b'TECHNIQUE CouncilPersistentUpdate Post-Concussion OUR HEALTHBy Dr. Christine Foss Syndromedetermine the origin of persistent post-concussion symptoms as well as guide the exercise capacity in the return to sport.The test is performed by walking on the treadmill at 3.4 mph at zero incline. Each minute, the incline grade is increased by 1 degree. Each minute, record the heart rate and rate of perceived exertion (RPE, Borg Scale) and assess presence of symptoms. Once the treadmill reaches maximum incline (12 to 15 degrees), speed is increased by 0.4 mph each minute. Continue this until the patient reaches maximum exertion (RPE 19.5) OR exacerbation of symptoms (3/10) or patient cannot continue due to safety. Upon termination immediately record the final measurements. If the BCTT increases symptoms, then you more than likely, have an autonomic system dysfunction. If this test fails to elicit exacerbation of symptoms you need to move forward Many of us have seen patients with complaints of headaches,and evaluate the vestibular, oculomotor and cervical spine dizziness, ringing in the ears, mental fogginess and fatigue.(see image). When you have completed the exam, you will A thorough history may uncover a history of concussion.know precisely where the cause of the prodromal symptoms Patients with concussion symptoms lasting longer than threeoriginates. Now, the correct rehab can be put in place!weeks may be diagnosed with persistent post-concussion syndrome. Although, most concussed patients will recover within this time frame, there is roughly 15% of patients with concussion that fall into this category. Many times, these prodromal symptoms will continue for months or years without improvement. How can we adequately assess, treat and rehabilitate these patients? Diagnosing concussion is complex due to the lack of objec-tive diagnostic tests that document tangible manifestations. Therefore, the diagnosis of concussion is challenging and solely based on history and clinical assessment. Our obligation as healthcare professionals then is to be equipped with the evaluation skills necessary to completely determine the mitigating factors that may be related to persistent post-concussion symptoms. It is well-known that we increase the specificity and sensitivity of testing when we implement aMakdissi et al, 2017; Ellis et al 2015)multimodal approach to evaluation. Therefore, this is how the assessment of concussion should be approached.Christine Foss, MD, DC, MSEd, ATC, DACBSP, ICCSP, is past Considering the systems that may be the origin of thepresident of the NJCCSIR and an ANJC member. She is co-owner persistent symptoms post-concussion is paramount inof Advanced Sports Medicine and Physical Therapy in Riverdale. formulating your evaluation strategy. The first order of business is to tease out the system that is the causative factor. In doing this, one must evaluate the autonomic nervous system, vestibular and oculomotor systems as well as cervical spine. The Buffalo Treadmill Concussion Test (BCTT) is the test that is easily implemented in the office and can help 28 I Spring 2020 www.anjc.info'