The Brain Injury Association of America has declared March to be Brain Injury Awareness Month. This year, the focus of the campaign is to share stories and build a community for TBI patients. In light of Brain Injury Awareness Month, we thought we'd share some frequently asked questions we've had about concussion specifically. A concussion is considered an invisible injury. This means that diagnosis and treatment often rely on subjective assessments and patient reports. With the current standard of care, recovery guidelines may often seem vague and are not personalized to an individual's needs. Recovery can also be expensive, especially when patients deal with recovery setbacks. Many concussion patients may also struggle with mental health symptoms.
Concussions can be challenging to understand and manage. We're hoping that this blog sheds some light on the invisible injury and provides clarity to concussion patients.
Frequently Asked Questions
WHAT IS A CONCUSSION?
A concussion is a minor traumatic brain injury that is caused by a hit to the head or body that causes the head and brain to move rapidly back and forth. This type of rapid head movement causes the brain to move quickly within the skull. This movement changes the shape of the brain, damaging the cellular structure and causing chemical and metabolic changes that make it more difficult for the brain to function normally.
WHAT ARE THE SIGNS OF CONCUSSION?
Loss of consciousness
Problems with balance
A glazed look in the eyes
Delayed response to questions
Forgetting an instruction, confusion about an assignment or position, or confusion of the game, score, or opponent
WHAT ARE THE SYMPTOMS TO LOOK FOR?
Headache, nausea, vomiting, blurred or double vision, seeing stars or lights, balance problems, dizziness, sensitivity to light or noise, tinnitus, vertigo
Drowsiness, fatigue/lethargy, irritability, depression, anxiety, sleeping more than usual, difficulty falling asleep
Feeling “slowed down”, feeling “in a fog” or “dazed”, difficulty concentrating, difficulty remembering
WHAT IS SECOND IMPACT SYNDROME?
During recovery, the brain is more vulnerable to re-injury. In rare cases, a second concussion sustained during recovery can cause the brain to undergo massive swelling. This extremely rare condition is known as Second Impact Syndrome (SIS).
40% of people with concussion may experience persisting symptoms beyond the typical three-month time frame. The consequences for these individuals may include reduced functional ability, heightened emotional distress, and delayed return to work or school.
WHAT SHOULD I DO IF I'VE HAD A CONCUSSION?
Concussions are complex injuries with multiple physiological factors. Concussion disrupts signal transmission and blood flow in the brain. This limits brain function. Overexerting the brain while in this state can cause recovery setbacks. To avoid these setbacks cognitive pacing is essential. Concussion can also cause autonomic dysregulation, the body's balance between parasympathetic (rest) and sympathetic (fight/flight) states. This can cause exercise intolerance, fatigue, and irritability. The ability of the eyes to track in unison and move appropriately can also be disrupted with concussion, as well as whiplash and muscle spasms which can also cause headaches. Finally, mental health is also commonly impacted by concussion and should be addressed if anxiety or depression is persisting. There are specific therapies for each of these components, and early intervention is very important to speed recovery.
Acute: (0-4 weeks):
The acute phase following a concussion is when the metabolic changes to the brain are most pronounced and in its most vulnerable state. This is when the patient is most susceptible to second impact syndrome and avoiding repeated head trauma is essential. During this period of time, cognitive pacing is very important. Staying mentally active is important, but it is very important to avoid overexertion. Eating healthy, sleeping well, and graduated exercise is important during this phase. During this period it's also important to begin targeted therapies for potential whiplash, vestibular and oculomotor deficits. It's essential to seek out medical care from clinicians who are experienced in concussion to ensure the appropriate therapies are initiated.
Post-Acute: (4-12 weeks):
Persistent symptoms may indicate that one or more of the components above are not being appropriately addressed. If the patient is not improving or symptoms are worsening, then a referral to an interdisciplinary clinic should be made. The focus should be on managing symptoms of sleep impairment, headache, mood, fatigue, and memory/attention. The focus is on a graduated return to activity, including work and school.
Persistent: (3 mo. +):
If symptoms persist for more than three months, patients require an interdisciplinary team for symptom management using an individualized management approach focusing on returning to pre-injury activities. At this point in time, it's important to ensure that all aspects of the concussion are being addressed. The patient should continue to engage in cognitive and physical pacing as they return to pre-injury activities. Along with eating healthy and sleeping well, mental health can begin to become a significant contributing factor to recovery and needs to be addressed as well. The Neurovine solution offers mindfulness-based meditation programs to help patients restore energy and improve mental health. At this point in time, the vast majority of concussion will completely resolve.
SHOULD I EXERCISE IF I HAVE A CONCUSSION?
A study by John J. Leddy, MD et al found that participants who engaged in sub-symptom threshold aerobic exercise recovered faster (13 days) than those who were assigned placebo-like stretching exercises (17 days). Overexertion may protract recovery but sub-symptom exercise is helpful for recovery. Through activity pacing, concussion patients can lower their risk of overexertion.
HOW CAN COGNITIVE PACING FACILITATE CONCUSSION RECOVERY?
Healing from concussion may take time and effort. Experiencing a concussion can make it difficult to manage your cognitive exertion on your own, since your threshold for sustainable cognitive activity can change. Cognitive activity for concussion patients may sometimes trigger symptoms, including headaches and brain fog. While it is important to reduce cognitive activity upon experiencing a concussion, experts agree that patients should include symptom-limited activities while staying below a cognitive exacerbation threshold. EEG-guided cognitive pacing can warn patients prior to symptom onset, to reduce the risks of setbacks in recovery.
DOES CONCUSSION IMPACT MENTAL HEALTH?
Approximately 1 in 5 people experience mental health symptoms up to six months after mild traumatic brain injury. Common mental health symptoms reported by patients include depression, anxiety, mood disorders, and PTSD. This could be due to structural and functional changes in the brain, sleep disturbances, emotional suffering, and many other potential causes. It may also be in part due to the fact that many concussion patients don't feel like they have control over their recovery process, due to the vague diagnosis and treatment options. They may isolate themselves and feel disconnected from others. While there's a commonality among concussion patients, no two concussion patients are the same. We have seen that there is a need for data-driven personalized treatment options tailored to individual patients.
HOW CAN PHYSICAL THERAPY HELP CONCUSSION RECOVERY?
Concussion physical therapy centers on aligning symptom management with recovery goals, much like the physical therapy treatment of a dislocated shoulder or sprained knee. Early intervention is also a key aspect of successful concussion recovery. A physical therapist will go through a series of tests to assess the patient and identify symptoms. Therapists will also want to identify thresholds so that patients can safely practice activity and cognitive pacing.
Physical therapy approaches concussion treatment with progressive exercises because, just like any other muscle injury, exceeding an exertion threshold sets back recovery time. Building progressive exercises starts with finding the exertion limits.
HOW DO DIGITAL THERAPEUTICS WORK TO HELP SUPPORT CONCUSSION RECOVERY?
Digital therapeutics like the Neurovine solution can help facilitate concussion recovery significantly. For Neurovine, early clinical trials have shown a 40% faster recovery rate and a significant improvement in mental health. By bringing visibility to this invisible injury, with aggregated centralized brain health data, the Neurovine solution allows clinicians to create personalized, targeted therapy plans that are unique to the individual's brain. It allows patients to return to work, school, and life with ease and reduces the risk of overexertion by promoting cognitive pacing. It makes it easier for patients to understand and communicate their symptoms, and feel more in control of their recovery process.
IMPORTANCE OF COMMUNITY - YOU ARE NOT ALONE
It's important for concussion patients to feel supported in their recovery. Whether that be through connection with family and friends, a community of patients, or sharing accurate brain health data with their clinician for more personalized treatment plans.
Neurovine is working to empower concussion patients on their path to recovery, by bringing visibility to this invisible injury. With the Neurovine solution, concussion patients can manage their cognitive exertion, reduce the risk of symptoms and easily share their brain health data with their clinicians and family.
We've also launched the Virtual Vine Concussion Community to connect patients, friends, and family with the goal of bringing more awareness to this invisible injury and brain health. Feel free to check out the additional resources to help support concussion patients and enhance brain health. If you have a question that we haven't addressed, feel free to comment or reach out to us directly.
- Brain Injury Awareness Month: Challenges and Guidelines for Recovery