Concussion Treatment
Concussion is the word used to describe traumatic brain injuries (TBI) at the most mild end of the spectrum. While more severe TBIs include changes to the brain structure that can be seen on neuroimaging (like bleeding or skull fracture), concussion changes the way the brain functions. This causes symptoms that can range from very mild to quite severe and debilitating
At Aptiva Health, Dr. Lisa Manderino, Dr. Robert Williams and Dr. Thomas Huhn will evaluate the signs and symptoms, review the medical history, and conduct a neurological examination when a concussion is suspected. Signs and symptoms of a concussion may not appear until hours or days after the injury so it is important for parents, or other members of the household, to pay attention to changes in mood, cognition, and symptoms of a person that may have suffered a concussive event.
Our Concussion Care Team
At Aptiva Health, our concussion providers will perform a comprehensive physical and neurological examination. In the event a concussion is suspected or diagnosed, the provider may continue with additional cognitive testing and imaging tests. At Aptiva Health, we have many healthcare providers and doctors that are certified in administering neuropsychological testing (ImPACT) for concussions and head injuries.
At Aptiva Health, we utilize the ImPACT testing program for both baseline testing before a concussion has occurred and for post-injury testing. By offering both baseline and post-injury testing, our healthcare providers can accurately pinpoint cognition deficits to effectively diagnose and treat each patient.
We have identified that there are actually 6 different types of concussion. Each type is characterized by specific symptoms and impairments on the tests performed by your doctor. Some individuals may experience only one type of concussion, while others may have several of the different types at once. Treatments can be matched to each patient’s unique presentation after a concussion to speed recovery.
Post-Concussion Care
At Aptiva Health, we provide a wide range of treatment options for patients suffering from concussions. Typically, patients are encouraged to rest and engage in conservative options first and encouraged to rest to allow time for their body to heal. Some of the first steps we recommend are:
Don’t rush back - it is generally advised that anyone who has had a head injury should take things slowly. If possible, try to return to your usual activities as gradually as possible after a head injury.
Sleep hygiene - if you are having problems sleeping and are feeling very tired, try to stick to a regular sleep schedule and avoid napping during the day.
Medication - your concussion provider may suggest some medication to help alleviate some of the most common symptoms associated with post-concussion syndrome, such as: Amitriptyline, Zofran, Tylenol PM, and similar.
Keep stress levels down - additional stress can aggravate or even worsen post-concussion symptoms.
Avoid alcohol, heavy stimulants, and recreational drugs - these substances can aggravate or even worsen post-concussion symptoms.
Vestibular rehabilitation - if you are suffering from vertigo, dizziness, or other balance issues following a concussion, your concussion provider may recommend you try vestibular rehabilitation with our Physical Therapy Department. Vestibular rehabilitation therapy (VRT) is a specialized form of physical therapy intended to alleviate problems caused by vestibular disorders, primarily vertigo and dizziness, gaze instability, and/or imbalance and falls.
Psychological symptoms - often patients who have suffered a concussive event will complain of anxiety, depression, or other psychological symptoms that are elevated or that began after suffering a concussion. It is very important to speak with your concussion provider about these symptoms to ensure they are addressed in addition to any physiological symptoms.
Concussion Myths Debunked
Myth: You have to hit your head to have a concussion.
Fact: A concussion can occur when the brain moves inside the skull. This can be caused by a direct blow to the head, but can also occur when a blow to the body causes a whiplash effect to the head and neck.
Myth: You have to lose consciousness to have a concussion.
Fact: Only about 10% of concussions result in a loss of consciousness.
Myth: There’s nothing you can do for a concussion except rest and wait.
Fact: Research has come a long way in the last 15 years! We can now identify different subtypes of concussion and match appropriate treatment strategies based upon the subtype of concussion that a person is experiencing. Based upon the unique features of the injury, a concussion specialist can recommend active treatment strategies such as physical therapy, a home exercise program, and a structured plan for approaching daily activities like work and school. Matching treatment strategies to the specific type of concussion has shown to improve speed of recovery and other key outcomes for patients.
Myth: You can return to sport after a certain amount of time or after a certain symptom resolves.
Fact: Returning to sport participation too early can lead to worse symptoms, long-term impairments, and in rare cases even death by second impact syndrome (in which someone suffers a second concussion before the first one has fully healed). This is why it is so important to be sure a concussion has fully resolved before returning to sport. However, concussion can affect many different brain systems, and these systems may recover at different rates. Someone may feel better physically before other brain systems have fully recovered. A multidisciplinary evaluation including objective assessment of concussion-related symptoms and impairments is imperative to ensuring that an athlete is fully recovered before returning to sport participation.
Myth: Rest is the best treatment for a concussion
Fact: Rest is NOT best after a concussion! Prescribed rest actually has a negative effect on symptoms after concussion, and this negative effect is worse in younger individuals and in athletes compared to civilians.
Myth: Wearing a special type of helmet or other equipment can prevent concussions.
Fact: Wearing appropriate protective gear when participating in sports is hugely important because they can prevent severe brain injuries (such as brain bleeds and skull fractures). However, since concussions occur when the brain moves inside the skull, no helmet or device can entirely prevent them. Fortunately, concussions are also highly treatable injuries and are rarely associated with the types of permanent impairments seen in more severe injuries.
Myth: You have to stop playing sports after a certain number of concussions.
Fact: There is no “magic number” for what is considered “too many” concussions. Many factors need to be considered, including an athlete’s medical history and how they recover from each concussion. A concussion specialist can discuss risks and benefits of continued sport participation based upon an athlete’s unique circumstances.
Emerging Concussion Treatments
Coming soon to Aptiva Health Sports Medicine will be the treatment option of hyperbaric oxygen therapy! The use of Hyperbaric Oxygen Therapy to treat concussions and traumatic brain injuries in patients aims to relieve symptoms and accelerate recovery by promoting damaged tissue repair and angiogenesis, or blood vessel growth.
The brain needs oxygen and energy to function optimally. An emerging concept is that these traumatic brain injuries are like wounds on other parts of our body, but not as readily visible. Exposure to hyperbaric oxygen increases the amount of oxygen that is carried by the blood. Because disruptions in blood flow are common in mTBI, HBOT allows for oxygen to be delivered and to facilitate healing. HBOT triggers healing by promoting the release of stem cells that can migrate to injured areas, promoting angiogenesis (the growth of new capillaries) and supporting energy production at the level of the mitochondria.
The most exciting research is being done in Israel on civilian patients with mTBI. This research is being led by Shai Efrati, MD. His team has published a series of articles that show excellent results inpatients with mTBI. They have had a marked reduction in symptoms, with many of them returning to normal levels of functioning. But these researchers have taken this a step further, by using advanced imaging techniques to show increases in cerebral blood flow/volume and the increase in white matter tracts, the physical improvements are now visible. Improvements that are seen clinically are being quantified.
Hyperbaric oxygen may be a very important clinical intervention in patient with mTBI when conventional modalities have not made a significant impact.
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