Rehabilitation of Persistent Post-Concussion Symptoms in Retired and Active NHL Players: Clinical Case Series

Objective To present the evaluation of 12 rehabilitation cases as a case series in sports-related concussion.

Background Sport-related concussion is a common injury in the NHL. While most athletes recover within few weeks of sustaining a mild head injury, some still experience persistent symptoms for months or years after following recommended recovery and return to play guidelines.

Design/Methods Twelve male NHL athletes (6/6 active/retired; mean age/height/weight/symptom duration/#concussions [SD]: 33.4 years [7.9]: 185.8 cm [5.1]: 94.8 kg [14.6]; 121 wks: [156]; 4.3 [2.3]) with persistent but mild post-concussion symptoms were treated for 10 sessions at an outpatient neurorehabilitation center specializing in functional neurology. The athletes were evaluated before- and after treatment utilizing the C3 Logix platform. The interventions included joint manipulation, neuromuscular re-education, vestibular rehabilitation in a whole-body off-axis rotational device, orthoptic exercises, and cognitive training. Graded Symptoms Checklist (0–162), Digit-Symbol Coding, Simple- and Choice Reaction Time, and Trail Making Test A/B were analyzed in Graphpad PRISM. 9.1.0 by multiple paired t-tests with Holm-Šídák corrections. Results are reported as differences-of-means pre- to post-treatment (SE) with Cohen's d effect sizes [ES] (0.2, 0.5, 0.8 represents small, medium, and large effect sizes, respectively). p-values <0.05 were considered significant.

Results Graded Symptom Checklist score (p < 0.001): −25.1 (4.0) [1.83]; Digit-Symbol Matching speed (#symbols) (p = 0.03): 6.2 (1.9) [0.92]; Simple reaction time (ms) (p = 0.03): −74.7 (22.9) [0.94]; Choice reaction time (ms) (p = 0.009): −106.1 (26.0) [1.18]; Trails A (s) (p = 0.04) [0.80]: −2.6 (0.9); and Trails B (s) (p = 0.04): −6.0 (2.2) [0.79].

Conclusions The present case series shows that a functional neurology approach of multimodal short duration intensive therapies can produce clinically meaningful improvements with large and very large effect sizes, in both the concussion symptoms and neurocognitive performance, of 12 professional NHL players experiencing symptom stagnation.