Cervico-vestibular Home Exercise Program Feasibility

Overview

The purpose of this pilot study is to: 1. Determine the feasibility of adherence to completing the home cervico-vestibular exercise program following concussion. 2. Investigate the acceptability of the cervico-vestibular home exercise program. 3. Investigate the impact of the cervico-vestibular home exercise program on symptom reduction, return to play, and return to learn 4. Analyze the timing at which a home exercise program is typically prescribed. Participants will be asked to do and keep track of exercises made to help in their concussion recovery over a two-week period. Participants will come back to see their doctor and complete surveys about how easy the exercises were to do and if they liked them.

This will be a prospective clinical trial of the acceptability and feasibility of HEP prescription following a concussion in the pediatric population. Patients who consent to participate in this study will be given an informational handout by clinical athletic trainers that provides information about the study, the exercises in their exercise program, and a detailed progression to higher HEP levels/intensities based on their symptoms. The handout will also provide the purpose of the program, definitions of unfamiliar terms, a planning section for frequency and success, how to monitor symptoms through program completion, and how to properly access their exercises, log their completion, and track their progression in the Medbridge Go app. The exercises that will make up the HEP will consist of: aerobic activity; horizontal saccades; vertical saccades; horizontal imaginary targets; vertical imaginary targets; pencil push-ups; Vestibulo-Ocular Reflex (VOR)x1 Horizontal; VORx1 Vertical; Horizontal VOR Cancellation; and Vertical VOR Cancellation. At the initial visit, participants will also receive an exercise log in which they can mark their progression in the different HEP levels/intensities each day until their follow-up visit, their symptoms before and after completing the exercises, if the exercises worsen their symptoms, and if they were able to complete their daily exercises. Patients will also be administered the Concussion Learning Assessment and School Survey (CLASS) if they are seen in clinic during the school year. Approximately 1-week after the patients' initial clinic visit, a member of the study team will contact the patient and their family via phone call, email or text messaging and ask questions about the patients' status in the HEP protocol, their adherence to the protocol, and if they have had any difficulties in performing and/or logging the exercises on their paper/virtual exercise log. If the patient remarks on any difficulties in performing and/or logging the exercises, a member of the study team will inform the clinical treatment staff and they will reach out to the patient and/or family to instruct them on completing the program again. At the follow-up visit, patients and their caregiver(s) will be provided with a survey by a member of the study team. This survey will consist of post-intervention questions that ask about the acceptability of the HEP, with questions such as their ability and access to time to perform the exercises, their ability to progress to higher levels/intensities, if they continued the HEP as their symptoms began to improve, and if they believe the HEP helped in their recovery from concussion. Outcomes such as CLASS, time to symptom resolution, return to play and return to learn will also be collected. OPTIONAL: Patients will be contacted by a member of the study team via phone call, e-mail or text messaging approximately 1 month after their initial clinic visit. The purpose of contacting the patient at this time point will be to ask if the patient has returned to play or returned to learn, as well as if they continued to perform their home program exercises after their follow-up visit. Patients will be contacted approximately 1-month post-clinic visit only if they are not cleared to return to play and/or learn at their follow-up visit.