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Post-Concussion Care for Equestrians

Lisa Harris, PT, MS, HPCS, Cert MDT, MSVSc, of Cardinal Hill Outpatient Rehabilitation in Lexington, Kentucky, has worked extensively with equestrians who have experienced brain injuries.
 
Additionally, Harris owns a private practice that incorporates hippotherapy into patient’s treatment plans to assist in healing. Harris is no stranger to the saddle, either, having graduated with an “A” rating from the United States Pony Clubs; she has evented through the two-star level and has coached young riders through preliminary.
 
Her educational and equestrian background make her a vehement supporter of horses as aides in healing—both physically and mentally. She spoke recently about post-concussion care at the inaugural Horse Industry Safety Summit, held April 23 at University of Kentucky’s Spindletop Hall, in Lexington.
 
Not a One-Size-Fits-All Treatment Plan
 
Cardinal Hill Outpatient Rehabilitation has a multidisciplinary approach to managing brain-injury patients. They believe, with supportive research to back them up, that approach is the most effective in managing and alleviating concussive symptoms.
 
There is no single test that can prove if a patient has post-concussion syndrome (PCS). Patients can experience PCS in a variety of ways, but common complaints include depression, nausea, blurred or double vision, sleep disturbances, restlessness, irritability, frustration, poor memory, poor concentration, dizziness, noise sensitivity, taking longer to think, headaches, and fatigue.
 
Patients with concussions frequently experience symptoms in multiple clinical domains, including cervical (neck) pain, headaches, dizziness, imbalance, visual motion sensitivity, convergence insufficiency, cognitive fatigue, difficulty with memory and attention, and sleep disturbances, Harris said. These symptoms require various healthcare specialists to collaborate to allow for optimal functional outcomes.
 
When first assessing an injured equestrian, Harris notes the following so she has a baseline for each patient: balance, visual scanning, and how the body responds to specific questions. She also notes the patient’s pain level and strength. She then considers which modalities mighty best help the patient return to a normal lifestyle; these include vision therapy, balance therapy, physical therapy, exertional therapy, and cognitive behavioral therapy.
 
Many people with brain injuries experience visual challenges. The early diagnosis of any form of head injury is key, especially if vision is involved. In such cases, Harris refers her patients to an optometrist who specializes in neuro-optometry (a specialty field of vision care that combines neurology and optometry to determine how the damaged brain is processing information sent to the eyes) and behavioral optometry (a field that takes into consideration what visual demands each person has at work and at home, including reading or working on computers). From there the goal is to return the patient as much as possible to their pre-injury state.
 
Balance therapy is helpful for patients with dizziness or balance problems after a concussion. This type of therapy can include balance training, gaze stability training, or habituation exercises, which repeatedly exposes patients to specific motions or stimuli that prompt vertigo in an effort to decrease their effects on the body.
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