Concussions may range from mild to severe and present very differently for each person.  In this ever evolving field it is important to have a practitioner specialized in concussion assessment and treatment to ensure a speedy recovery. If you are having symptoms we are here to provide comprehensive assessment, treatment, and referral within our team of concussion specialized providers as needed.

Vestibular Ocular System

The vestibular system is located within the inner ear and is one of the three balance systems of your body (the other two being vision and somatosensory).  When disrupted following a concussion injury the following symptoms may present:

  • Dizziness
  • Headache
  • Fogginess
  • Nausea
  • Space and motion discomfort
  • Blurred/double vision
  • Balance problems
  • Poor visual concentration 

A vestibular physical therapy assessment will test all of the systems as well as screen the cervical spine to determine the source(s) of your symptoms. The Physical Therapist will then use this information to appropriately design a treatment plan. 

Exertion Testing and Treatment

The latest recommendations following a concussion injury are a brief period of rest (24-48 hours) followed by beginning daily subthreshold aerobic exercise. In fact, research has found that performing aerobic exercise actually speeds recovery! How does one know where to start? We perform a graded walking treadmill test while monitoring heart rate, perceived exertion, and your symptoms and will determine if there is an issue with blood flow. If this is part of what is causing symptoms the treatment is exercise and we will provide a detailed prescription based on your test.

For our athletes, we also provide more extensive exertion testing that will further test the cardiovascular system as well as the vestibular-ocular demands required for safe return to sport. Any areas that need continued work will be addressed with formal training (specific to your sport) in our strength and conditioning gym.

Cervical Spine/Neck Assessment and Treatment

A comprehensive approach to concussion rehabilitation must also address the cervical spine. Due to the high forces required to sustain a concussion, we consider every concussion to be a whiplash injury. Dysfunction in the neck/cervical spine can cause headaches, dizziness, vision and balance issues, and cognitive issues to name a few. It is important to have an experienced practitioner thoroughly assess to determine where these symptoms are coming from as there can be multiple sources including the spine.   As part of the physical therapy assessment process the cervical spine will be evaluated to determine the need for treatment. 

Cervical spine treatment may include: joint mobilization, myofascial release, postural training, stabilization training, and progressive resistive strengthening.

Concussion Experience

 Kirsten Carmichael PT,DPT,CSCS gained experience with concussions early in her career while working for Dr Saglimbeni and the California Concussion Institute in San Jose, CA as he created the first comprehensive concussion clinic in the area. Following the model developed at UPMC she worked together with the doctors and a Vestibular Therapist performing the Exertion Therapy and cervical spine treatments for post-concussive patients.  In May 2016 Kirsten and her husband moved to Roseville, CA where she discovered a need for post-concussive care in the area. She combined her prior experience with further continuing education in the areas of concussion and vestibular rehabilitation to develop a comprehensive concussion program in her new home.  She has teamed up with several of the concussion specialized doctors in the area working together to provide a comprehensive approach to care. Her goals are to further education, treatment, and prevention of concussions and she is passionate about staying up to date on the latest research in these areas. She recently completed her first presentation at the 2019 California Concussion Institute Symposium.