Early care: Most concussions will resolve within days to months with no long-term functional consequences. But concussion recovery depends on many factors including factors that are external as well as internal to the person. Internal factors can include: a person’s coping style, injury severity, level of education, number of previous concussions; while external factors include: level of social support (family, society, co-workers) and availability of rehabilitation programs. Many people will require longer recovery times following a concussion due to ensuing symptoms like fatigue, headaches, dizziness, thinking inefficiencies (slowed thinking, attention and memory difficulties), and emotional challenges (e.g., anxiety, depression, irritability). On a side note, recovery also can be prolonged when the concussion occurs within the context of other injuries, e.g., injuries sustained during a motor vehicle accident can, but don’t have to, include a concussion.
Either way, early care/ intervention is important in order to decrease the probability of secondary difficulties that can arise due to concussion symptoms. Research suggests that rest is not the best way to treat concussion. The challenge lies in the question of how to increase level of activity following concussion gradually to allow for effective recovery. This gradual increase in activity level depends on many factors and requires the person to take breaks on a regular basis and monitor symptoms while working an uphill battle against fatigue (i.e. pacing). Rehabilitation is a full-time job for the injured person! Thus, the focus during rehabilitation is not the successful completion of the task at hand but rather the person him/herself (doing activities while asking oneself, am I ok to continue or do I need to take a break). In short, people need to learn strategies to deal with the fatigue and resulting difficulties in order to regain functionality. Too much resting rather enhances the challenges that concussion creates.
Generally speaking, because the brain is responsible for and controls all activities (see non-exhaustive list of activities below), an injury to the brain can impact any function that we need for successful functioning in everyday life:
- Emotional regulation,
- Balance (this includes vestibular functioning),
- Output behaviour like walking/ talking,
- Autonomous nervous system activity like heart rate and breathing,
- Sleep regulation,
- Homeostasis (keeping everything stable in the body such as temperature and internal fluid compositions)
Rehabilitation also needs to focus on the functions that have been impacted. For example, when balance is negatively impacted as a result of vestibular system involvement, vestibular rehabilitation is needed (provided by physiotherapists with the appropriate experience/ specialization). Oftentimes, concussion leads to difficulties in thinking and emotional functioning while fatigue is the most common and long lasting symptom that challenges rehabilitative efforts.
Symptoms (non-exhaustive list):
- Thinking: Following concussion, many people experience slowed thinking speed and more complex or multi-step tasks are difficult to complete efficiently. These difficulties can result in attention and memory difficulties, all of which make everyday life a challenge.
- Emotions: a) effective regulation of emotions can be impacted (e.g., getting seemingly suddenly angry or crying for no apparent reason) while also b) anxiety and / or depression can occur due to the experience of decreased ability to function successfully, and c) pre-concussion emotional difficulties can be enhanced following concussion
- Fatigue: oftentimes physical and cognitive/ mental fatigue- both types require pacing
- Headaches: there are different types of headaches, and medication is not always the most efficient approach to dealing with headaches following concussion
- Sensory sensitivity: photo and noise sensitivity are a common result of concussion, and can be addressed by gradual exposure to stimulation
How can you help: If the person becomes irritable, be patient, and ensure that the person takes a break (rest period) before continuing with the task.
Read here about a) the sources of emotional distress following brain injury and b) the gradual approach to activity to support your recovery, i.e. how to know when to take a break to avoid the “crash and burn” cycle:
I utilize a biopsychosocial approach to tailor treatment to an individual client’s needs while providing support in a safe and a compassionate environment. Clients can learn about the connections between their thoughts, emotions, and behaviours as well as about cognitive (thinking) functioning and its importance to daily life. Importantly, Heike is specialized in cognitive rehabilitation to support clients if their cognitive functioning (e.g., memory difficulties, difficulties with organizing and planning, or decision making) has been compromised. Heike also has more than a decade experience in early concussion intervention, and teaches/ guides clients in how to approach and manage physical symptoms (e.g., headaches, fatigue, sensory sensitivity) effectively. Heike’s goal is to support and guide clients on their journey to regain their footing in life, one step at a time, to improve their quality of life.