Admission criteria
The mTBI POC is for injured people who:
- have an allowed WSIB claim
- have been diagnosed with mTBI by physician or nurse practitioner
- have negative findings on all neuroimaging studies, if completed
- are 18 years of age or older
- are within three months of their date of injury
The mTBI POC is not recommended for injured people:
- with moderate or severe brain injuries
- with identified risk factors
- with a pre-existing diagnosed psychiatric disorder / psychopathology such that treatment would interfere with this condition
- with reported and observed psychological symptoms that would likely interfere with engagement in the mTBI POC
- with physical impairments or concurrent injuries or conditions that would prevent the worker from being assessed and participating in the mTBI POC
- who are under the age of 18
Program structure and duration
The program consists of two four-week blocks of care for a total duration of eight weeks. The first block includes the initial assessment and four weeks of treatment. The second block is an additional four weeks of treatment. A minimum number of visits is required to be provided in each block.
Recommended treatment interventions
- Education
- Gradual integration of activity
- Progressive exercise therapy
- Manual therapy
- Vestibular rehabilitation*
The recommended treatment interventions chosen for an injured person should be based the clinical judgement of the delivering Regulated Health Professional (RHP) and take into consideration the injured person’s functional recovery needs. To deliver the mTBI POC, the RHP, either as a sole provider or as part of an interdisciplinary team, must be able to deliver all interventions with the exception of vestibular rehabilitation. Education is a required intervention for all injured persons in the mTBI POC.
*When clinically required and available, vestibular rehabilitation can be delivered within the mTBI POC by those RHPs who are able to within their scope of practice, knowledge, skill and judgement.
Treatment session duration and frequency is left to the clinical judgement of the treating RHP.
Outcome measures
The following outcome measures are required in the mTBI POC:
Patient-Specific Functional Scale (PSFS)
• to measure functional improvement throughout the mTBI POC
• completed at initial assessment, mid-point (end of block 1) and discharge.
Rivermead Post-Concussion Symptoms Questionnaire (RPQ)
• to rate severity of symptoms assisting with treatment planning as well as identification and monitoring of symptoms that may require intervention beyond the scope of the mTBI POC (e.g., psychological or cognitive impairment).
• completed at initial assessment and discharge.
Communication and reporting
The Regulated Health Professional must contact the WSIB:
- at the end of the first block if there is not a detectable change on the PSFS and/or if vestibular rehabilitation is recommended
- one week prior to the completion of the second block if the injured person is not expected to meet their recovery and return-to-work goals
- at any time during the program if the injured person’s recovery is not progressing as expected, to discuss options for specialized assessment
Three reports are required:
- Initial assessment report – submitted two business days after completion of initial assessment
- Mid-point report – submitted two business days after the last treatment session in block 1
- Care and outcome Summary – submitted two business days after discharge