Michelle Rumpel

A systematic review in 2012 found that there is not clear evidence for the efficacy of DFM alone, however when combined with other manual techniques it seems to be superior to exercise alone in cases of tendinopathy. bit.ly/2zPusrT #PT582 #NM

A systematic review of older individuals found that the most correlated risk factors for knee OA are obesity, past knee trauma/injury, hand OA, female gender and age rather than repetitive loading of the joint. bit.ly/2mrFYzY #PT582 #RP

@JakehansenS How often are the patients with concussions being referred to and actually treated by physical therapists? Is there a way to increase this number so physical therapists can see the pts more and make better recommendations?

#PT582 #MR I think that PT’s should absolutely be in the decision process for return to play. With the right knowledge and tools to recognize the SINSS of each individual pt, as well as having much more one on one time with our pt’s, we are in a spot to keep these athletes safe.

Although many posts suggested all PTs should be able to decide RTP, this article suggests not even all PTs should be allowed on the sidelines of games. New grads and general orthos are not prepared, only SCS. Should concussion eval be the same way? bit.ly/2KPt11H #PT582

@Christo54275309 thanks for the input! What additional training do you suggest PTs should have?

However, this article from the APTA cited a study where PTs could diagnosis and manage return to play as efficiently as physicians. (Freemont et. al 2016) apta.org/PTinMotion/201… #PT582 #MR

I think more training in recognizing all the symptoms with concussions is needed. Concussions are minor and can go unnoticed and PTs (as well as any HC provider) could miss them. #PT582 #MR

@TommyLittlePT Do you think that PTs would be just as successful in the decisions if they are not affiliated with the team?

...return to play decisions bjsm.bmj.com/content/51/11/…

#PT582 #MR This study showed that "when the team PT makes return-to-play decisions, concussion is managed just as safely as it is when the team physician is making that call", so overall I would say that PT's are just as qualified as AT's and physicians to make concussion...

@JHaggerty_SPT Do you think it is feasible to have multiple medical professionals associated with one team? Should there be collaboration for the decision then?

@PJThompson93 How do you propose distributing the information for this continuing education? Should every PT be required to do this, or just those interested in treating concussions?

@MichelleRumpel Perhaps there should be some kind of concussion CEU for PT's who haven't learned those tests, whether they are DPT's or not.

#PT582 #MR PT's are 100% capable to make return to sport decisions. Vestibulo-ocular, exertional, cognitive and cervical testing skills are learned in PT school. Paired w/ stepwise return to play protocol, we are more than capable. bit.ly/2zGcQyK

@DptShewantsthe From what I experienced at the APTA NEXT conference, not all schools are quite as heavy in neuro and vestibular training. We are very fortunate to have Dr. Heick with a background in that. What about older PTs who may not have gotten this education?

@Reannon26 If PTs take on the role of concussion evaluation, how do you think the ATs will react? Is this pushing too far into their scope of practice?

#PT582 #MR PTs are well qualified to make the return to sport decision and to provide concussion management. Since PTs are often on the sidelines making calls about msk injuries it also makes since to also allow PTs to evaluate for concussions. bit.ly/2JfmV4V

@kalechip00 Who do you think should have the final say in this decision, if not PTs?

#MR #PT582 I think that we as PTs should be allowed to suggest return to sport with injuries. With our differential dx, msk, and neuro education I think we have the ability to communicate with other health care professionals.

@houseofstark22 @NAUPT582 I agree that collaboration should occur. My concern is that with more people involved, there is a higher chance of conflicting opinions This could potentially lead to a delay in patient care if the providers cannot agree on the proper course of treatment or time of return.

@MichelleRumpel @NAUPT582 I never think collaboration is bad. I think that when it comes to a brain injury there should be multiple disciplines. However, there should be some independence. What do you think about this?

apta.org/PTinMotion/201… Here is a really interesting article by the APTA saying we have earned our spot at the table in making this decision. We have the knowledge and the understand not only how to treat concussions, but also when to return them to play. @NAUPT582 #PT582 #MR

@APulverSPT Sounds like you had a great experience in your clinic! Was the PT who did this treatment certified in vestibular rehab, or did he just have an interest in concussions? Networking is key! Maybe concussion management can be a new specialty area?

@MichelleRumpel I think we can spread the word by showing how educated we can be on the topic & reaching out to the community. But I think its sometimes difficult bc often other therapists in the clinic didn't feel they had the expertise to treat concussions.

#PT582 #MR bit.ly/2zGcQyK This article mentions a study that found concussions are managed just as safely by PTs as by physicians in making return-to-play decisions. I think we as PTs spend a lot more time with these pts&are able to observe more signs/symptoms&progress.

@krs572 @NAUPT582 Kat, I agree that multidisciplinary approaches are great to ensure a holistic view is taken. What do you recommend if there are disagreements between the different health care providers on when the patient would be safe to return?

@NAUPT582 #PT582 #MR It should be a group effort involving the pt, PT, MD and ATC. Each of these health care professionals see a different aspect of the pt, its important to collaborate to provide the best quality of care and ensure the safety of the pt. researchgate.net/publication/49…

@AlfredoSayeg Thanks for you input! Do you have any evidence to show that a PT is as good as, or better than ATs or MDs to recognize the S/S of a concussion? Do you think all PTs are equipped to make this decision, even those who are new grads?

#PT582 #MR I think as physical therapists we have the background and education to best make return to sport calls along with physicians. Specifically, we know the neurological signs involved with impairment to gauge if the athletes are safe to play immediately following injury.

@GauchoSilver @NAUPT582 Thanks for your input! Are you suggesting that RTS should occur before discharge from PT care? What if the athlete was not being treated for the concussion, but just wanted to be evaluated by a PT to return to playing. Should this be allowed?

@NAUPT582 #PT582 #MR Yes, PTs should be able to make the return to sport (RTS) decision in each state. PTs are well trained to treat PCS and are arguably more equipped to check in with athletes following their RTS to monitor progress or lack thereof.

@lilguiido94 @NAUPT582 I agree that PTs work most closely with patients, and would have a good handle on progress and s/s that still persist. In some cases, an athlete will need an MRI before RTP to ensure there are no small bleeds or complications. How would a PT address this?

@NAUPT582 #PT582 #MR PTs should be able to clear concussions for return to sport. We have an education in neuroscience and brain pathways affected during concussion. As PTs we also work most closely w/ that patient and see them most often in order to gauge their progress.

@JHaggerty_SPT Jenna, you mentioned that the article is concerned with ATs having a conflict of interest. Do you think a team PT could have the same problem, with pressures coming from the parents, coach, or organization? Should the diagnosis/RTP come from a PT not associated with the team?

@Bri_RedaSPT Bri, thanks for the insight! I agree that PTs making this decision should have plenty of exposure to patients with concussions and the treatment of them. I would like to see PTs have sports specialty or neuro speciality to ensure the best care and understanding.

#PT582 #MR I think that PTs can make a return to play call! The APTA & CAPTE think so too! bit.ly/2NK059j Iowa just passed legislation so PTs can do this. HOWEVER, PTs making this call should maybe have their OCS or special training in concussion? What are your thoughts?