Tag Archives: head injury

Concussion Management Part 2: How Long Does Recovery Take?

By Cassandra Kroner, PT

In part 1 of the concussion management blog series we covered how the brain is affected following a concussion, common symptoms, why early intervention is critical, and how physiotherapy can help optimize recovery. One of the most frequent questions people have following a concussion is about recovery time – ‘when can I go back to work full time?’ or ‘when can my son/daughter play soccer again?’. It can be helpful to understand the general stages of injury and potential progression of symptoms:

concussion blog image_jan2019

The initial days following a concussion are considered the acute stage of injury, and cognitive and physical rest is critical at this time. After 7-10 days of adequate rest the chemical balance and blood flow in the brain has been restored, and symptoms that continue are known as post-concussion syndrome. Some symptoms can last upwards of 6 months or years post injury. It is important to keep in mind that not everyone will progress through all three stages, and the length of time symptoms last will vary between individuals.

Why Recovery Can Take Longer

There are a number of factors that can complicate and prolong recovery, and these can help us predict if symptoms are likely to persist longer than the usual 6 weeks. A history of migraines, mental health conditions such as depression or anxiety, or learning disabilities, have been found to increase recovery times. Additionally, visual or vestibular dysfunction or a high number of initial symptoms following a concussion usually indicate prolonged recovery.

History of Concussion

People who have had a previous concussion are more susceptible to have another one due to a lower threshold for injury after each concussion – meaning the next concussion can happen from a lower severity injury than the first time. Additionally, there is often an increased number of symptoms and a longer recovery time after each subsequent concussion. A concussion at a young age risks disruption of brain circuits yet to be developed, and also creates a wider window for repeated future concussions.

Repetitive hits that are common in sports such as hockey or football, which do not cause a concussion, are known as sub concussive trauma. Research has shown this repetitive trauma can result in increased reaction and processing time, memory impairments and increased chance of making mistakes. These effects can place an athlete at an increased risk for a concussion during sport. If the athlete does sustain a concussion at this point, the brain has a diminished reserve capacity to manage injury, and the effects of subsequent concussions are cumulative and result in increased impairment in function with each concussion.

Additional Injuries

Another complicating factor is the presence of other injuries, such as whiplash or neck sprain/strains, that can occur with falls or car accidents. These neck injuries alone can cause similar symptoms to a concussion including headaches and dizziness, and in combination with a concussion can result in more severe and prolonged symptoms. Having an assessment by a physiotherapist can determine which symptoms are from the neck injury and which are from the concussion – resulting in individualized treatment strategies to target the cause of each symptom.

To conclude, although concussions can be an invisible injury, they need to be properly managed and rehabilitated just like any other injury. This management includes assessment to determine the cause of symptoms, specific treatments to address each impairment, and strategies to manage recovery at home. Visiting a physiotherapist trained in concussion rehabilitation will ensure that both concussion symptoms and neck injuries are addressed. The goals of treatment are to restore physical and cognitive function while facilitating a safe return to work and sport. Awareness and education about concussions and treatment options are important to ensure that people don’t suffer unnecessarily from prolonged symptoms – this is where a trained Physiotherapist can help!

BodyTech Physiotherapy

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Concussion Management Part 1: The Role of Physiotherapy

By Cassandra Kroner, PT

What is a Concussion?

Concussions are a type of mild traumatic brain injury. Common causes include car accidents, sports, falls, or workplace accidents. Concussions can result from direct impact to the head, or from forces elsewhere in the body such as sudden acceleration or deceleration that cause an  injury to the brain and brain-stem.  The result is damage to cells and chemical imbalances that disrupt normal brain function.

Concussion Head imageImmediately following injury a sequence of chemical processes occur as the brain attempts to restore its normal balanced state. This increased activity in the brain is happening at a time when blood flow is decreased to the site of injury, creating an increased demand for energy. The resulting impairments in neurological function can cause a variety of signs and symptoms:

Physical Behavioural/Emotional Cognitive
Headache Drowsiness or fatigue Feeling foggy
Nausea Irritability Trouble thinking clearly
Vomiting Depression Feeling slowed down
Blurred or double vision Anxiety Difficulty concentrating
Balance problems Sleeping more than usual Difficulty remembering
Dizziness Difficulty falling asleep Trouble finding words
Sensitivity to light or noise Sadness Confusion

 

First Steps Following Injury

Concussions are often under-reported and misdiagnosed, and it is important to note that loss of consciousness is not necessary for a diagnosis. Contributing to the difficulty in identifying concussions is the lack of imaging or other tests to aid in diagnosis. Unless there is bleeding or swelling in the brain, the changes that occur with a concussion are not visible on a CT or MRI. If a concussion is suspected, an evaluation by a physician is recommended, and unless symptoms are severe or quickly worsening it is usually not necessary to visit the emergency room. Once the diagnosis is established and conditions requiring further medical treatment are ruled out, treatment should begin immediately.

Early Management

HeadacheTimely intervention following a concussion is essential to ensure optimal management and recovery. An outdated approach to concussion treatment is to stay in a quiet dark room until symptoms are resolved. With a growing demand for evidence-based treatment strategies, there is a wealth of new research that refutes this old-fashioned ‘dark room’ approach. Although complete rest is recommended for the first 48-72 hours after injury, research supports a more active approach to recovery following the initial rest period. Prolonged physical rest can lead to de-conditioning, depression and fatigue, making it more difficult to return to the previous level of physical activity.

Complete physical and cognitive rest immediately following a concussion is critical to ensure adequate energy supplies for the brain as it attempts to heal. Excess physical or cognitive exertion at this time will use precious energy that the brain needs and can result in exacerbation of symptoms and prolonged recovery. Physical rest means no exercising and caution with exertion around the house. Cognitive rest should focus on refraining from activities that require concentration (schoolwork, reading), as well as visual attention (television, video games, computer or phone use). Alternative options are listening to music or audio books.

Importance of Physiotherapy

A visit to a physiotherapist with advanced concussion management training is recommended for a detailed assessment following a concussion. Your physiotherapist will take a thorough history and can assess visual and vestibular symptoms, balance, cognitive function, and any additional injuries sustained at the time of concussion. Recommendations for the initial rest period as described above will be tailored to each individual, and further suggestions for management of symptoms will be provided.

Treatment plans involve a carefully monitored graded program of exertion to assist with a safe return to work/school and then sport. Every individual will experience a different set of symptoms following concussion, and as a result there is not a ‘one size fits all’ approach to treatment. This is why having a professional guide you through recovery is valuable. Specific and progressive exercises will be provided to target deficiencies in the vestibular and visual systems. To facilitate a gradual return to school or work, suggested accommodations would be provided to minimize symptoms and maximize participation. Additionally, manual therapy to address complaints such as neck pain or headaches can be part of treatment. Once the individual has returned to school or work, physical exertion testing is the last step before being cleared for sport.

Recovery time frames vary between individuals, but for many people, symptoms resolve in a month or less. However, there are a number of factors that can delay or prolong recovery. Stay tuned for part 2 of the concussion management blog series to learn more.

BodyTech Physiotherapy

Update: Continue reading on part two of our Concussion Management blog series.