So, you have a concussion. Now what?

How do you know if you have a concussion… and if you do… now what???

For athletes, especially those who participate in contact sports, there is a much greater exposure to concussions than the average person. However, even knowing that going into a game, many of these head injuries can go undetected, even by the player… at first.

Concussions occur when there is a rapid acceleration and deceleration of the brain causing a violent shaking or twisting of the brain within the skull. This rapid movement of the jelly-like brain tissue can be easily damaged, causing cognitive, behavioral, physical, visual and auditory symptoms that can increase over time. Unfortunately, even though an athlete is at risk of sustaining some form of injury virtually any time there is a hard hit to the head or body, these injuries can seem to go unnoticed by the coach or even the players themselves, until they wake up the next day and aren’t feeling so good.

Unless the hit was obvious and/or the player was knocked out or stumbled around appearing confused afterwards, concussion symptoms can be mild and go undetected for hours, days and even years following an event. Even though athletes may not be initially aware of the subtle changes that may be taking place within their brain at the time of injury, it doesn’t mean that symptoms can’t worsen over time, or that further concussions aren’t more likely to occur as a result of this initial concussive injury. This is why in a perfect world there are concussion spotters and athletic trainers present during play, with a firm policy in place to pull the athlete if there is any suspicion of an injury. This can be frustrating for the player and the coach who both want to win the game, but for the athlete, it really is the best practice when it comes to their long-term health and well-being going forward.

In fact, athletes who have experienced even just one concussion are more likely to sustain another one within the same season. If you have a history of multiple concussions, then you are more than three times as likely to sustain another one as compared to someone who has never experienced a concussion. This is why prevention and early detection are the key focuses of concussion experts. We want to get ahead of these serious injuries and help athletes of all ages prevent, enhance and recover completely so that they can maintain happy, active and healthy lives.

Concussion specialists in charge of providing concussion therapy will typically take a four-step approach towards treating concussion patients:

1. First, provide thorough baseline and post-injury testing and evaluation.
2. Second, provide the appropriate therapy to relieve concussion symptoms.
3. Next, develop and implement a rehab program aimed at recovering optimal physical and cognitive functionality.
4. And finally, perform return testing to assess the stage of recovery, so that the athlete can return to play safely when appropriate.

When to have a comprehensive evaluation and why

If you are feeling like you may be suffering from concussion-like symptoms, getting to a concussion specialist early can really help sort out what is going on and help to get you on the straightest path to recovery (before symptoms get worse). It is very easy to either do too little (because you don’t feel good) or too much (because you are determined to muscle through it), but if you can get started on the “just right” amount of activity safely, you really can speed things up, and get back to your life without the added risk of ongoing problems.

While most concussions symptoms will disappear on their own within the first 2-3 weeks, even in the best of circumstances it takes at least 3-4 weeks for the metabolic shift that occurs in the brain to clear. During this time the injured person is very vulnerable to suffer from another injury, primarily because they don’t know their limitations and their reaction times are off. If they happened to be proactive and performed a baseline test prior to the injury, this information can be used to assess the impact of the injury and guide the recovery process. A good baseline test will typically include some form of neurocognitive testing, like the imPACT test, as well as a good objective balance assessment1, some functional vision testing and a good look at the person’s overall coordination and reaction time.

These are most often done by physical or occupational therapists trained in concussion rehabilitation. Based on the findings of their evaluation, the therapist will be able to provide a roadmap to recovery to return you to your optimal state.

Address symptoms

The other thing a good therapist can do is to address the variety of symptoms that may continue to show up. These may include:

• Headache (the most common)
• Dizziness
• Foggy thinking
• Poor reaction time
• Light sensitivity
• Sleep disturbances
• Nausea
• Vomiting
• Behavioral and mood alterations
• General weakness
• Memory loss
• Lethargy
• Hand-eye coordination loss
• Balancing issues

The first step in treating concussions is to address these immediate symptoms and consequently provide the individual with a more comfortable and functional quality of life, along with guidelines for appropriate activity. This helps to form a more stable and comfortable foundation for recovery.

The initial treatment for concussions will typically be physical and cognitive rest (for 1-2 days), followed by symptom-guided exercise and activity. Sometimes a physician will prescribe anti-nausea or pain relief medications, but these should be used with caution since side effects from these medications can sometimes cloud real symptoms and complicate the recovery process. For concussion symptoms that persist for longer than a few days, or that are more severe, other therapeutic measures can be very helpful.

CranioSacral Therapy is a wonderful tool that can help to reduce headaches, relieve cervical strain and enhance recovery, without medication!

Physical Therapy addresses symptoms of vertigo or dizziness. A physical therapist trained in vestibular rehab uses specific maneuvers and exercises to clear crystals dislodged into the semicircular canals of the ears, causing these uncomfortable symptoms.

Occupational Therapy focuses on restoring functional vision, cognitive and fine motor skills. They can also help with activities of daily living, and driving in more severe cases.

Vestibular Therapy promotes good balance and coordination and can help with gait, coordination and fall prevention.

Functional Vision Therapy using tools like Dynavision, vision exercises and RightEye can help to reclaim the patient’s functional vision, peripheral awareness, reaction time, focus and attention, all of which can contribute to problems with thinking clearly and efficiently (a common complaint).

Interactive Metronome & Dynavision are both motor training systems that can help to improve the patient’s peripheral awareness, eye-hand coordination, visual reaction time, concentration, attention and cognitive functional skills under the guidance of a physical or occupational therapist.

 

Prevent recurrence

The more that your concussion team of therapists and physicians know about your previous and current cognitive and motor state, the greater understanding they will have towards your overall potential and susceptibility to further concussions. For patients who are at an elevated risk of sustaining another traumatic brain injury, a different lifestyle (or sport) may be recommended, especially if there is a history of multiple concussions.

By providing patients with a detailed outlook of their cognitive health and stability, they can learn which activities can place them at a higher risk for another concussion and what might be better options for them. For some patients, concussion symptoms may be mild with symptoms resolving on their own, but for others, concussion therapy can help to pave the way for a solid recovery with less of a chance of a repeat injury and long-lasting damage.

You can never be too informed or protective when it comes to the health of your brain. By utilizing the information provided in your baseline and functional testing as well as engaging in the appropriate activities to improve your overall physical and cognitive health, you give yourself the best chance of a full recovery and greater likelihood to resume a healthy, active and fully functional life.

Notes

1. Eur J Phys Rehabil Med. Author manuscript; available in PMC 2011 Jun 1. Published in final edited form as:
Eur J Phys Rehabil Med. 2010 Jun; 46(2): 239-248. PMCID: PMC3033730. NIHMSID: NIHMS258907
PMID: 20485226 The relevance of clinical balance assessment tools to differentiate balance deficits
Martina Mancini and Fay B Horak) (C)