Life after a Concussion
Allison Maffei, DPT, NCS guides Lieselotte Koegler to challenge and improve her balance.
By Margaret "Mags" Matthews, MPT Published in the Union
Concussions have been getting more attention in the news recently as we become more aware of the effects of cumulative brain injuries for people of all ages. Many people think that sports injuries from such as football and soccer are the primary way people get concussions. However, concussions also frequently result from falls, car accidents, military service, and domestic violence. Personally, I have known multiple people with concussion symptoms that have lingered for more than a month after injury, which lead me wanting to highlight this topic.
Allison Maffei is a doctor of physical therapy (DPT) and is a Neurological Certified Specialist (NCS) which includes concussion treatment. Per Maffei, “a concussion is a mild traumatic brain injury (mTBI), but no one usually calls it a concussion unless it’s a sports injury. Some people might think it’s less severe, but we still have a brain injury.”
The difficulty with functioning normally after a brain injury is that the metabolism of the brain changes. The brain cells, called neurons, have been damaged; there is inflammation, less blood flow and a potassium and calcium imbalance resulting in what is know as a metabolic storm. The neurons are less able to communicate with each other, are making less energy, and the little energy that is produced is prioritized for healing instead of ongoing, regular function. Since two-thirds of the brain connections are involved with the visual system, people recovering from a concussion might have difficulty with vision. Difficulty with headaches, altered balance, spatial perception, emotional regulation, dizziness, memory, and learning are also common. These medical problems are known as post-concussion syndrome, which describe the symptoms one experiences after a head injury.
Healing from concussions can vary. In an ideal environment, adults might take one to two weeks to recover from a concussion, and children can take 4 weeks or longer. In more complicated situations, recovery might take from three months to over a year.
Tracking healing in children is more difficult. Forty percent of mTBI in children result from sports. “Concussions from youth sports are underdiagnosed, and undertreated. Part of the difficulty is that they are underreported by kids who want to play,” reports Maffei. Currently 2-4 days of brain rest are suggested initially, followed by a return to normal basic activity and a gradual return to exercise when symptoms are resolved. The challenge lies in how to return to activity, when typically patients report a worsening of symptoms when they participate in too much activity. “After practice [or work] they might need to close their eyes because light is painful, or they feel like they are walking around in a fog,” says Maffei. “Brain fog is a general slowdown of processing in the brain. Patients say they feel that everything is happening around them, but they can not focus, concentrate, read, and everything is moving slow.”
Physical therapy is endorsed by the 5th International Consensus on Concussion to provide the top 2 effective treatments, as well as other beneficial treatments to improve and shorten the healing process. Physical therapy addresses stability and weakness in the neck, dizziness and difficulty with eye tracking, changes in balance and brain fog. A physical therapist will develop an individualized aerobic exercise program and targeted therapy for neck dysfunction. The idea is to exercise at a level of seventy percent before symptoms occur. This graded exercise increases the circulation to the brain while challenging and enforcing new connections between the neurons with multitasking as well.
When asked what she enjoyed most about working with people recovering from concussion, Allison Maffei DPT, NCS stated “It’s interesting to see how individualized therapy is, because each person’s brain is so different, as compared to a knee which is relatively the same [in its’ function]. A similar injury will manifest with completely different symptoms. One thing I like about neurological physical therapy is being keyed in to what people want to do and to make the care plan specific to each person. For instance walking and texting at the same time challenges the balance, cognitive, and visual systems. I might recreate activities like passing and shooting a basketball to work on balance. Playing sports means being able to move your feet, look and see who is coming at you, and to identify who you need to pass to. Being able to drive requires so many different cognitive and physical skills all at the same time as well. Walking down stairs and talking to friends at school might be something we work on.” Maffei anticipates that, “After being treated for concussion, people should feel that their mind is sharper, no mind fog, better attention, and that they feel greater ability to do the things they want to do, including sports, without any issues.”
If students report a decreased ability to focus in school, neuropsychological therapy is needed as well. Mood issues such as depression and anxiety, as well as behavioral issues compound with brain injury, and can result in prolonged healing processes. Cognitive behavioral therapy is another treatment to address persistent mood or behavioral issues in people healing from concussion.
If you suspect a concussion, or difficulty healing from concussion, you may have post-concussion syndrome, please see your medical provider to see what types of treatment are right for you.
Move Better, Live Better!