Diagnosis and Treatment for Concussion

What is concussion?

            A concussion is a type of traumatic brain injury known as a mild traumatic brain injury (mTBI). Concussions are caused from direct contact or a quick jolt to the head causing rapid acceleration and deceleration of the brain inside the skull. This rapid back and forth of the head and brain can cause mechanical stress to the brain’s neurons such as stretching and shearing. This stretch and shear of the brain cells then causes a cascading series of changes in the brain, both chemically and metabolically, resulting in symptoms associated with concussion.

Signs and symptoms of a concussion

            Recognizing signs and symptoms of concussion is very important because concussions don’t show up on imaging such as X-rays, CT scans, or MRI, and there are no other medical tests to diagnose mTBI such as blood tests or monitors. Concussion diagnoses are made by an experienced healthcare professional who conducts a thorough exam observing a patient’s signs and symptoms following an accident or impact event.

Common Concussion Signs:

• Loss of consciousness
• Trouble with balance
• Glazed look in the eyes
• Amnesia
• Delayed response or slow speech
• Forgetting an instruction, confusion about an assignment or position, or confusion of the game, score, opponent, location, day and time.
• Sensitivity to light or noise
• Emotional
• Vomiting

Concussion Symptoms:

1. Somatic (Physical) Symptoms:
   1. Headaches
   1. Nausea
   1. Light-headedness
   1. Dizziness
2. Cognitive and Emotional Symptoms:
   1. Difficulty paying attention
   1. Difficulty multitasking
   1. Difficulty completing mental tasks
   1. Anxiety/Panic Attacks
   1. Depression

• Sleep Symptoms
  • Sleeping more than usual
  • Sleeping less than usual
  • Having trouble falling asleep

Response to Concussion:

            First and foremost, remove yourself or the athlete from activities that may expose to head trauma, or excessive stress to heart or brain. The first 48 hours after injury, you should engage in relative rest. This includes maybe taking a couple days off from school or work. You can still engage in light physical and cognitive activities, such as walking, reading, watching TV, computer activities. Most important guideline to remember here is that any activity that you engage in shouldn’t overly stress you or cause an INCREASE in symptoms.

            Second, get evaluated. If you have any signs or symptoms of a concussion after a hit to the head or impact to the body, assume you have a concussion until you have a chance to be evaluated by an appropriate medical professional.

            Graded exposure. Returning to work or school, and returning to sport, should be a gradual, phased approach, guided by a trained healthcare professional familiar with managing concussions. See Concussion: What You Need to Know After Head Injury blog for more info and guidance here.  

            Keep a positive attitude and outlook. You will get better with time, rest, and gradual return to your normal activities. Seek guidance from a knowledgeable rehab team to help you in this process.

Concussion Treatments:

Treatment options can include but are not limited to physical therapy, occupational therapy, optometry/ophthalmology, psychiatry/psychology, speech/language pathology, endocrinology, ENT, and meditation/mindfulness.

Physical Therapy Treatments:

PT treatments all begin with a thorough examination to identify what are the major contributing factors driving your signs and symptoms. Based on the findings of your initial examination, PT can address:

1. Physiological (Blood Flow to the brain). Steady-state cardio is best once cleared by a doctor.
2. Visual Therapy. Retraining accurate and smooth eye movement including visual tracking, saccades, convergence, hand-eye coordination, peripheral vision, reactive eye training.
3. Vestibular. BPPV, dizziness, vertigo, and trouble with positional changes can be common after concussion. Repositioning maneuvers can help clear out floating crystals in the inner ear causing BPPV which help alleviate vertigo and disorientation symptoms.
4. Cervical. Concussion is usually accompanied by some level of whiplash. Treating neck pain, stiffness, range of motion, and proprioception (body-awareness) can be pivotal in managing headaches, dizziness, eye strain, TMJ dysfunction, and other issues stemming from trauma to the cervical spine. We incorporate the NecksLevel device into our treatments with great success, to improve neck mobility, proprioception, coordination, and strength
5. Psychological. Educating the patient on their condition and how to manage it can make all the difference. This experience can be quite stressful, emotional, and traumatic, so having someone to lean on and guide you through this experience can help people recover faster and with less prolonged issues as they return to their normal activities.

Remember, concussions or mTBI’s do not result in brain damage. The effects are temporary, and signs and symptoms should resolve within 1-4 weeks. You can still participate in most activities even with a concussion, but taking breaks and modifying those activities may be necessary. As long as those activities don’t put you at risk of another impact, and you can tolerate them without INCREASING your symptoms, you are good to go. We are here to help guide you in this recovery so come in for a free consult or book your initial evaluation today!