Concussions are a common type of traumatic brain injury that can lead to a variety of symptoms, including headaches, dizziness, and cognitive difficulties. One less frequently discussed but significant condition associated with concussions is orthostatic intolerance (OI). This condition involves difficulty regulating blood pressure and heart rate when moving from a lying down to a standing position, leading to symptoms such as dizziness, lightheadedness, and even fainting.

What is Orthostatic Intolerance?

Orthostatic intolerance is a condition characterized by an abnormal cardiovascular response to standing. When a person stands up, gravity causes blood to pool in the lower extremities. Normally, the autonomic nervous system compensates by increasing the heart rate and constricting blood vessels to maintain blood flow to the brain. However, in individuals with OI, this compensation is inadequate, leading to decreased cerebral blood flow and symptoms of dizziness and lightheadedness. To have a diagnosis of OI, you must NOT meet the criteria for other common conditions that can cause similar symptoms such as Orthostatic Hypotension, and Postural Orthostatic Tachycardia Syndrome (POTS).

Orthostatic Intolerance and Concussions

Recent research has begun to explore the link between concussions and orthostatic intolerance. A study by Worley et al. (2021) has provided preliminary evidence that individuals with sport-related concussions may experience altered cerebral vascular control, contributing to orthostatic intolerance. This study highlights the importance of considering cardiovascular and autonomic dysfunctions in the assessment and management of concussion patients.

Key Findings from the Study

The study by Worley et al. (2021) involved athletes who had sustained concussions and aimed to investigate the presence of OI and altered cerebral vascular control. The key findings of the study included:

Increased Incidence of OI: Athletes with concussions were more likely to exhibit symptoms of orthostatic intolerance compared to their non-concussed counterparts.
Altered Cerebral Blood Flow: Concussed individuals demonstrated significant changes in cerebral blood flow regulation, which could contribute to the symptoms of OI.
Implications for Recovery: The presence of OI in concussed athletes suggests that cardiovascular and autonomic dysfunctions should be considered in the management and rehabilitation strategies for these individuals.

Evaluation of Orthostatic Intolerance Post-Concussion

Evaluating orthostatic intolerance in concussion patients involves a comprehensive assessment to identify cardiovascular and autonomic dysfunctions. Key evaluation techniques include:

Postural Blood Pressure Testing: This test involves monitoring vital signs while the patient moves from lying down to standing up. You can find testing forms here: Orthostatic Blood Pressure Test.
Exertion Testing: This test involves monitoring symptoms, heart rate, and rating of perceived exertion (RPE) during a cardiovascular test that gradually increases in difficulty. You can find testing forms here: Buffalo Concussion Treadmill Test, and Buffalo Concussion Bike Test.

Managing Orthostatic Intolerance Post-Concussion

Given the potential impact of orthostatic intolerance on concussion recovery, it is crucial for healthcare providers to incorporate cardiovascular assessments into their concussion management protocols. Here are some strategies that can help manage OI in concussed patients:

Gradual Reconditioning: Gradual reintroduction of physical activity can help improve autonomic function and reduce symptoms of OI.
Hydration and Salt Intake: Increasing fluid and salt intake can help maintain blood volume and improve orthostatic tolerance.
Compression Garments: Wearing compression stockings can help prevent blood pooling in the legs and improve symptoms.
Medications: In some cases, medications that enhance vascular tone and improve blood pressure regulation may be prescribed.
Lifestyle Modifications: Patients are encouraged to make gradual changes to their daily routines, avoiding prolonged standing and making slow transitions from lying down to standing.
Physical Therapy: A tailored physical therapy program can include exercises to improve cardiovascular fitness based on the results of your exertion testing.
Biofeedback and Relaxation Techniques: These can help patients manage symptoms by improving autonomic control and reducing stress responses.

Conclusion

Orthostatic intolerance is an important but often overlooked aspect of concussion management. The study by Worley et al. (2021) underscores the need for a comprehensive approach to concussion care that includes cardiovascular assessments and interventions. By recognizing and addressing OI in concussion patients, healthcare providers can enhance recovery outcomes and improve the overall quality of care for individuals with concussions.

References

Worley, M. L., O’Leary, M. C., Sackett, J. R., Schlader, Z. J., Willer, B., Leddy, J. J., & Johnson, B. D. (2021). Preliminary Evidence of Orthostatic Intolerance and Altered Cerebral Vascular Control Following Sport-Related Concussion. Frontiers in Neurology, 12, 620757. https://doi.org/10.3389/FNEUR.2021.620757/BIBTEX

Understanding Orthostatic Intolerance in Concussion Management