Concussion Management
What is a concussion?
A concussion is a relatively common type of traumatic brain injury that can occur as a result of a sudden impact to ANY part of the body (not just the head directly). While concussions are often referred to as mild, they should never be taken lightly, as they can have significant short-term and long-term effects on a person's well-being.
COACH CV
In 2017, an article in Brain Sciences described the seven phenotypes (ways in which it can manifest) of concussion. This acronym stands for:
Cognitive function
Oculomotor (eye-movement related)
Affective Disturbances (mood disruptions)
Cervical (neck)
Headaches
Cardiovascular
Vestibular (dizziness and balance disturbances)
This is not an exhaustive list, but understanding how a concussion may affect you can be very beneficial. It is common to experience any number of these symptoms in any combination, which is why a thorough assessment is imperative to developing a treatment plan.
How can we help?
As stated above, we work closely with each person to assess their unique symptoms and limitations, providing an accurate diagnosis and tailored treatment plan. Our trained professionals use a wide range of techniques and modalities to decrease symptoms, improve physical function, and promote a safe return to daily activities, work, and sports.
What can you expect?
Because your treatment plan will be based on the symptoms and the objective examination, it may involve any/all of the following:
Cardiovascular exercise:
Studies show that concussion symptoms can be associated with altered cerebrovascular regulation (control mechanisms of blood flow to your brain). This phenomenon is termed autonomic dysregulation- and should be evaluated using a graded exercise test as soon as possible. If this is in fact a driver of your symptoms, a symptom-guided, progressive exercise program should be commenced to normalize your nervous system’s response to exertion.
Cervical rehabilitation:
Your upper cervical spine (neck) plays a vital role in coordinating head and neck movements in relation to the visual system, as well as providing accurate perceptual information and reactive control relating to your head and neck’s orientation in space. Increased cervical muscle tone (tightness), causing headaches, can arise from the traumatic impact itself, as well as in a protective response to your symptoms (dizziness, disequilibrium). Treatment for all of the above may involve manual therapy, IMS, and corrective exercise.
Vestibular/ocular rehabilitation:
Your vestibular system is highly interconnected with your oculomotor (visual) system and cervical spine (as discussed above). Altogether, they provide us with a clear, accurate, dynamic and adaptable perception of our surroundings. In 60% of concussion cases, this typically well-oiled machine is impaired in one way or another, which may lead to one or more of the following symptoms:
Dizziness, disequilibrium, nausea, motion sickness, imbalance/gait abnormalities, blurred/double/shaky vision, fogginess, fatigue, cognitive challenges, light sensitivity, difficulty with visual scanning/tracking (reading, driving), discomfort in busy environments (grocery stores), and headaches (eye strain).
Due to the complexity of possible impairments, treatment is complex, multi-faceted and may involve multiple practitioners. Also due to the complexity and nature of impairments, this is often the most commonly mismanaged source of symptoms.
Cognitive/social/work:
Other common predictors of post-concussion recovery timeline include depression/anxiety, pre-existing cognitive challenges/learning disability, female gender, migraine history, sleep challenges. In cases involving any/all of the above risk factors, involvement of an occupational therapist (OT), psychologist and/or counsellor can be an integral piece of the recovery puzzle. Symptom management and successful return to normal activity may involve cognitive behavioural therapy, energy management/task prioritization, coping strategies, breathing techniques, etc.
Sport:
Evidence-based guidelines for concussion management in high level athletes differs from that of non-athletes. For example, athletes have been shown to tolerate and positively respond to exercise at a higher % of their heart rate symptom threshold. Rehabilitation goals relating to work and activities of daily living should precede those of return to sport. Safe re-introduction of strength and conditioning should be carefully re-introduced after resolution of autonomic dysregulation and in collaboration with higher level vestibular/ocular exercises.
Remember, your concussion presentation is unique and cannot follow the same rehabilitation pathway as that of your previous concussion, or your colleague/friend/teammate.
If you or a loved one has recently experienced a concussion, don't hesitate to reach out to the dedicated team at Nelson Physiotherapy. We are here to guide you through every step of the recovery process, to help you regain full physical and cognitive function. Take the first step towards recovery and contact us today to schedule a consultation.