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Symptom Management

New Tools in the Fight Against Concussions

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The Concussion Center staff is dedicated to expedite recovery and will treat you or your loved one with state of the art clinical resources utilizing the most up to date information that science has to offer.

Each visit is geared towards collecting information that will help individualize treatment plans and answer any questions that pertain to the brain injury.

When Does Recovery Start?

Recovery from a concussion starts immediately with physical and mental rest and may take days to several weeks. This means no activity. The patient needs to remain under the observation of an adult, caregiver or healthcare professional during their recovery.

We focus on three parameters as a patient recovers: symptom checklists, neuro-cognitive components (memory and processing), and neuro-physical components (balance and reaction time). These three parameters will need to be back to "normal", or baseline, prior to starting a return play, work or school.

Athletes should not return to play until the appropriate healthcare professional ensures that they are totally symptom-free and approved to start a gradual stepwise progression. Once the signs and symptoms of a concussion have resolved, gradual stepwise exertion (such as light aerobic training) is started. The athlete can then move on to sport specific training. Non-contact drills are followed by full-contact drills, and, if no symptoms appear, a return to competition.

If at any point signs or symptoms of concussion recur, the individual must be reevaluated, rest and be symptom free at rest before returning back to stepwise progression.

Symptom Management

Like recovery, the ideal treatment plan starts immediately and requires both cognitive (mental) as well as physical rest in order to recover as quickly and fully as possible.

Increased stimuli to the brain by either physical or mental activities can slow down the recovery process and subsequently delay a patient's return to their sport, school or work. Symptom management is designed to give you tips to assist you in decreasing symptoms as well as speeding up your recovery.

Sleep

The importance of sleep cannot be underestimated in the recovery from a concussion.  Our brains rely on a good night’s sleep to recover from the day’s activities. When recovering from a concussion, the brain needs to rest even more, and it rests best when sleeping.

Inability to stay awake or arouse the concussed individual is not normal and can be a warning sign of a more serious injury. This is especially important to watch for in the first 48 hours after the concussion. Should you notice this, you should seek medical attention.

The first several days after the injury the concussed athlete will typically sleep more than what they normally do. You may notice that after the first week or so, there may be difficulty falling or staying asleep.

  • Take short naps (30-60 minutes) when you are tired. Naps are effective at “refreshing” the brain, but should be kept short (30-60 minutes) so as not to disrupt the ability to fall asleep for a full night’s rest.
  • Stick to a routine: Go to bed and get up at the same time every day.
  • Minimize distractions (TV, phones, computers) in your bedroom.
Avoid Triggers

In addition to rest, recovery consists of identifying and avoiding triggers that may worsen one’s symptoms.  Any activity that produces or increases your symptoms can be considered a trigger. It is important for you to know what aggravates your symptoms because these are different for everyone.

Avoiding triggers will:

  • Reduce your symptoms faster
  • Speed up your recovery

These triggers can include activities such as reading, studying, writing, note taking, concentrating, noise, light, watching TV, texting, computer work, video games, or even just walking. A concussed individual will typically notice their symptoms worsening throughout the day as their brains become more fatigued.  Pushing through the symptoms may prolong the recovery process.

Symptom or symptom onset caused by: Tip
Light Sunglasses (even inside), hats, dim lights, pull shades, be careful when transitioning from dark to light rooms, dim computer monitor.
Noise Use noise canceling headphones, ear plugs, adjust volume control.
Studying/reading Note the time when the onset of symptoms occurs and plan on taking a break prior to that cutoff time in the next study session. Take frequent breaks. Listen to the symptoms and don't push through them.
Television Limit time. More "intense" shows may be more difficult to watch. Monitor the intensity of light and volume. Pause and take frequent breaks.
Cell phones Limit talk time and volume. Limit or avoid texting.
Video games Best to avoid altogether during the mental rest phase.
Note taking Monitor neck position. Avoid multitasking. Record lectures. Ask for pre-printed presentations so writing is kept to a minimum. Ask a friend, colleague or teammate to take notes for you.
Computer work Keep to a minimum. The screen light, typing, reading, and focusing can all worsen symptoms. Take frequent breaks.
Neck pain Neck position may cause symptoms. Try to keep "chest out, chin back." Raise computer screen or reading material to eye level. Massage. Treat with topical medications or ice. Medications prior to bedtime may help neck discomfort while sleeping.
Physical activity Any activity that increases your heart rate (even as simple as walking or going up stairs) may help reproduce symptoms of your concussion. Avoid increasing your heart rate. Rest as needed.
Missed Time

The concussed brain will fatigue more easily and is typically the freshest earlier in the morning after a good night’s sleep.

As the demands of the day increase, the concussed individual will have more fatigue and more difficulty completing tasks. Listen to these symptoms as they are related to your concussion and fighting through them will prolong your recovery. Step away from the activity and take the necessary rest as needed. If you are in school, it may be best to step out of class and see if your symptoms resolve with a brief rest. If they do, you may consider going back to class. If not, you probably require more rest.

For college athletes, you may need to stay home to study, if you can study at all. You may find that studying in small increments with frequent brain rest breaks may make studying more manageable than being in the classroom.

Workload Reduction

Memory, attention span and processing speed are usually impaired during the recovery process. More time to complete assignments or projects can help a concussed patient. They may need to take frequent breaks in order to get through the day and their assignments.

Note Taking
If possible, it would be ideal to have pre-printed notes, photocopied notes from classmates, co-workers or teammates, or even recorded lectures to assist in decreasing cognitive over stimulation.  Multitasking, such as combining listening, reading, taking notes, and weeding out distractions in the classroom or work environment, can be very difficult, if not impossible, during the recovery phase.
Medications

It is not recommended that the concussed individual take medications to relieve their symptoms of their concussion, especially during the day. This may mask their symptoms and the patient may feel worse once the medication wears off. If medicine is needed and rest is going to follow taking the medication (i.e., prior to bedtime), then it should not interfere with recovery.

There is anecdotal evidence that fish oils (the DHA component in particular) may assist with brain health and recovery from concussions. You should take approximately 500mg of the DHA component a day.

Melatonin (a substance secreted by the brain to initiate sleep) has been shown to help at low doses, 0.3 to 3 mg. If you are taking other medications, you should discuss this further with us or a pharmacist to assure no adverse interactions. You may also try medications like ibuprofen (Advil, Motrin), naproxen (Aleve), or acetaminophen (Tylenol) to help with sleep as these medications may decrease head or neck pain that can make sleeping more uncomfortable and thus interfere with restful, quality sleep.

Other over the counter sleep medications such as Unisom or “PM” type medications (Tylenol PM, Advil PM) can also help with sleep, but should be used for a short period only. If there are more issues with initiating or maintaining sleep, please make a follow up appointment with your provider.

Alcohol

Alcohol use is strongly advised against during the recovery phase as it may worsen your symptoms and prolong recovery.

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