Concussion

If you suspect a concussion, or have been diagnosed, you should:

·   Immediately stop playing and going to school or work

·   See your doctor or a licensed healthcare provider for an assessment

·   Rest for at least 24 to 48 hours after the injury (physical & cognitive rest)

Warning Signs to look for:

Immediately go to the emergency department if any of these signs or symptoms are present.

These are known as Red Flags, and could mean a more serious injury such as a bleed or skull fracture.

Concussions happen because of a hit, bump or blow to the head or elsewhere on the body. This impact causes the brain to move back and forth inside the skull.

Each concussion case is different.  If you experience any one or more of these symptoms following a big hit to the head or body, then you should suspect a concussion:

Physical:

Head Ache - Neck pain - Sensitivity to light/noise - Visual problems - Dizziness - Balance issues - Nausea - Vomiting

Thinking:

Memory issues - Difficulty concentrating - Confusion - Feeling slowed down - Feeling “in a fog” - Trouble thinking clearly

Emotional:

Anxiety - Nervousness - Depression - Sadness - Irritability - More emotional

Sleep:

Fatigue - Low energy - Sleeping more or less - Difficulty falling asleep

So, you had a Concussion… Now WHAT?

Seizures or convulsions - Loss of consciousness - Weakness or numbness in arms/legs - Unable to wake up - Worsening headache - Bad nausea or repeated vomiting - Increasing confusion - Unsteadiness standing or walking - Bruising around eyes or ears - Odd behavior - Slurred speech - Inability to remember injury

DO's:

REST:

Concussion results in a very low energy state in the brain. Avoid strenuous activity for the first 24 to 48 hours.

SLEEP:

If there are no Red Flags, then get a good night's sleep. Take naps, if needed.

EAT RIGHT:

Proper nutrition can give you energy and play a role in recovery.

FOLLOW PROTOCOLS:

Guided return to learn, work and play protocols can help you make a full recovery. Follow the direction of you healthcare provider.

DON’T’s

PLAY SPORTS:

Do not participate in sport before full recovery, and clearance from your healthcare provider. It's dangerous, and can put you at risk.

WORK OR STUDY:

Take some time off from school or work until you feel better.

DRIVE:

Do not drive for at least 24 hours. Wait until you feel better.

TAKE PAIN MEDICATION:

Pain medication can "mask" symptoms, and make it difficult to tell how the concussion affects you. Talk to your doctor first.

DRINK ALCOHOL OR TAKE DRUGS:

These can make you feel worse or "mask" symptoms.

A thorough “Assessment” and the right “Treatment” approach can help most patients and athletes safely “Recover” from a concussion.

TIPS FOR DEALING WITH CONCUSSION SYMPTOMS:

Mild Headache:

Sleep, rest or take breaks from activities that require concentration or effort. Some headaches are caused by tension in the neck, which can be treated by manual therapy by a trained healthcare provider.

Difficulty Concentrating:

It’s difficult to concentrate when you are tired or suffer from headaches. Your ability to concentrate should gradually get better but take breaks when you need to. Don’t push it.

Light or Noise Sensitivity:

Shaded glasses can help you manage light sensitivity, but don’t wear them for a long period of time. It can make things worse. If you’re sensitive to noise, don’t be afraid to ask people to turn it down or leave the room.

Sleep Problems:

Sleep problems are usually temporary and will gradually return to normal. Practice good sleep hygiene: go to bed early, avoid caffeine before bed and reduce screen time.

MORE TIPS:

This information may be helpful in the first few days after injury, but is not a substitute for the medical advice of your doctor and/or healthcare provider.

Anxiety or Depression:

Feeling anxious, worried, scared or mad is normal after a concussion. These feelings often go away when your symptoms go away. Keep in mind that these are normal feelings after injury. Explain to friends and family what you're experiencing to help them understand.

Irritability or Mood Swings:

You might get easily annoyed after a concussion. This doesn’t last long. Ask your friends and family for support. You could try some relaxation techniques or breathing exercise to reduce stress. Light exercise may also help. Follow the direction of your healthcare provider.

Dizziness or Nausea:

You might feel dizzy or sick to your stomach after quickly moving or changing positions. This usually only lasts for a few days. Take your time and avoid sudden movements.

Balance Problems:

Feeling a little bit more clumsy than usual? This is common after a concussion. Your brain is your body’s control center. Take everything a little bit more slowly. Give your brain a chance to make sense out of all the messages coming from your senses.

Difficulty with Decision Making:

You might feel like you’re less able to plan ahead or have difficulty completing an activity. This is common in the first few days after a concussion. Plan ahead. Write things down. Try to stay organized. Come up with step-by-step ways to complete tasks.

Feeling Slowed Down:

Can’t keep up with conversations, follow directions or complete tasks? Ask people to slow down or repeat certain things. Give yourself extra time to complete tasks and avoid pressure situations.

Ringing in Ears:

Hear a whistling, ringing or roaring sound? This is caused by damage to the inner ear after brain injury, and usually goes away in a few days to weeks after injury. Reduce normal noise intake. This can help. Otherwise, ask your healthcare provider.

Fatigue:

After a concussion, your brain has less energy than normal. Even a little bit of effort can make you feel tired. If you need more sleep, that’s okay. Let your brain tell you when it needs sleep or a nap.

RETURN TO ACTIVITY PROTOCOL:

If you are injured in sport, DO NOT return to play on the same day of your concussion. You may only return to play “AFTER” you have been “Assessed” and cleared by your medical doctor or a licensed healthcare provider with training in concussion. You may need to take some time off from school, work and/or sport after a concussion. Most protocols include frequent breaks, fewer hours at school or work, diet and nutritional interventions and less screen time.

With a thorough “Assessment” and the right approach, most people with a concussion can make a full recovery. Step-by-step return to activity programs can help you through the process.

RETURN TO LEARN:

Concussion symptoms that affect memory and concentration can impact your performance at school. Return to learn helps students gradually return to mental activity and learning, without putting too much strain on the brain.

Return to play protocols may be different for each person, depending on their age, gender and sport.

1) MODERATE, SYMPTOM LIMITED ACTIVITY

You should rest and avoid any physical and cognitive activity that could increase symptoms. Remain at this stage until symptoms go away for 24 to 48 hours (up to a max of 3 - 4 days). If you are still having symptoms at rest for longer than 4 days, book a visit with your healthcare provider.

DO: Light walks (15 – 30 minutes), household chores, limit screen time

DON'T: Physical activity that makes symptoms worse, risk another hit to your head

2) LIGHT COGNITIVE ACTIVITY

You can gradually increase your cognitive activity such as light reading, homework or working from home. If your symptoms come back, take a break and try again another time. Once you can tolerate up to 1hour of activity without getting symptoms, you can move to Stage 3.

DO: Light reading, homework, texting or emails, work from home

DON'T: Physical activity that makes symptoms worse, risk another hit to your head

3) HALF DAY OF SCHOOL OR WORK WITH RESTRICTIONS

You can go back to school or work for one-half day – morning or afternoon. Keep in mind that you should have some restrictions in place. Speak to your healthcare provider.

DO: Lower your school or job workload (modified duties), adjust screen and monitor settings (light sensitivity)

DON'T: Physical activity that makes symptoms worse, risk another hit to your head, participate in recess or gym class, take quizzes or tests, complete homework assignments

RETURN TO PLAY: HIGH-RISK ATHLETE

4) FULL DAY OF SCHOOL OR WORK WITH RESTRICTIONS

You can now attend a full day of school or work with certain restrictions.

DO: Attend class or go to work (desk job), and gradually increase cognitive activity, complete small homework assignments, take frequent breaks

DON'T: Physical activity that makes symptoms worse, risk another hit to your head, participate in recess or gym class

5) LIGHT PHYSICAL ACTIVITY

You should be evaluated by your healthcare provider with a graded exercise test to determine your ability to exercise and tolerance. Once completed, your healthcare provider can provide recommendations for you.

DO: Light walking, jogging or weight training

 DON'T: Physical activity that make symptoms worse, risk another hit to your head, sport-specific activities

6) LIGHT SPORT-SPECIFIC ACTIVITY

You can return to non-contact practice in your sport. This is your first step to safely returning to sport.

DO: Remove academic restrictions, individual drills and exercises

DON'T: Another hit to your head, increase heart rate too much, practice if you have symptoms

7) NON-CONTACT TRAINING DRILLS (HIGHER INTENSITY)

You can gradually increase intensity and participate in some team-based drills at practice. No contact!

DO: Individual drills and exercises at a higher level of difficulty and intensity, some team drills

DON'T: Participate in contact drills, risk another hit to your head

8) HIGH PHYSICAL EXERTION PROTOCOL

This step includes a high-intensity physical exertion test, overseen by your healthcare provider, to determine if you are ready for full contact practice.

9) FULL PRACTICE

You can participate in full practice and contact drills.

DO: Participate in practice at a high level, including contact

10)   FULL GAME

Once you get clearance from your doctor or healthcare provider, and feel ready to return, you can go back to full game play

While most people make a full recovery, about 15 to 30% of people will go on to have persistent symptoms such as headaches or dizziness. Following proper return to learn or play guidelines, and receiving information about concussions, expectations of recovery and strategies for symptom management can help to reduce the risk.

There are some risk factors for prolonged recovery and persistent symptoms:

• History of concussions

• Anxiety or depression

• Family or life stress

• Age (i.e., adolescents)

• Sex (i.e., females tend to be at higher risk)

• Misinformation (i.e., return to sport too soon, prolonged rest in a dark room)

• Improper management

 Treatment may involve addressing specific symptoms such a mood issues, anxiety, difficulty concentration or headaches. If you are experiencing ongoing problems, speak to your doctor or healthcare provider.

CONCUSSION TREATMENT & REHABILITATION

Rest is no longer considered the only approach in concussion care. Early intervention of various therapies can significantly improve recovery following a concussion. Through a thorough assessment and the right treatment approach, trained healthcare practitioners can help you safely return to learn, work and play.

EXERCISE THERAPY

Following a short period of rest and symptom-limited activity, guided exercise therapy has shown to improve blood flow and speed recovery.

MANUAL THERAPY

Headaches, balance and visual issues, dizziness and blood flow abnormalities are symptoms of both Concussion and neck injuries (or whiplash). Oftentimes, ongoing symptoms are coming from your neck, which can be treated with manual therapy.

VISUAL & VESTIBULAR THERAPY

Visual disturbances and dizziness are common following concussion. A balance and visual rehabilitation program may help to reduce symptoms such as dizziness, visual abnormalities, concentration issues and memory problems, among other symptoms.

EDUCATION & REASSURANCE

Education and reassurance is an important part of concussion care. Understanding exactly what is going On and why you feel a certain way can help to improve recovery.

DIET & NUTRITIONAL INTERVENTION

Avoiding pro-inflammatory foods (e.g., processed meats, fast food, sugar) and replacing them with more nutritious foods (e.g., whole foods, fruits, vegetables) may help to offset inflammation and reduce Symptoms