Mild traumatic brain injuries (MTBIs) are of increasing concern in both the military and civilian populations as the potential long-term effects and costs of such injuries are being further recognized. Injuries from conflicts in Afghanistan and Iraq have increased public awareness and concern for TBI. The Proponency Office for Rehabilitation and Reintegration, Office of the Surgeon General, US Army tasked a team of physical and occupational therapists to assemble evidence-informed guidelines for assessment and intervention specific to MTBI. Given the paucity of specific guidelines for physical therapy related to MTBI, we focused on literature that dealt with the specific problem area or complaint of the Service member following MTBI. Recommendations, characterized as practice standards or practice options based on strength of evidence, are provided relative to patient/client education, activity intolerance, vestibular dysfunction, high-level balance dysfunction, posttraumatic headache, temporomandibular disorder, attention and dual-task performance deficits, and participation in exercise. While highlighting the need for additional research, this work can be considered a starting point and impetus for the development of evidence-based practice in physical therapy for our deserving Service members.
Proponency Office for Rehabilitation and Reintegration, Falls Church, Virginia (Dr Weightman); Sister Kenny Research Center, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Weightman); Department of Veteran Affairs, Miami and Broward County OPC, Sunrise, Florida; US Army Reserves, 4225th USAH/Army Professional Management Command, Forest Park, Georgia (Ms Bolgla); Division of Physical Therapy, University of North Carolina–Chapel Hill (Dr McCulloch); and Polytrauma Rehabilitation Center, Minneapolis VA Medical Center, Minnesota (Dr Peterson).
Corresponding Author: Margaret M. Weightman, PT, PhD, Sister Kenny Research Center, Abbott Northwestern Hospital, 800 E 28th St at Chicago, Minneapolis, MN 55407 (firstname.lastname@example.org).
Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Army, the US Navy, the Department of Defense, the US PHS, the NIH, or the US Government.
This project was supported in part by Margaret M. Weightman's appointment to the Internship/Research Participation Program for the US Army Center for Health Promotion and Preventative Medicine (USACHPPM) administered by the Oak Ridge Institute for Science and Education through an agreement with the US Department of Energy and the USACHPPM.
The first 2 authors thank for the other members of their OT/PT MTBI Guidance Work Group for the invaluable contributions: Marilyn Rodgers, MS, PT; Mary Vining Radomski, PhD, OTR/L, FAOTA; and Leslie Davidson, MSEd, OTR/L. We recognize our many interdisciplinary advisors as well as the other physical therapy advisors who participated in the summit and/or the development of the guidance document including Carla Alexis, PT; Yadira DelToro, CPT, USA, SP, DPT; Barbara Darkangelo, DPT, PT, NCS; Lynnette Leuty, MSPT, NCS; Jeanne Lojovich, PT, NCS; Janice Kehler, MSc, MA, PT; and Pam Millington, DPT, MS, PT. Finally, we also recognize the leadership and support of Lynne Lowe, LTC, USA, SP, DPT, PT, OCS; Mary Lopez, COL, USA, SP, PhD, OTR/L; Barbara Springer, COL, USA, SP, PhD, PT, OCS, SCS; and Barbara Sigford, MD, PhD.