concussionMilad Bazaz Jazayeri, BSc (KIN.), MPT
Milad is a Registered Physical Therapist, practicing in downtown Toronto @ the Orthopaedic Therapy Clinic.

Concussions in both youth and adult populations has been growing exponentially over the past decades. During a 12 months period from 2009 to 2010, Statistics Canada reports that more than 94,000 Canadians aged 12 and older experienced a concussion. Some of this increase may be explained by increased awareness but it also suggests that better prevention strategies are critical.

What is a Concussion?

A concussion is a traumatic brain injury – often classified as a mild traumatic brain injury (mTBI) – that affects the brain’s function. A concussion can be caused by a direct or an indirect blow to the head. Often concussion does NOT involve loss of consciousness. Signs and symptoms of a concussion are generally classified into three categories (Parachute Canada):

A) Physical symptoms include: headache, dizziness, nausea, feeling unsteady, feeling “dinged” or “stunned” or “dazed”, feeling like their “bell was rung”, seeing stars or other visual disturbances, ringing in the ears, double vision, simply “not feeling right”.

Physical signs of concussion include: loss of consciousness or impaired consciousness, poor coordination or balance, easy distractibility and poor concentration, slowness answering questions and following directions, vomiting, looking “glassy eyed”, extreme sensitivity to light (photophobia), slurred speech, personality or behavior changes, and significantly decreased performance or playing ability.

B) Cognitive symptoms include: confusion, amnesia, disorientation, poor concentration, and memory disturbance.

C) Emotional symptoms include: feeling of depression or moodiness.

Post Concussion Syndrome (PCS)

The majority of patients with sport-related concussions recover within 7-10 days and non-athletes recover within the first three months after the injury. After a concussion, some people experience residual physical, cognitive and emotional symptoms. If the symptoms persist for longer than three months, they may be diagnosed with post-concussion syndrome (PCS). This diagnosis requires three or more of the following post-injury symptoms:

  • Headache
  • Dizziness
  • Fatigue
  • Irritability
  • Insomnia
  • Difficulty concentrating
  • Memory difficulties

How does a concussion affect your body?

A concussion not only affects an individual on a cognitive level, it also affects them on a physical level. Concussions can alter heart rate and the autonomic nervous system function, which subconsciously controls important body functions such as breathing and digestion. These changes can mean that someone with a concussion may experience a greater increase in heart rate compared to a healthy individual doing a similar physical activity.

Concussion may cause an unnecessary increase in blood flow to areas of the brain that are not needed during physical cognitive tasks. Healthy individuals have more efficient cerebral blood flow, supplying only the areas of the brain needed for the task. This increase in blood flow in PCS is an indicator that the brain is exerting much more energy and may explain the physical and mental fatigue when performing both exercise and mental tasks after this type of injury.

Guidelines for return to physical activity post-concussion

Too intense of cognitive and physical activity should be avoided immediately after this type of injury as this can increase the severity of the symptoms and lengthen your recovery. In order to safely return to your previous activity level, use these established guidelines to ensure a speedy recovery and to return to your pre-concussion activities. It is important that you are symptom free at each step before you progress onto the next level.

  • Step 1: no activity, only complete rest.
  • Step 2: light aerobic exercise
  • Step 3: sport specific activities.
  • Step 4: begin drills without body contact
  • Step 5: on field practice with body contact
  • Step 6: game play

To assure safety, it is best to consult a physician/therapist before beginning this step-wise return to sport program.

How can Physical Therapy help?

A variety of different types of treatments can be used to help people recover from concussions and PCS. Some of these treatments include; rest, education, neurocognitive rehabilitation, antidepressants and physiotherapy.

When seeing a physiotherapist you can expect a thorough history and physical examination to be completed at the first visit. Your therapist may assess your balance, coordination, cognition, symptoms, and endurance as well as a full neurologic assessment to establish a baseline.  This will help to determine which functions have been affected the most.

Balance and postural stability can be challenged after a concussion as the brain may receive abnormal signals regarding the position and movement of the head in space. Vestibular and balance rehabilitation may reduce dizziness and improve gait and balance deficits if they have not resolved with rest.

You and your physical therapist should establish safe and achievable therapy goals and then design an individualized rehabilitation program to facilitate your post-concussion recovery. There are also an increasing number of studies suggesting a graded aerobic exercise training/intervention program facilitates the healing process. This may help by targeting the physiological dysfunction through increasing parasympathetic (1) activity, reducing sympathetic activation and improving cerebral blood flow. During this type of program your therapist should closely monitor your heart rate, rating of perceived exertion and blood pressure to help progress through the stages of healing while normalizing physiological properties and returning these levels back to the pre-concussion level.

For more information visit Parachute Canada’s After a concussion guidelines for return to play

 

(1) The sympathetic and parasympathetic nerves regulate the automatic functions of the body i.e. sweating,  These nerves supply organs, blood vessels and glands.