervicogenic PCD) that can be distinguished by features of the clinical history, physical examination and treadmill exercise testing. This novel approach also allows for the initiation of evidence-based, multi-disciplinary therapeutic interventions that can improve individual symptoms and promote efficient neurological recovery.

Conclusion: Future studies incorporating neuro-imaging and exercise science techniques are underway at the author's institutions to validate this novel pathophysiological approach to acute concussion and PCS.

Keywords: Concussion; physiology; post-concussion syndrome; treatment.