WESTBOROUGH, MA May 4, 2014 Concussion management requires a sensitive and honest discussion between the patient and the concussion specialist. The reason for this is most apparent when the athlete, or anyone recovering from a brain injury, fails to return to his or her baseline within 7-10 days. There are a host of factors that contribute to this some of which have to do with the degree of physical and cognitive activity immediately after injury. It is now well understood that post injury rest is a key component to the recovery from concussion. Extra sleep is sometimes just what may be needed until the brain has returned to normal. Arguably this is sometimes not possible – especially when an athlete has to attend school. Prolonged symptoms like headaches, irritability, and fatigue may signal that the brain has not returned to its normal equillibrium after injury.
When symptoms persist beyond what may be expected I often take a careful history about what rest and what activity are truly going on? This is often quite surprising. As many as 3-10 percent of concussions are outliers and have persisting symptoms greater that 21 days. I encourage complete rest immediately after injury. That includes physical and cognitive rest. Rest from physical activity is largely intuitive – no running, no practice, no lifting weights and so forth. It also means – no internet, no instagram, no social media, no TV, no fun! At least for the first few days. When this fails it may be a signal that the brain has not return to its baseline. Concussion may be thought of as an energy crisis in the brain. In order for the healing to take place the brain needs rest. The failure to allow full recovery to take place prior to exerting the athlete places him or her at risk for additional injury from second impact.
History of prior concussions
Another important clue to a prolonged symptom profile may be the prior history of concussion. Second and subsequent concussions sometimes demonstrate an alternate recovery curve and take longer to heal. These factors will also determine the course of recovery as well as the return to play protocol and the return to learn accommodations that may be necessary to support a student athlete. Just as athletes should not return to play before they are ready an athlete suffering with symptoms of concussion should modify the school day so as to allow for time needed for recovery. There should be an understanding that no student may be expected to take tests – even state mandated achievement tests until they are fully recovered from their injuries. Some students require a formal 504 support plan for the duration of their symptoms. This is a plan that mandates a host of school-based accommodations to support prolonged symptoms. Some students experience physical signs like lingering fatigue, poorly deployed attention, headaches, sensitivity to sound or light, and decreased balance. Other students exhibit changes in behavior and mood as a prominent sign of the concussion. Some students have the combination of physical and emotional symptoms that are worsened by forced overwork and failure to rest.
The Concussion Assessment and Management Program is now at Whittier Rehabilitation Hospital in Westborough. It isn’t easy getting student athletes to rest. They want to be active and to be with friends and teammates. Unfortunately, unless they can permit themselves to fully shut down they may expect to have symptoms longer than most. This protocol often requires coaches and parents to closely monitor their activity and set firm limits on physical and cognitive activity during recovery from concussion. There are health risks when athletes try to “work through” an injury. It is now well known that repeated concussions lead to long term brain injury with potentially fatal outcome. Concussion is thought of as an invisible injury because a player show’s no outward sign of debility but a price is paid when the first step to recovery is not heeded. Rest. Complete rest and no exertion until the athlete is symptom free. Whittier can offer assessment and rehabilitation of athlete’s dealing with concussion.