Concussion

Not every hit to the head results in a brain injury. If hitting your head was that dangerous, our toddler years would be pretty rough, and we would not survive as a human species. However, some hits do result in concussions. A concussion, also known as a mild traumatic brain injury, is an immediate and temporary alteration in brain functioning due to physical trauma.

A concussion can occur because of a hit to the head, or forces causing a sudden jolt to the head such as whiplash or blow to the body. Loss of consciousness is not necessary for a concussion to occur. In fact, only 10% of individuals who sustain a concussion lose consciousness. Up to a third of individuals experience post-traumatic amnesia, also known as a post-traumatic confusional state, which disrupts memory for events occurring shortly before or after injury. Loss of consciousness, post-traumatic amnesia, plus feeling dazed, disoriented, or ‘out of it’ are all examples of altered brain functioning which suggest that a concussion may have occurred (a physician, nurse practitioner or neuropsychologist are able to diagnose concussion).

For early diagnosis of concussion, see your physician or nurse practitioner, or if there are delays, attend a walk-in clinic. If you are experiencing severe symptoms such as severe headache, confusion, seizure, repeated vomiting and worsening in your symptoms, then a trip to the ER may be needed to ensure you did not sustain a more severe injury.

The content on this website is for informational and educational purposes only and is not intended to be a substitute for medical advice, diagnosis, or treatment.

Following a concussion, a brief period of rest is recommended for the first 24-48 hours, such as avoiding intensive work or pushing yourself cognitively or physically. Rest does not mean lying in a dark room with no stimulation and avoiding all activity. We now know that isolating yourself in a dark room is not helpful and can actually prolong your concussion symptoms.

After the brief rest period, gradually increase your activity levels while still taking it easy by staying just below your symptom threshold (e.g., onset or worsening of symptoms), taking breaks as needed to stay comfortable, and not pushing into and making your symptoms worse (Type A personalities beware!).

In fact, ignoring and pushing through your symptoms will not get you back to life faster. Instead, it could make your recovery take longer.

So, what does a Type A person with a concussion do?

Don’t beat yourself up. Take it easy, take breaks as you need, make room for some self-compassion, and gradually increase activities over time over the next couple of weeks. After the initial rest period, research has shown that light cardio exercise (e.g., walking) can help with recovery. But don’t push into your pain and symptoms. In the case of concussion, “no pain, no gain” does not apply.

The content on this website is for informational and educational purposes only and is not intended to be a substitute for medical advice, diagnosis, or treatment.

80% of people recover from concussion symptoms within 7-14 days of injury, with the average recovery period lasting 10 days. Although post-concussion symptoms may resolve within 2 weeks, we do not yet know how long it takes the brain to physically heal after a concussion. So, take care not to re-injure yourself in the weeks ahead, it could set you back in your recovery.

The following are risk factors for longer than expected recovery following concussion. The more risk factors you check off, the higher the chances for a prolonged recovery.

• Multiple moderate to severe physical symptoms and sensitivities following mild traumatic brain injury (concussion).
• Moderate to severe cognitive symptoms.
• Post-traumatic headaches and/or migraine that won’t quit.
• Symptoms of depression, anxiety, trauma or sustaining the injury within the context of a stressful period in your life or stressful circumstances.
• Pre-existing mental health history including anxiety, depression, trauma.
• Adverse childhood history or adverse life events pre-existing injury (adversity can wire the brain for chronic pain).
• Past history of concussion(s)

Being at risk for prolonged recovery following a concussion does not mean that there is nothing you can do to change your outcome. If you have checked off several of the above risk items, you may benefit from targeted treatment to reduce your recovery time.

The short answer is yes.

The longer answer is, it depends. They don’t have to. There is a lot we have learned over the past several years about who is at risk for prolonged concussion recovery, what the barriers are to recovery and how to effectively target barriers to concussion recovery in treatment.

Although symptoms experienced immediately or shortly after injury can be directly related to brain injury, over time the brain heals and persistent symptoms can be maintained by many other factors, known as barriers to recovery.

Barriers to recovery following concussion can include depression, anxiety, avoidance of triggers (e.g., sound, lights, screens, physical or cognitive exertion), sleep problems, fatigue, pain (e.g., headaches), focusing on your symptoms, over exertion and experience of repeated setbacks in symptoms, and misinformation by well meaning family and health professionals. These factors can further interact to escalate each other (e.g., anxiety can fuel pain circuits in the brain) and maintain or even worsen symptoms.

Fortunately, neuropsychologists knowledgeable in concussion management can treat most barriers to recovery and get you on the right track to feeling like yourself again.

Neuropsychological treatment at Toronto Brain Health may include the following:

• Education and guidance to resolve symptoms more quickly.
• Biopsychosocial approaches to the treatment of chronic pain and physical symptoms (e.g., headaches, light and sound sensitivities), in conjunction with physiotherapy and neurology at other clinics or programs.
• Treatment of anxiety, depression, irritability, trauma, sleep problems, symptom preoccupation, low stress tolerance.
• Cognitive exertion training and cognitive rehabilitation , if indicated.
• Return to work or school readiness determination, a return plan, and guidance through the process.
• Many of our psychologists provide services under the WSIB Community Mental Health Program, insurer benefit plans and auto insurance for motor vehicle accidents.