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

Why Constellations?

All concussions are different and you may experience some but not all of these symptoms. In most cases, people have a fairly complete recovery within 3 months of injury, but when symptoms persist beyond that it is often referred to as Post Concussion Syndrome or Persistent Symptoms from Concussion. There are common symptoms associated with concussions referred to here as a constellation. Please read below for information on each symptom.

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, and 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 perios 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.

Learn More

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?

Three Stage Protocol for Return to Learn for Students from Brain Injury Association of America