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Postural orthostatic tachycardia syndrome and concussion

...is it possible to train individuals suffering from POTS and concussion?

It is estimated that 11.4% of individuals diagnosed with postural orthostatic tachycardia (POTS) have sustained a concussion within the previous 3 months. As the symptoms of POTS include dizziness, lightheadedness, cognitive dysfunction, and fatigue, it is important to be able to distinguish 'regular' concussion symptoms from POTS.

Concussion pathophysiology is described as a metabolic process that can impact cerebral blood flow and inflammatory processes, and changes in the neural communications of the brain. These changes can impact sleep cycles, autonomic functions, and is now thought to be able to have an impact on cardiovascular autonomic dysfunction during the acute phases of concussion.   

POTS is a condition of dysautonomia that occurs during standing. Patients will often experience reduced mental clarity and 'fogginess', elevated heart rate with position changes, and generalised fatigue.  

This study describes a clinical training protocol that can be used to help patients who have suffered a concussion and may also be presenting with POTS.

The authors of this article state that the benefits of controlled and gradual exercise can be applied to those who have sustained a concussion but are also suffering from POTS. By closely monitoring the heart rates with exertion, and controlling for a reclined position with exercise, activity tolerance can be improved.

Moreover, they argue that several additional medical management treatments may be needed to support symptoms of POTS, but this is one training protocol that can be beneficial in managing concussion and POTS patients, especially in those with a complicated or delayed recovery pattern.

> From: Miranda et al., J Neurol Phys Ther 42 (2018) 163-171 . All rights reserved to The Author(s). Click here for the online summary.

Expert opinion

POTS is often overlooked in the population of individuals suffering from concussion. Clinicians should consider taking baseline vitals as part of a routine assessment for concussion.

Additionally, concussion patients - who are often labeled as having a low threshold for activity, or malingering - and report symptoms with very little exertion, may very well be suffering from POTS. Therefore, screening for POTS should be taken into consideration.

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