Concussion

Concussion

Concussion is a traumatic brain injury that can cause lasting effects on brain tissue and change the chemical balance of the brain. Concussion may cause physical, cognitive, and behavioral symptoms and problems, both short-term and long-term. Every concussion is considered a serious injury by health care providers. If you have experienced a head injury, seek medical help immediately.

 

What Is Concussion?

Concussion is a brain injury that occurs when the brain is violently shaken. The injury can happen during rapid movement changes (such as whiplash) or when the head is directly hit. This shaking or hitting of the head causes unpredictable injury to any area of the brain, resulting in immediate or delayed changes in the brain's chemistry and function. Less than 10% of concussions involve a loss of consciousness. Depending on which area of the brain suffers injury, many different temporary or permanent problems with brain function can occur.

Concussions can occur at any age, from a variety of causes, including:

  • Motor vehicle collisions (ie, head impact, whiplash)
  • Work accidents (ie, falls, head trauma)
  • Playground accidents (ie, falling from a slide or swing)
  • Sports injury to the head or neck
  • Falls (which are the leading cause of concussions)
  • Violent events, such as:
    • Physical abuse during which the head is shaken
    • Being too close to a blast or explosion
    • Direct blow to the head, face, or neck
    • Assaults, domestic violence

Recovery from a concussion can take several weeks to several months and sometimes years, depending on many factors, including severity of the injury and the age of the person affected.

Concussion may occur along with other injuries, such as those to the neck and surrounding tissues, which should be managed by a licensed physical therapist. More serious brain injuries, such as bruising, bleeding, or tearing, may also occur and require the immediate care of a medical doctor, such as a neurosurgeon. 

 

How Does It Feel?

A concussion is a brain injury; patients living with a brain injury often don’t have the language to express how they feel after injury. Therefore, it is important to work with a physical therapist who gets to know you, your family, teammates, and/or coworkers who may notice any changes in you.

 

Signs and Symptoms

There are many symptoms related to concussion, and they can affect your physical, emotional, and mental well-being. Some symptoms occur immediately, some a few hours after the injury, and some show up months or years after a concussion.

It is important to seek medical treatment immediately following any head injury. The risk of death or permanent brain damage from a concussion can be minimized by immediate and appropriate treatment from health care providers, like a physical therapist. Only health care providers have the knowledge and training to identify concussion in the maze of symptoms that can occur following a head injury.

Immediate and short-term symptoms

Physical symptoms of a concussion can include:

  • Headache
  • Dizziness
  • Difficulty with balance and coordination
  • Nausea/vomiting
  • Fatigue
  • Difficulty sleeping
  • Increased sleepiness
  • Double or blurred vision
  • Sensitivity to light and sound
  • Slurred speech
  • Glassy-eyed stare
  • Seizures

Cognitive (thinking) symptoms can include:

  • Difficulty with short-term or long-term memory
  • Confusion
  • Slowed "processing" (eg, a decreased ability to think through problems)
  • "Fogginess"
  • Difficulty concentrating
  • Worsening grades in school

Emotional symptoms can include:

  • Irritability
  • Restlessness
  • Anxiety
  • Depression
  • Mood swings
  • Aggression
  • Decreased tolerance of stress
  • Change in personality or behavior

Longer-term symptoms

  • Loss of libido
  • Loss of menses/menstruation
  • Growth problems (children)
  • Fatigue
  • Weight gain
  • Low blood pressure
  • Muscle weakness
  • Chronic headaches or dizziness
  • Muscle spasticity
  • Early dementia/chronic traumatic encephalopathy (brain disorder)

Some concussion symptoms do not go away in the expected time frame, and these symptoms are where your Rose physical therapist can have the most impact on your recovery.

Postconcussion syndrome is the term applied to symptoms such as headaches or dizziness that persist for weeks or months after the initial injury.

Second-impact syndrome is a serious, although preventable, complication that can occur after a concussion. If a person who has suffered a recent concussion experiences another concussion, permanent brain damage or death can occur. Permanent brain damage can include learning disabilities, personality changes, walking disability, or other brain or nerve disabilities. Research suggests that a person who suffers a second concussion before the initial concussion has healed, has a 100% chance of permanent brain damage, and a 50% chance of dying.

An example of second-impact syndrome would be a football player who suffers a concussion in a game, keeps playing, and is hit again; or a person who suffers a concussion from whiplash in a car accident, and then falls at home and endures another concussion very soon after the initial injury.

Extreme care should be taken after a concussion to prevent a second injury.

Athletes who suffer a concussion during practice or competition must be removed immediately from play, in order to prevent subsequent concussions and second-impact syndrome. A physical therapist will work to develop safe guidelines for return to play, return to work, and return to life’s daily requirements.

A longer recovery time may be required for those with a history of prior concussions, eye tracking/movement issues from childhood, migraines, attention deficit hyperactivity disorder, or a learning disability. It's important to disclose your entire medical health history to your physical therapist.

 

How Is It Diagnosed?

Concussion is most often diagnosed through careful testing by your health care provider, such as a physical therapist. Unfortunately, no single test or tool exists to diagnose a concussion. The diagnosis usually does not rely on hi-tech testing, such as an MRI or CT scan, because brain scans often do not show any brain abnormality, even when the person has symptoms of a concussion.

Your physical therapist will ask you many questions to understand all of the symptoms that you are experiencing. He or she also will perform numerous tests to identify problems caused by a concussion, including muscle strength, coordination, balance, sight, smell, hearing, and memory tests.

During treatment, your physical therapist will repeat the same questions and tests frequently to gauge your progress and help judge when you can return to work, school, sport, or recreational activities.

If you are an athlete who underwent preseason memory (neuropsychological) testing, your physical therapist may collaborate with the health care provider who performed that testing to help determine if you have a concussion.

Your physical therapist may also examine your neck for problems following a concussion. Neck injuries can occur at the same time as concussions, and can cause or increase headaches and dizziness.

 

How Can Your Rose Physical Therapist Help?

Rose physical therapists are specially qualified to evaluate and treat many problems related to concussion. Because no two concussions are the same, your Rose physical therapist will examine your neurological, orthopedic, and cardiovascular systems in order to best prescribe a routine to address your particular symptoms and your needs in all of your daily environments. The physical therapy approach to concussion treatments is evolving and may not always follow the old practice of placing the patient in the dark for long periods of time.

Physical therapy for concussions includes restoring strength and endurance, stopping dizziness and improving balance, reducing headaches, and monitoring your return to sport. In some instances, rest and recovery might be necessary.

Restoring strength and endurance. The physical and mental rest required after a concussion can result in muscle weakness, and a decrease in physical endurance. A Rose physical therapist can help you regain your strength and endurance when the right time comes, without making your concussion symptoms worse. It is common for elite-level athletes and fit athletes to experience exercise intolerance with concussion and brain injury. A physical therapist at Rose will work with you to identify and treat your particular concussion symptoms.

Your physical therapist at Rose will design a therapeutic exercise program just for you, and closely monitor your symptoms as you participate in the program.

Stopping dizziness and improving balance. If you have dizziness or difficulty with your balance following a concussion, a type of physical therapy called vestibular physical therapy may help. Physical therapists at Rose are experienced in treatment of vestibular disorders. The vestibular system includes the inner ear and its connections with the brain and helps you keep your balance and prevent dizziness. Your Rose physical therapist may be able to help reduce or stop your dizziness or balance problems after a concussion by applying special treatments or teaching you specific exercises.

Reducing headaches. A physical therapist at Rose will assess the different possible causes of your headaches, and use specific treatments and exercises to reduce and eliminate them. Treatment may include stretches, strength and motion exercises, eye exercises, hands-on techniques like specialized massage, and the use of technologies such as electrical stimulation.

Returning to normal activity or sport. As symptoms ease and you are able to regain your normal strength and endurance without symptoms returning, your Rose physical therapist will help you gradually add normal activities back into your daily routine. A Rose physical therapist will help you avoid overloading the brain and nervous system as you increase your activity level. Overloading the brain during activity after a concussion interferes with the healing of the brain tissue, and can make your symptoms return. A Rose physical therapist will help you return to your normal life and sport activities in the quickest and safest way possible, while allowing your brain to properly heal.

Rest and recovery. Your physical therapist will help you and your family understand why you should limit any kind of activity (daily tasks, work, school, sports, recreation, the use of electronics) after a concussion, until it is safe to return to these activities. A period of rest helps the brain heal and helps symptoms clear up as quickly as possible. Your physical therapist will prescribe the rest and recovery program most appropriate for your condition. It is important to understand that while you may feel different, others around you may not understand your condition and your physical therapist at Rose can help advocate for you. With the fast pace of Washington, DC, it is important to engage your physical therapist in being your advocate in addition to designing and implementing your plan of care.

 

Rose Physical Therapy is here in Washington, DC to help!

Physical therapists at Rose in Washington, DC are experienced experts in treating concussions. It is imperative to begin treatment for concussion as soon as possible, so please reach out for an appointment at either our downtown Washington, DC office or our office in Navy Yard near Capitol Hill to begin your therapy quickly. Please be sure to emphasize that you are suffering from a concussion and the date/time your concussion occurred so that our team can take this into account in getting your appointment setup.