Concussion

Overview
A concussion is a type of traumatic brain injury (TBI) caused by a blow or jolt to the head or body that results in a temporary disruption of brain function. Concussions can affect various aspects of cognitive, physical, and emotional health. Common in contact sports and accidents, concussions require careful management to ensure complete recovery and to prevent long-term complications.

Symptoms

• Cognitive Symptoms: Difficulty concentrating, memory problems, confusion, and feeling mentally foggy.
• Physical Symptoms: Headache, dizziness, nausea, sensitivity to light or noise, and fatigue.
• Emotional Symptoms: Irritability, mood swings, anxiety, and depression.
• Sleep Disturbances: Difficulty falling asleep, sleeping more or less than usual, and experiencing vivid dreams or nightmares.

Causes

• Direct Impact: A blow to the head from a fall, collision, or sports injury.
• Indirect Impact: Whiplash or sudden movements causing the brain to move within the skull.
• Accidents: Car accidents or other trauma that involve a forceful impact to the head or body.

Medical Treatments

Initial Care

• Rest: Physical and cognitive rest is crucial immediately following a concussion. This includes avoiding activities that exacerbate symptoms.
• Observation: Monitoring for worsening symptoms or new symptoms that may require further medical evaluation.
• Gradual Return to Activity: Following a step-by-step process to gradually return to physical and cognitive activities based on symptom tolerance.

Specialized Care

• Neuropsychological Evaluation: Assessment of cognitive function to identify specific deficits and guide treatment.
• Vestibular Therapy: To address balance and dizziness issues often associated with concussions.
• Cognitive Therapy: Techniques to improve memory, attention, and executive function.
• Medication: In some cases, medications may be prescribed to manage symptoms such as headaches, sleep disturbances, or mood changes.

Role of Physiotherapy

Physiotherapy for concussion focuses on managing symptoms and aiding recovery through a variety of techniques. While physiotherapy is not a primary treatment for concussion itself, it can be beneficial in addressing related issues, particularly those affecting the neck and musculoskeletal system.

• Neck and Postural Therapy: Addressing neck pain and stiffness that may accompany a concussion, including exercises to improve posture and reduce neck strain.
• Vestibular Rehabilitation: Techniques to help manage dizziness and balance issues resulting from a concussion. Exercises may include gaze stabilization, balance training, and habituation exercises.
• Oculomotor Exercises: These exercises improve visual tracking, focus, and coordination of eye movements, which can alleviate symptoms of dizziness and improve balance. Common exercises include saccades (rapid eye movements), pursuits (tracking moving objects), convergence (focusing on near and far objects), and accommodation (adjusting focus at varying distances).
• Manual Therapy: Gentle techniques to address musculoskeletal issues and improve comfort in cases where concussion symptoms are associated with neck pain or discomfort.
• Acupuncture and Dry Needling: May be used to alleviate neck pain and improve overall comfort in concussion recovery. Both can help reduce muscle tension and support relaxation.
• Laser Therapy: Can help address neck pain and inflammation that may accompany a concussion, promoting healing and reducing discomfort.

 

Frequently Asked Questions (FAQs)

How long does it take to recover from a concussion?
Recovery time varies, but many individuals recover within a few weeks. It is crucial to follow a step-by-step approach to return to physical and cognitive activities to avoid exacerbating symptoms.

How can I differentiate between a concussion and other head injuries?
A concussion is characterized by a temporary disruption of brain function with symptoms affecting cognitive, physical, and emotional domains. More severe head injuries might involve prolonged unconsciousness, severe confusion, or persistent neurological deficits and require immediate medical attention.

What is the difference between a concussion and persistent concussion symptoms?
A concussion is an acute injury with a set of symptoms that typically resolve within weeks. Persistent concussion symptoms, also known as post-concussion syndrome, occur when symptoms like headaches, dizziness, and cognitive difficulties persist for months after the initial injury.

Is it safe for children and adolescents to use screens during concussion recovery?
Recent research indicates that for children and adolescents, using screens like phones or computers in the first week after a concussion doesn’t necessarily worsen symptoms, especially after the first 30 days. In fact, avoiding screens too much might not always be helpful and could even lead to more symptoms. Instead of enforcing strict limits, it’s better to use screens in moderation and adjust based on how the child feels. The focus should be on balancing screen time with other recovery activities and monitoring their response to screen use.

How can I manage symptoms of a concussion at home?
Pacing, avoiding activities that worsen symptoms, managing stress, and following a gradual return to normal activities can help manage concussion symptoms at home.

When can I return to normal activities after a concussion?
Return to activities should be gradual and based on symptom tolerance. It’s important to follow medical guidance and avoid activities that could lead to further injury.

Can physiotherapy help with concussion recovery?
Physiotherapy can be beneficial in managing neck pain, dizziness, and balance issues associated with a concussion. Techniques include vestibular rehabilitation, neck therapy, manual therapy, and oculomotor exercises.

Is acupuncture effective for concussion-related symptoms?
Acupuncture can help alleviate associated neck pain and improve overall comfort, contributing to a more comfortable recovery process.

References

1. Daly, E., Pearce, A. J., Finnegan, E., Cooney, C., McDonagh, M., Scully, G., … & Ryan, L. (2022). An assessment of current concussion identification and diagnosis methods in sports settings: a systematic review. BMC sports science, medicine and rehabilitation, 14(1), 125.

2. Master, Christina L., Darron Bacal, Matthew F. Grady, Richard Hertle, Ankoor S. Shah, Mitchell Strominger, Sarah Whitecross, Geoffrey E. Bradford, Flora Lum, and Sean P. Donahue. “Vision and concussion: symptoms, signs, evaluation, and treatment.” Pediatrics 150, no. 2 (2022).

3. Schlemmer, E., & Nicholson, N. (2022). Vestibular rehabilitation effectiveness for adults with mild traumatic brain injury/concussion: a mini-systematic review. American journal of audiology, 31(1), 228-242.

4. Reid, S. A., Farbenblum, J., & McLeod, S. (2022). Do physical interventions improve outcomes following concussion: a systematic review and meta-analysis?. British journal of sports medicine, 56(5), 292-298.

5. Haider, M. N., Herget, L., Zafonte, R. D., Lamm, A. G., Wong, B. M., & Leddy, J. J. (2021). Rehabilitation of sport-related concussion. Clinics in sports medicine, 40(1), 93-109.

6. Lin, K., & Tung, C. (2016). Acupuncture for recovery from pediatric sport-related concussion. Medical Acupuncture, 28(4), 217-222.

7. Cairncross, M., Yeates, K. O., Tang, K., Madigan, S., Beauchamp, M. H., Craig, W., … & Silverberg, N. D. (2022). Early postinjury screen time and concussion recovery. Pediatrics, 150(5), e2022056835.