Fear Avoidance Behaviors in Concussion Management: Using the Pain Science Framework to Improve Outcomes (APTA CSM 2021 Course)
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This course was originally presented at APTA CSM 2021 but has updated content for this presentation. Characteristics of individuals at risk for experiencing post-concussive syndrome (PCS) include a previous history of psychological conditions such as anxiety, depression and/or mood disorders, history of headaches/migraines and post-concussive vestibular ocular dysfunction. The nature and extent of PCS is complex and has been associated with fear-avoidance behaviors similar to those with chronic pain, fibromyalgia and persistent postural perceptual dizziness (3PD). Fear-avoidance behavior has been associated with chronic disability in musculoskeletal conditions and has recently shown to be a predictor of adverse clinical outcomes associated with concussion injury. Patients with mTBI have potential to misinterpret information regarding their injury, catastrophizing their symptomology, with resultant increased levels of anxiety and avoidance behavior over time. Physical therapists are in a unique role to alter behaviors contributing to protracted recovery through education and self-care promotion, which are hallmarks for success in the pain science model. Early intervention utilizing active rehabilitation in concussion can reconceptualize fear avoidance and potentially alter neurophysiology associated with these behaviors, decreasing the significant cost associated with post-concussive symptomology. This course aims to show the parallels between post-concussive rehab strategies and pain neuroscience to assist in combatting post concussive symptoms for improved outcomes.
Learning Objectives:
1. Conceptualize the Fear Avoidance Behavior Model as it relates to Post-Concussive Syndrome for earlier recognition and intervention
2. Demonstrate utilization of pain neuroscience framework to include patient education and earlier patient self-care promotion based on current evidence supporting active recovery.
3. Discuss available patient reported outcome measures to assist in identifying those at risk for fear avoidance behaviors
4. Demonstrate language changes and “growth mindset” approach with focus on abilities and progress during patient interactions
Course Recorded July 2021
Becky Bliss
PT, DPT, DHSc
Becky Bliss, PT, DPT, DHSc: is an Assistant Teaching Professor in the Doctor of Physical Therapy program at the University of Missouri and is board certified in Neurological Physical Therapy. She also serves the role of Program Coordinator for the Neurological Physical Therapy Residency. She holds her Certificate in Vestibular Rehabilitation from the APTA, as well as Advanced Vestibular Certificate and is an Impact Trained Physical Therapist. Becky graduated from Ithaca College Department of Physical Therapy with a combined undergraduate-graduate Master of Physical Therapy in 2001. She completed her Doctorate in Physical Therapy from Des Moines University in 2014 and her Doctor of Health Science from the University of Indianapolis in 2019. Becky has been actively practicing in the field of physical therapy for 21 years with specialization in concussion management since 2006. Her research interests include dysfunction of the vestibular ocular reflex following mild traumatic brain injury as well as early detection of impairments that lead to post-concussion syndrome and currently has several active studies specific to higher level motor control deficit identification in the sport athlete. Becky is active within the Academy of Neurological Physical Therapy and serves on the Knowledge Translation Committee for the Concussion CPG as well as is part of the core committee of the APTA Concussion CPG Revision group.
Jeff Bridges
PT, DPT, OCS, ATC
Jeff Bridges, PT, DPT, OCS, ATC is a Clinical Assistant Teaching Professor in the Doctor of Physical Therapy program at the University of Missouri and is a board-certified specialist in Orthopedic Physical Therapy. He holds a Therapeutic Pain Specialist certification through Evidence in Motion and is also a certified Athletic Trainer. Jeff graduated from the University of Missouri Department of Physical Therapy with a Master of Physical Therapy in 2001. He completed his Doctorate in Physical Therapy from AT Still University in 2008. Jeff has been actively practicing in the field of physical therapy with specialization in sports medicine, spine care, and chronic pain.
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