By Carolyn Scott, Ph.D., CBIST
Rainbow Rehabilitation Centers
In the last issue of Rainbow Vision’s magazine, Tom Constand, President and CEO of The Brain Injury Association of Michigan, wrote the article Good News, Fake News, and New News on the Concussion Front. His article was a great summary of the current controversies in the field. This article serves as a follow-up to reassure those that have experienced their first concussion and are looking for guidance. We will discuss concussion or mild TBI (the terms are used interchangeably) briefly and what steps you might want to take after your concussion to help in your return to “normal” life.
A concussion is caused by biomechanical forces acting on the brain. There may or may not be a brief loss of consciousness as well as a period of post-traumatic confusion. Common complaints after concussion include headache, nausea/vomiting, balance problems, dizziness, sensitivity to light and noise, difficulty with attention and memory, and not “feeling right.” Independent observers may report that the individual had a brief loss of consciousness or appeared dazed, had difficulty recalling events prior to or after the concussion, and demonstrated changes in mood and behavior. Fortunately, the vast majority of people recover fully from a concussion or mild TBI (mTBI). In a critical review of 120 best-evidence studies, the World Health Organization’s Collaborating Centre Task Force on Mild Traumatic Brain Injury found that most symptoms resolve in the first one to two weeks and at most one to three months after being hurt.1 A meta-analysis of 39 studies examining cognitive functioning after traumatic brain injury found similar recovery periods among individuals with mTBI.2 Those with mTBI demonstrated rapid recovery in the first weeks after their injury and returned to baseline cognitive status within one to three months.2
Resolution of symptoms may be influenced by a number of factors. For example, The Centers for Disease Control and Prevention states that history of previous concussion or brain injury, neurological or mental health disorders, learning difficulties, and/or family and social stressors may slow recovery from mTBI in children.3 Among adults, these same factors as well as substance misuse and litigation factors,1,4 may contribute to a poor recovery.
Evidence of a bleed on neuroimaging may also predict a longer recovery. Prolonged experiencing of symptoms related to concussion may also be explained by psychosocial models. For example, often after a negative event people may attribute all symptoms to that event and ignore any prior history of these same symptoms or other factors that may be contributing to their appearance/ maintanence.5 As many concussion symptoms are nonspecific, over time, individuals with a history of mTBI may ascribe them to their concussion rather than more benign and typical experiences.
Fortunately, literature exists and is continuing to develop (particularly related to sports concussion) that helps individuals with a history of concussion recover more completely and quickly from their symptoms.
Rest and Return
Resting for the first 24-48 hours after a concussion may be beneficial as it reduces brain energy demands and may reduce some post-concussion symptoms.6 However, prolonged rest and avoidance of activity may lead to difficulties itself. Deconditioning and time to focus on experienced symptoms are two examples of this. As such, a return to typical levels of functioning is important.
Return to sport, work, or school demands can occur in a gradual manner. Typically, the recommendation is to take on reduced demands. If these can be achieved without exacerbating symptoms, then additional demands can be resumed.3,5
Difficulty with sleep related to pain or distress can complicate recovery. Initially after a concussion, naps to reduce fatigue and experienced symptoms may be beneficial. However, napping is not helpful if it interferes with night time sleep. With time, resumption of a sleep schedule is beneficial. Individuals should go to sleep and wake at the same time each day. It is useful to limit caffeine intake later in the day and choose quieter activities before bed. Creating a bedtime routine may also be useful.
Behavioral pain management strategies can be taught by a psychologist. Learning relaxation skills and mindfulness techniques have been found effective in addressing chronic pain. Additionally, the appropriate use of medications as prescribed by your physician, massage, and exercise may all help address pain.
Depression and anxiety can affect cognition and sleep. Therefore, addressing underlying mood issues can help reduce concussion symptoms. Additionally, depending on how you were injured, there may be ongoing distress related to that experience.
Working with a neuropsychologist or rehabilitation psychologist who has experience with mTBI can help tease apart the many issues that can be contributing to your current experience and help you to find symptom relief.
It can be frightening to have a big fall, accident, or injury. These events may take you away from your normal routine, and change can be scary. It may also be frightening to hear the word “concussion” as reports in the media suggest a series of negative and long-term consequences. I encourage you to look back at our last magazine (Fall 2017, tinyurl.com/RainbowVisions) and remember that we need more research in the field of multiple concussions and their long-term effects. If you have ongoing concerns about your symptoms, speak with your physician or someone knowledgeable about concussion.
The overwhelming research supports that you will recover fully from your concussion. Ease back into your routine and do this sooner rather than later. Remember that many of the symptoms experienced after concussion are normal (we all forget where we put our keys!) and not necessarily indicative of mTBI. Address symptoms that may lead to a prolonged recovery and rest easy in knowing that the data is on your side.
For additional materials that you can review at your leisure, the Michigan TBI Services and Prevention Council put together the guide “Recovery from Mild Traumatic Brain Injury/Concussion” that you can find here rainbowrehab.com/wp-content/uploads/2017/12/ mTBI_Recovery_Guide_10.8.08.pdf.
1. Carroll LJ, Cassidy DJ, Peloso PM, et al. Prognosis for mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on mild traumatic brain injury. J Rehabil Med. 2004; Suppl 43:84-105.
2. Schretlen DJ, Shapiro AM. A quantitative review of the effects of traumatic brain injury on cognitive functioning. Int Rev Psychiatry. 2003; 15(4):341-9.
3. Recovery from concussion. Centers for Disease Control and Prevention website. https://www.cdc.gov/headsup/basics/ concussion_recovery.html. Updated on June 26, 2017. Accessed November 22, 2017.
4. McCrea MA. Functional outcome after mTBI. In: Mild Traumatic Brain Injury and Postconcussion Syndrome. New York, NY: 2008. 129-33.
5. Gunstad J, Suhr JA. “Expectation as etiology” versus “the good old days”: postconcussion syndrome symptoms reporting in athletes, headache sufferers, and depressed individuals. J Int Neuropsychol Soc. 2001; 7:323-33.
6. McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport – the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51:838-47.