Answer:

Shelly Massingale, PT, MPT: “You had mentioned you didn’t get to see Dr. Padula’s lecture, but it was so good. And he really talked a lot about just focal binding, where we need to move out into the periphery more and not be so centrally fixated with our therapy, really. So this question is, during Dr. Padula’s lecture, he talked about how VMS is more of a visual processing deficit. You seem to classify it as a vestibular issue. I’m guessing they’re related, as vision and vestibular are so tightly linked, but can you go more into what you think the causes of and the appropriate treatment for VMS is?”

Anne Mucha, PT, DPT, MS, NCS: “What I know is that, in patients who have visual motion sensitivity, there is an interactive effect. It’s visual and vestibular, and it’s a problem generally with people becoming visually dependent because they don’t use their vestibular system effectively. So I don’t think it’s only about visual processing. I think it’s about the fact that you would normally not be bothered by that stimulus because you would switch to using your vestibular sensation normally, but now, because you are dependent on using your eyes for all of your balance function in this particular issue, then you’re much more sensitive to anything that has movement or optic kinetic flow or complexity, or when you’re just moving your head. I would potentially just think about this a little differently. I think it’s an interactive effect, and so I think it’s about training somebody to utilize all their sensory inputs appropriately and to also filter the visual system better. So, that’s how I conceptualize it.”

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RESOURCES & LINKS:

• This Q&A is an excerpt from the Concussion Health Summit Sessions
• The Concussion Health Summit Sessions are included with 360NeuroGO Enterprise

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FACULTY:

Anne Mucha, PT, DPT, MS, NCS

An expert in the assessment and rehabilitation of balance, dizziness and visual symptoms following concussion, Anne Mucha coordinates the vestibular rehabilitation for the Concussion Program at UPMC. In addition to her clinical practice, she works in research and also serves as an adjunct faculty member at the University of Pittsburgh. Dr. Mucha, with 20 years of clinical experience, has lectured nationally on the subject of concussion and, in particular, the presence and treatment of balance and vestibular concerns after concussion. Dr. Mucha holds appointments on national concussion panels for the American Physical Therapy Association. Mucha, board certified as a neurologic physical therapist, is a Pittsburgh native.

Shelly Massingale, PT, MPT

Shelly Massingale is the Service Line Administrative Director for Sports Medicine at Banner in Arizona. She is a specialist in vestibular and balance therapy. Shelly has been practicing physical therapy in the outpatient neurological setting for 22 years and has specialized primarily in mild traumatic brain injury since 2013. Since opening the Banner Sports Medicine and Concussion Center in 2013, she has focused her treatment and research solely on concussion. She is a co-developer of the Concussion Balance Test (COBALT) and has published articles that explored the utility of COBALT as an objective measurement of balance for the healthy and injured athletic population.