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Concussion Matters:

Why Concussion Matters?


Sections

1. Myths

2. Recovery

3. Symptoms

4. Management and Rehabilitation

5. Concussion Rehab


a: Acute stage

b: Mid Term

c: Long Term


6. Choose a Clinic

7. Clinical research



Myths:


Myth 1

You need to be ‘knocked out’, loose consciousness to have concussion.

Answer : No.

Trauma to the brain does not always lead to the loss of consciousness i


Myth 2

Concussion resolves spontaneously with rest.

Answer : No.

Sometimes but many people suffer from concussion syndrome for months years or a lifetime. To get optimal return to pre trauma levels will often be achieved following a guided recovery process.


Myth 3

After concussion or tbi, you should ‘just rest’.

Answer. No.

Whilst rest and reducing the excitation of the train for the first 72 hours is often advisable. If forced to use phones or computers it is believed that Blue Blocking Spectacles can be of assistance. see light*


Recovery

Following the initial concussive period a gradual and individualised return to activity can improve neurogenesis through improving vascular supply and oxygen to the brain. A program of physical and cognitive (brain activity) can help if controlled by a sub-threshold approach, often with a pulsed excitation protocol.


*Light: Blue light from electronic devices needs to be regulated at the early stages. Blue light is the high energy end of the spectrum and so it can be disruptive. Over 70% of all neural input to the brain is visual and so a regulated approach to Blue Light needs to be considered. Additionally this may support sleep patterns when used prior to sleep. This is achieved through the up-regulation of Melatonin.

*Blue light protection.

In addition the beta caratonoid levels (especially Macular Pigments, Lutein and ZeoXanthin) can be supplemented in order to improve cognition and offer a neuroprotective approach both to the visual system and cognitive function)


The majority of concussed patients spontaneously during a period of 6 weeks. Although many continue to have symptoms, constant or intermiitent for many months or sometimes years. Some may present with head-aches months later. Post Concussion Re


Symptoms

of concussion include


• Headache/pressure in the head

• "Not feeling right”

• Nervousness or anxiety

• Brain Fog ‘Drowsiness’

• Dizziness/vertigo

• Slow responses

• Irritability

• Low energy

• Nausea

• Poor memory and organizational capability.

• More emotional than usual

• Double Vision

• Sensitivity to light or noise

• Poor concentration

• Trouble falling asleep

• Numbness

• Repeats questions

• Sleeping more than usual

• Balance problems

• Looking “dazed”



Management and Rehabilitation

For those with persisting symptoms, confusion regarding appropriate management strategies remains.


Using rigorous methodology, Concussion Rehab Centre (CRC) reviewed, evaluated, and synthesized the evidence on concussions into clinical practice guidelines and includes some of the most tried and tested Concussion Protocols and has validated many of the innpvative and new techniques and advanced technologies available in 2020.


It is important that patients and families receive clear and accurate information from trusted medical providers and clinicians with experience and training in concussion care.


Concussion Rehabilitation

offers a pathway to find appropriate clinicians in a location need you.


Find a Concussion Rehab Clinic. CRC


Patients and their caregivers/families should be provided with information on diagnosis, post-injury care during early and later stages of recovery, and about helpful resources that support recovery and provide reassurance.


Acute stage

In the acute stage, every patient who is suspected of having a concussion needs to be assessed by qualified medical practitioners licensed to provide this clinical diagnosis. A concussion is a mild traumatic brain injury.

This diagnosis can only be made by those qualified and licensed to do so; other health care providers may suspect a concussion but cannot diagnose one. Following medical rule-outs, neuro-psychologists are also able to assess and diagnose concussions, particularly in patients with persistent symptoms.

It is important that an initial medical assessment occur to rule-out more serious forms of traumatic brain injuries or other medical and neurological conditions that can present with concussion-like symptoms. A diagnosis of concussion may be made (or ruled out) after conducting a comprehensive evaluation of the patient with a suspected concussion. This medical assessment includes:

• A clinical history

• Identification of potential risk factors that may impact the duration of recovery

• A review of current symptoms

A physical examination with evidenced-based use of adjunctive diagnostic tests as indicated (eg, CT scan, MRI)


Major change in practice

Recent research has found that after a concussion patients should not remain in a darkened room without any stimulation until they feel better, as this does not facilitate recovery. This is a change from what has been accepted practice.

After a concussion, it is important to have relative rest during the first 24 to 72 hours followed by a gradual re-introduction of physical and cognitive activity to a level that is tolerated by the patient.

Regulated Excerise Recovery Programs following Concussion / tbi

Regulated Cognitive Recovery Programs (ELctronic Devices, return to Stress)


Depending on the severity and symptoms, patients will progress at different rates. This is true of regular daily activities, school/work, and exercise at subthreshold levels.

Being active and having some stimulation is part of the healing process. This should not include a return to contact sports or other activities in which there is a high risk of re-injury. Resuming such activities should be done in consultation with the diagnosing professional and the interdisciplinary care team. Evidence indicates that physical and cognitive activities should be started at levels below that which would trigger symptoms (subthreshold).


Risk factors

It is important to assess the patient’s risk factors for a prolonged recovery, after a concussion. The presence of one or more risk factors should be identified in care plans and referrals. These risk factors include:

• High score on either the Post-Concussion Symptom Scale (PCSS; > 40), or the Rivermead Post-Concussion Questionnaire2-4

• Previous concussion history5-8

• Persistent post-traumatic headache and migraine7,9

• Depression/anxiety7,8,10-14

• Symptoms/signs of vestibulo-ocular abnormalities (problems maintaining visual stability during head movements) and of cognitive difficulties (problems with perception, memory, judgment, and reasoning)5,6,14-17

• Pre-injury history of sleep disturbance and/or post-injury changes in sleep patterns, difficulty sleeping10,18,19

• Increased symptoms with return to school, work, or exercise16

• Returning to a contact/risk of contact sport activity12,20

Female concussion patients seem to be at higher risk for prolonged recovery and this should be considered along with the other risk factors when determining if multidisciplinary care is required.3,9,10


Mid Term

Follow-up assessment

One to two weeks after a concussion, a follow-up assessment with a primary care provider or a physician who have experience in concussion management needs to be done, which includes:

• Corroboration of the diagnosis of concussion and/or re-evaluation based on observed symptoms

• Identification of ongoing symptoms that may require intervention if they persist beyond 3 to 4 weeks, or the identification of risk factors for a prolonged recovery (ie, high post-concussion symptom score, previous concussion history, migraine or mood symptoms)

• Considerations for diagnostic imaging and referrals for additional medical and clinical consultations

• Additional educational resources such as written information or video tutorials regarding symptom management strategies and reassurance


Long Term Evaluations and Rehabilitation

Be assured that the brain retains long term capabilities in Neuroplasticity and regeneration.

Whilst important to treat early with a targeted approach, it is also possible t o reduce symptoms and improve quality of life many years after concussion.

The approach often needs a sensory guided approach with both visual and vestibular rehabilitation. This is often under the guidance of a Neuro-Optometrist and a Osteopath / Physiotherapist.


Multi- disciplinary care

Some patients will need interdisciplinary care to help manage their post-concussion care. Post-concussion care requires the integration of interdisciplinary care to provide services for the constellation of symptoms that may present (physical, cognitive and/or emotional). Patients who experience persistent symptoms as well as those at risk of a delayed recovery, may benefit from a referral to a concussion clinic that has access to medical and clinical professionals with licensed training in brain injury (eg, sports medicine, neuropsychology, physiotherapy, occupational therapy, athletic therapy, speech and language therapy, neurology, neurosurgery, and rehabilitation medicine). Patients need access to timely coordinated interdisciplinary care that includes the primary care provider.

Concussion clinic

A concussion clinic consists of an interdisciplinary team with three or more different regulated health care provider disciplines. No one provider or discipline can manage and treat all persistent symptoms of concussion. The core functions required to manage post-concussion symptoms include:

• Diagnosis and access to medical services

• Physical treatment options

• Cognitive evaluation and treatment

• Evaluation and treatment of emotional conditions

• Functional integration

• Education

• Coordination of care


Clinical research

It can be difficult for a busy clinician to keep on top of clinical research and to evaluate the credibility of the new research. Because knowledge is continually changing it is important to stay up-to-date, which can be done by using clinical practice guidelines. Two examples of current guidelines can be found at concussionsontario.org: the Guideline for Pediatric Concussion, and the Second Edition of the Guidelines for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms; the third edition will be released in the fall of 2017).


Additional Reading

1. VA/DoD Clinical Practice Guidelines: Management of Concussion—Mild Traumatic Brain Injury (mTBI); 2016. https://www.healthquality.va.gov/guidelines/rehab/mtbi/. Accessed October 3, 2017.

2. McCrory P, Meeuwisse W, Dvorak J, et al. Consensus Statement on Concussion in Sport: the 5th International Conference on Concussion in Sport. Berlin, Germany: October 2016. Br J Sports Med. 2017. http://bjsm.bmj.com/content/early/2017/04/28/bjsports-2017-097699. Accessed September 28, 2017.

3. Parachute. Canadian Guideline on Concussion in Sport; 2017. http://www.parachutecanada.org/injury-topics/item/canadian-guideline-on-... . Accessed September 28, 2017.

4. The Top 5 Key Messages From the Canadian Concussion Collaboration; June 32017. http://physicians.cattonline.com/resources/files/key-messages-eng.pdf. Accessed September 28, 2017.

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