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Activity and Exercise Intolerance After Concussion: Identification and Management of POTS

Discussion in 'Other Health News and Research' started by Murph, Jun 5, 2018.

  1. Murph

    Murph :)

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    J Neurol Phys Ther. 2018 Jun 1. doi: 10.1097/NPT.0000000000000231. [Epub ahead of print]
    Activity and Exercise Intolerance After Concussion: Identification and Management of Postural Orthostatic Tachycardia Syndrome.
    Miranda NA1, Boris JR, Kouvel KM, Stiles L.
    Author information
    Abstract

    BACKGROUND AND PURPOSE:
    Postural orthostatic tachycardia syndrome (POTS) is increasingly recognized as a complication affecting recovery from concussion. Individuals with POTS demonstrate refractory dizziness, lightheadedness, cognitive dysfunction, fatigue, headache, chronic pain, nausea and gastrointestinal dysmotility, activity and exercise intolerance, syncope, and tachycardia.

    Subtypes of POTS may include hypovolemia, hyperadrenergic states, autonomic neuropathy, and underlying autoimmunity, which may variably impact response to rehabilitation in varying ways. The subtle presentation of POTS postconcussion is often mistaken for underlying anxiety, conversion disorder, or lack of motivation for recovery. This article will present clinical features of POTS that may arise after concussion, and propose a role for physical therapists in the diagnosis and management of POTS during concussion recovery.

    SUMMARY OF KEY POINTS:
    Data recorded and entered into a database during clinic visits from a large pediatric institution indicate that 11.4% of individuals diagnosed with POTS report onset of symptoms within 3 months of sustaining a concussion. Activation of the sympathetic nervous system can result in lightheadedness, shortness of breath, chest pain, tachycardia, palpitations on standing or with exertion, and activity and exercise intolerance. Identified comorbidities in people with POTS such as joint hypermobility and autoimmune disorders can further influence recovery.

    RECOMMENDATIONS FOR CLINICAL PRACTICE:
    Physical therapists may identify signs and symptoms of POTS in a subset of individuals who remain refractory to typical interventions and who exhibit symptom exacerbation with orthostatic activity. Incorporation of an individualized POTS exercise program into current established concussion interventions may be useful, with emphasis on initial recumbent exercises and ongoing physical therapy assessment of exercise tolerance for dosing of activity intensity and duration.

    PMID:
    29864098
    DOI:
    10.1097/NPT.0000000000000231
     
    lafarfelue, sb4 and ScottTriGuy like this.
  2. sb4

    sb4 Senior Member

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    United Kingdom
    This ties in nicely with cervical spine problems and chiari. Could a significant amount of POTS be caused by spine issues?
     

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