Education
Why Education?
It is generally accepted that the more an individual knows about their injury the better their recovery. Understanding one's symptoms and how they can best be treated is paramount to recovery.
Takeaways from this page
This page aims to provide information about concussions, concussion symptoms and treatments. We hope it will help you gain more knowledge about concussions and options for treatment.
Constellations of Symptoms Associated with Concussion
Vestibular
Dizziness
Loss of balance
Nausea
Disorientation in space
Motion Sensitivity
Vertigo
Hearing Changes
Ringing in ears
Ocular
Frontal Headache
Eye fatigue
Difficulty with visual information
Pressure behind eyes
Difficulty focusing
Double vision
Words "jumping"
Veering off in one direction when walking
Having to close one eye to read
Cognitive
Poor concentration
Distractibility
Memory Problems
Slower processing
Difficulty making decisions
Difficulty staying on task
Problems multi-tasking
Losing track of time
Difficulty thinking of specific words
Difficulty following complex conversations
Fatigue
Mental
Overwhelmed
Over-stimulated
Slow processing
Performance worsens later in the day
Physical
Sleep disturbance
Low energy
Tired
Psychological
Emotionally drained
Loss of interest
Behavior / Mood
Anxiety
Depression
Irritability
Mood swings
Ruminative thoughts
Hyper vigilant
Social isolation
Impulsivity
Stress
Anger
Acting out / Rage
Other Physical / Sensory
Sleep
Drowsiness
Altered patterns
Excessive sleep
Interrupted sleep
Insomnia
Light sensitivity
Noise sensitivity
Ringing in ears
Hearing changes
Loss of appetite
Loss in sense of taste or smell
Headache
Migraine
Generalized headache increasing during the day with activity
Frontal headache
Variable headache
Headache radiating from the neck
Nausea with light sensitivity
Headache at site of impact
Cervical / Neck
Musculoskeletal injuries in the neck are common with concussion
They can contribute to a variety of problems associated with vestibular-ocular function and/or headache
Early Management
Rest vs. Activity
There are differing opinions regarding rest vs. activity and exercise after concussions. Currently it is felt that after an initial period of rest, controlled return to exercise and activities can be beneficial in recovery. During this period it is essential, however, that the individual remains sub-symptom. That is, they begin to return to activity and exercise when they are no longer experiencing physical symptoms (headaches, dizziness, nausea, etc.) and they stop the activity if the symptoms return. Continue to gradually increase the length of time of activity and exercise and the intensity of activity and exercise as long as the symptoms do not return. Returning to contact sports on the other hand has other recommendations. For information on returning to contact sports, please refer to these thinks.
Read more:
Basic Principals Regarding Initial Recovery
Reference: Brain Injury Association of America
After sustaining a concussion, it is very important to avoid any activity that places the person at risk of sustaining another concussion.
It is critical to balance rest and activity throughout recovery.
A gradual return to activities will include increasing and/or decreasing participation in an activity based on how the recovery is progressing.
Since most people will recover completely, accommodations for them will be temporary.
Return to previous life activities are most successful in stages.
There is no miracle cure or one-time intervention.
After you have recovered from your concussion, you should protect yourself from having another one. People who have had repeated concussions may have serious long-term problems, including chronic difficulty with concentration, memory, headache, and occasionally, physical skills, such as keeping one’s balance.
Ongoing / Persistent Symptom Management & Treatment
When symptoms from concussions persist and are problematic, it is important to seek treatment from individuals with expertise in treating people with concussions. Your physician or a physiatrist can be helpful in determining where to start.
Treatment may include:
Education
Development of Compensatory strategies
Direct intervention of the follow areas:
Vestibular
Vision/Ocular
Cognitive/thinking
Headache
Fatigue
Cervical/neck
Mood
Professionals who treat concussion these symptoms include:
Physiatrists- Physician who specializes in physical medicine and rehab. This is a physician who can help with identifying appropriate referrals through out your recovery.
PT- Assess and treat vestibular, walking, balance, strength, coordination, cervical neck problems
OT- Assess and treat ocular motor, visual including double vision, peripheral vision, eye fatigue
ST- Assess and treat thinking skills including attention, memory, executive functioning, speed of processing, and language
Psychologists/Counselors- Assess and treat emotional issues- depression, anxiety, emotional regulation, acceptance
Sleep Disorder clinics – specialized clinics to assess and treat sleep disorders
Headache clinics- specialized clinics to assess and treat headaches
Neruo-Optometrist - Provides assessment of the visual processes commonly effected following an acquired brain injury including concussions.
Neuro-Ophthalmologist (MD) - Take care of visual problems that are related to the nervous system; that is, visual problems that do not come from the eyes themselves.
The Concussion Resource Center can provide referral sources with expertise in these areas.
Sleep
Sleep is important
Sleep is essential to healthy brain function, both for rest and to flush away waste products that accumulate during the day. After concussion, an individual can experience problems with sleep, either in terms of excessive need (hypersomnolence) or difficulty sleeping (insomnia). Disruption to the cycles of sleep can cause fatigue, “fogginess”, memory problems, and even depression. It is important to develop a regular sleep routine that stabilizes sleep patterns and ensures quality rest. If you are having difficulty sleeping, consult your physician, as there are behavioral interventions which can be very effective.
The following websites have good information on sleep disorders and strategies:
Recommendations for developing good sleep hygiene:
Most adults need between 7-9 hours of sleep daily. If you are consistently getting less than this, you should talk with your physician about your concerns.
Turn your bedroom into a sleep inducing environment – quiet, dark, comfortable and cool.
Create a bedtime ritual.
Try to stick to a schedule as much as possible, going to bed and getting up at about the same time each day.
Avoid caffeine and alcohol.
Eat a light meal at dinner time.
Nap early or not at all.
Avoid using electronic devices at least 2 hours before bedtime. This includes not watching TV in bed.
Nutrition
Good nutrition is key
It is important to maintain a healthy diet when recovering from a concussion. This includes foods that specifically promote brain health, including nuts and seeds, dark leafy greens, herbs, fish, fermented foods. In general, the following nutritional guidelines are usually recommended.
The following books & websites have some good information on nutrition
Recommendations for maintaining good nutrition:
Make sure you stay well hydrated.
Eat lots of fruits and vegetables, especially those rich in antioxidants.
Eat a reasonable amount of protein, from lean meats, eggs, fish, dairy products, nuts or beans. Fatty fish such as salmon, mackerel, herring and sardines are high in Omega-3.
Eat foods rich in Omega 3 fatty acids.
Reduce sugar and sodium if you consume excessive amounts.
Reduce processed foods.
Fermented foods such as yogurt and cultured vegetables (kraut, kimchi) are natural probiotics that promote a health gut.
Limit use of corn oil and regular safflower; substitute with olive oil, coconut oil, canola oil or flaxseed oil.
Avoid or restrict caffeine and alcohol.
Talk with your physician before using any over the counter supplements.
How to prepare for your doctor's appointment
Prepare a list of symptoms and your medical history:
Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including any major stresses or recent life changes.
Make a list of all medications, vitamins or supplements that you're taking.
Ask a family member or friend to go with you, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Preparing a list of questions can help you make the most of your appointment. List your questions from most important to least important in case time runs out.
For post-concussion syndrome, some basic questions to ask your doctor include:
Why are these symptoms still occurring?
How long will they continue?
Do I need any additional tests? Do these tests require any special preparation?
Are there any treatments available, and which do you recommend?
Are there any activity restrictions that I need to follow?
When can I return to work?
When can I drive again?
Is it safe to drink alcohol?
Is it OK to take my medications that were prescribed before the injury?