POTS After Concussion

There is a growing body of evidence that some patients with post-concussion syndrome develop a dysfunction of their autonomic nervous system known as Postural Orthostatic Tachycardia Syndrome (POTS) (Kanjwal et al., 2010; Heyer et al., 2016; Pertab et al., 2018). Although more common in children and adolescents, it can occur in adults as well. 

POTS may be diagnosed by: 

  • Cardiologists, 
  • Neurologists
  • Doctors who specialize in autonomic neuropathy  

If you have a patient with a known POTS diagnosis, or you suspect they may have POTS, here are three quality online resources to investigate:

  1. Dysautonomia International has a quick 4 minute educational video about POTS – great for patients and family members trying to understand the pathology
    (Shoutout to Malou Cristobal, PT, DPT at the NY VA for her Tweet about this video)
  2. Cardiology tech group MyHeart.net explains how POTS is diagnosed 
  3. This comprehensive research article by Miranda et al. (2018) gives a solid and detailed picture of POTS and post-concussion syndrome, including:
    • Pathophysiology, 
    • Presentation (including common comorbidities such as Ehler Danlos syndrome, mast cell disorders, and autoimmune disease), and
    • Medical and exercise therapy treatments

Clinical Pearl

POTS Exercise Training Protocol

Once a patient with POTS is receiving physical therapy, it is important to utilize a graded exercise program, starting primarily in supine and then progressing the patient to more upright exercise over gradually longer durations. Here is an excellent sample exercise protocol for activity ideas, developed in Texas and modified by the Children’s Hospital of Philadelphia.

Want to learn more? Here’s 10 Facts Doctors Should Know About POTS

Product Update

Insight Infrared Video Goggles

We are proud to announce that we have contracted with the manufacturer for the upgraded goggles and have finalized the features. We expect to have the first set of new units available in December 2019.  Current customer receive the upgraded goggles for free!  Here’s the list of our new features:

  • Fixation Light – one light for each eye with a low profile switch on the top of the front cover for reliable access
  • Shorter – Increased ease of positioning for downward facing positions e.g. nose down position during Epley/CRM
  • Lighter – The new design uses lighter materials for a streamlined form factor
  • Cushion – Improved comfort and nose fit while maintaining light blockage
  • Strap –  Smooth, easily cleaned silicone material, quick release buckle for quick removal, and refined tightening/loosening adjustment lever
  • Removable Cover – Patient can view the room without having to take off the goggles 

 

Practice Tips

Increasing Referrals to your Vestibular Practice

Looking to grow a robust and successful vestibular caseload? Check out this article about 5 strategies to increase referrals for your vestibular practice. The article even includes a quick informational marketing handout (pdf) that current users of the Insight Infrared Video Goggles can email or physically provide to their referral sources!

 

Frequently Asked Questions

Improving Comfort and Reducing Light Leakage at the Nose

  • Question: How do I improve the nose comfort and reduce light leakage around the face cushion when using the Insight Infrared Video Goggles?
  • Answer: You’re in luck! We’ve just developed two short educational videos to demonstrate how to optimize face cushion placement for nose comfort and light blockage

Organizations to Know

Matt Rome’s Physical Therapy Nation + Vestibular Video Library

Knowledge sharing rockstar Matthew Rome, PT, DPT, OCS provides a wide range of videos on vestibular and orthopedic exam/treatment techniques on his  Physical Therapy Nation YouTube. Also, explore his PT clinic’s Vestibular Video Library. Both are great for self-review, as well as for sharing with your students and mentees. Everybody wins!