Jun 7, 2022 | Faces of HDGH, Road to Recovery – Restorative Rehabilitative Care
June is Brain Injury Awareness Month and according to the Ontario Neurotrauma Foundation (ONF), concussion is one of the most common brain injuries experienced by people of all ages.
What is a Concussion?
A concussion is a mild traumatic brain injury that results from a blow to the head or mechanical force to the brain from a fall, assault, exposure to an explosion, or a sudden stop in a high-speed collision. This injury usually results in functional changes to how the brain operates (software) rather than structural changes to the brain (hardware).
After a concussion, people might experience physical symptoms (headaches, dizziness, fatigue, sleep problems, tinnitus, noise & light sensitivity & poor balance), cognitive symptoms (slowed thinking, poor concentration, memory problems, impulsivity & word-finding difficulties), or emotional symptoms (irritability, anger outbursts, anxiety, & depression). Everyone’s experience of concussion is different and not everyone will experience the same symptoms. These symptoms are normal after a concussion and not a sign of worsening brain damage. The good news is that these symptoms will gradually resolve over a few days to a few weeks, especially with symptoms management strategies.
At one time, healthcare providers recommended that people rest until their symptoms resolved. Yikes! Turns out that the research shows that this advice was wrong and we now know that after a concussion, rest is only needed for 1-2 days. People benefit from gradually resuming their normal activities and by alternating periods of activity with periods of rest (i.e., pacing). As long as symptoms do not get worse, it is O.K. to increase the length of time and the intensity of an activity every few days over several weeks and gradually decrease the rest periods. Staying connected with others and doing things you enjoy is important to your physical and mental health so text your friends, watch some T.V., and go for a walk, but start off with brief manageable bits of these activities that do not make your symptoms worse.Persisting Symptoms After a Concussion The ONF reports that about 10-30% of people with concussion continue to experience persistent symptoms for several months. Again, the symptoms are not a sign of a worsening brain injury but rather that your brain functioning has “gotten stuck” or other factors may be prolonging your symptoms. These symptoms do not only occur after concussion but can also result from other conditions that affect how the brain functions (i.e., pain, sleep disturbance, substance use, and the stress of having persisting symptoms). If you continue to have symptoms after 4 weeks, it may be time to get some specialized help. A recent review by researchers (Mollica et al, 2022), recommended prioritizing treatment of dizziness and balance problems, posttraumatic headache, sleep problems, depression and anxiety as these symptoms may contribute to other persistent symptoms. So how can healthcare providers help you with these persisting symptoms? Your family physician or nurse practitioner can review your pain medication use and determine how to best manage your headache pain as well as refer you to other health care providers. Physiotherapists can treat balance problems and vertigo (as well as a neck injury that can contribute to headaches) and also coach you through graded exercise programs. Occupational therapists can help with pacing and prioritizing activities to find that “sweet spot” of activity that does not make symptoms worse and offer strategies to help get things done easier. A psychologist or social worker can provide psychotherapy to deal with sleep problems, depression, and anxiety s well as by changing unhelpful illness beliefs and reducing avoidance behaviour. It can be discouraging to deal with persisting symptoms but individuals can continue with their recovery by finding the “sweet spot” of activity level that does not make the symptoms worse; by gradually returning to activities and exercise; and, by targeting problematic symptoms such as headaches, sleep disturbance and depressed mood.
For more information, check out these resources & references:https://concussionsontario.org/https://www.uhn.ca/Krembil/Canadian-Concussion-Centre/EducationMollica et al. (2022). Neuropsychiatric treatment for mild traumatic brain injury: Nonpharmacological approaches. Seminars in Neurology. CogSmart – Traumatic Brain Injury: A Guide for Patients. VA San Diego Healthcare System.
Dr. Anne McLachlan is a clinical neuropsychologist at HDGH who has provided psychological services to the rehabilitation programs for over 25 years. Always open to different perspectives, she has a passion for learning from her patients, students, and colleagues. Outside of work, she is a community volunteer, amateur cook, and weekend gardener.
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