Customized treatment from a concussion rehab specialist in Midtown should be based on the symptoms presenting after the concussion. This is the best way to ensure each patient completely recovers.
In our last article of our three-part concussion series, we explained why concussions can be so dangerous and debunked many of the myths surrounding these injuries that often prevent the truth from being known. Another common misconception is that the only way to treat a concussion is by allowing the patient to stay away from any risks that can result in another head injury and rest until the symptoms go away. While this approach may be appropriate in some situations, it’s certainly not the only—or the best—way to deal with concussions, and we strongly believe that a treatment program that targets each individual’s set of symptoms is a far more effective way of moving forward.
For a long while, the majority of doctors believed that after a concussion, rest was the best method to reduce and eventually eliminate the effects of the injury. But over time, an abundance of new research and advancement in the understanding of concussions has led many medical professionals to question this approach.
Although it’s estimated that 80-90% of all concussions will heal on their own within 7-10 days, there’s no way of knowing how each patient will react to their symptoms or whether they will fall into this group or not. In addition, for the 10-20% of patients that do not recover within this timeframe, the first week after the concussion is a valuable period of time during which they can begin treatment to advance their recovery. And finally, recent research has shown that a well-designed treatment and exercise program that is performed at the right time can actually play a key role in helping patients return to full participation in their daily activities quicker.
It’s for these reasons that a shift has occurred in concussion management, and the preferred approach of many experts today is to treat each concussion as soon as possible with the most appropriate strategy to help patients recover more effectively.
Determining the best path forward by getting an accurate diagnosis
If someone has sustained a head injury and is showing any signs of a concussion, the next step is to have them evaluated by a trained professional such as a physical therapist. Unfortunately, there is no single, simple test for diagnosing a concussion, and the process requires several steps that are each important for the diagnosis. In most cases a concussion assessment will include the following three parts:
- Interview: the therapist will ask the patient a number of questions about the incident that led to the injury and its aftermath; the questions will particularly focus on any loss of memory or consciousness after the event, as well as any other abnormal feelings or occurrences since it occurred
- Loss of memory after a concussion (post-traumatic amnesia) is the best determination of a patient’s prognosis after a concussion, so this step is extremely important
- Determination: additional questions and assessments of the patient will help the therapist determine the range and severity of each patient’s symptoms on the field; cognitive tests like the ImPACT and SCAT-2 are commonly used to evaluate memory and attention, which may have been impaired by the injury
- Examination: this step focuses primarily on neurologic—or brain-related—signs and symptoms, and tests the patient’s sensation, reflexes, coordination, mental status, and other neurologic functions to determine if there are any injuries to the brain; this portion will also likely include a neurovestibular exam, which looks for balance or vision-related problems that often occur with a concussion
Based on the results of these tests, the therapist will be able to diagnose the concussion and decide what the best path forward will be. Nearly all symptoms associated with concussions can be attributed to one—or more—of three main impairments of the body: vestibular system (balance) dysfunction, visual issues, or neck-related issues. After completing the evaluation, a trained physical therapist can tell which of these three impairments each patient’s symptoms are primarily related to. Once this is established, the therapist can design a carefully tailored treatment program that focuses on the dysfunction at hand and get the patient started on their road to recovery.
Why focusing on balance is so important in concussion management
The vestibular system is the body’s sensory system that contributes to our sense of balance and coordination, and it tells us where we are in space. As a result, it keeps us steady and prevents us from falling. This system uses information from the eyes, muscles, and joints to communicate to the brain where we are and how to react, but the most important organs involved in balance are the semicircular canals located in the inner ear. These canals detect acceleration and deceleration of the head in relation to our movement and gravity, and the vestibular system responds to the data it receives from these canals to reposition the eyes, neck, and limbs to keep the body upright and stable.
Research has shown that the vestibular system is affected in approximately 60% of sports-related concussions. What happens in these cases is that the trauma to the brain can disrupt the vestibular system and result in abnormal functioning of the brain, such as incorrect signals regarding the position and movement of the head in space. This can result in symptoms like dizziness, vertigo, and impaired balance, which are usually noticed immediately after the concussion.
If rest alone is prescribed after a concussion, many patients will appear to recover and be cleared to return to activities after a week or two, but in truth, they may still have vestibular impairments that were overlooked and not addressed. This is why it’s so important to identify any issues related to the vestibular system and manage them appropriately with a targeted treatment program. Vestibular therapy focuses on any dysfunctions identified and works to improve them and reduce symptoms with a specific set of exercises. There are many different types of vestibular rehab interventions, but the three most commonly used principles are as follows:
- Gaze stabilization exercises: these exercises are used to improve the control of eye movements so that vision can be clear during head movement; the patients that will benefit most from these exercises are those who experience difficulty when reading or dizziness when walking or driving; one key gaze stabilization exercise is called visual fixation, which can be performed by doing the following:
- Keep your eyes fixed on a single stationary target held in hand or placed on a wall 3-10 feet away
- Move your head from side to side for 30 seconds, and repeat three times
- Repeat three more times while your moving head up and down for 30 seconds
- Habituation exercises: these types of exercises are indicated for patients who experience symptoms when they move around or when they are in visually stimulating environments; the goal of habituation exercises is to reduce dizziness through calculated, repeated exposure to these types of environments
- Balance and exertional training exercises: since balance is usually impaired when the vestibular system is involved, these exercises are used to improve the patient’s overall steadiness and cardiovascular response, so that they can better perform daily activities and sports
- Home-exercise program: the therapist will also likely prescribe a home-exercise program to supplement the work completed in the clinic, which will help patients better regain their balance and coordination
How vision is also connected to concussions – explained by our concussion rehab specialist in Midtown
More than half of the brain is associated with vision in some way, and most of our senses and processing is directly affected by information that is sent to the brain from the eyes. With this in mind, it’s not hard to imagine that when any type of injury to the brain occurs, the visual system can easily be affected.
This is particularly true with concussions, as the majority of patients experience at least some sort of visual dysfunction after their injury. A concussion can interfere with the sending and receiving of messages to and from the brain, which can throw several aspects of vision out of whack. Symptoms of visual dysfunction after a concussion include double vision, blurry vision, sensitivity to light, intolerance to visual stimulants, depth perception issues, peripheral vision issues, and intolerance to computer work and reading. In some situations, a patient may have 20/20 vision but still be impaired in other ways because of the damage to their visual system, which is why examinations are so important.
If it’s been determined that a patient’s visual system has been affected by the concussion, vision therapy can be very effective for addressing their symptoms, even when they persist after other symptoms—like dizziness and balance issues—have been resolved. Vision therapy typically includes a variety of vision-based exercises that use tools like eye patches, mirrors, lenses, prisms, and other tools to improve the function of the eye muscles. Below are two examples of vision therapy exercises for concussion patients:
- Two thumb exercise
- Hold one thumb close to your face and the other hand out at arm’s distance
- Focus your eyes on the farthest thumb till the nail looks clear and hold that focus for 10 seconds
- Rapidly move your eye focus to the closer thumb and focus on the thumbnail, then hold that focus for 10 seconds and return your eye focus to the far thumb
- Repeat this 5 times, building up your tolerance to repeat 10 times
- Saccades exercise (horizontal)
- Place two sticky notes with a capital letter on each on the wall at eye level, about 12 inches apart
- Stand about 3 feet from the wall, or stretch out your arms in front of you and hold up your index fingers at eye level, about 12 inches apart
- Keep your head still during all exercises, only moving your eyes
- Start the exercise by quickly looking at the target to your right, then quickly move your gaze from the right to the left target, then back from the left to right target
- Repeat the back-and-forth eye motions for one minute, three times a day
- For more vision therapy exercises, click here
Getting the concussion care you need at the Hospital for Special Surgery or Dynamic Sports Physical Therapy
As you can see, there is a great deal that can be done in lieu of rest to properly manage a concussion and improve the chances of a full recovery, but this requires a group of trained professionals that understand the nuances of concussion management.
One location that patients can count on for this type of care is the Hospital for Special Surgery (HSS). HSS offers a concussion program, which is an active recovery clinic dedicated to providing expert, timely, and comprehensive care to patients with concussions. Peter Schultz, DPT, co-owner of Dynamic Sports Physical Therapy, is a board-certified orthopedic specialist and member of the concussion team at HSS. He, along with other medical professionals, rehabilitation specialists, and trainers, work together to properly diagnose all concussions and direct patients to the appropriate course of treatment.
Here at Dynamic Sports Physical Therapy, we also pride ourselves on offering the latest and most effective techniques in concussion management. With our team of concussions specialists, which includes Peter, physical therapists Alan Ng, DPT and Bridget Dungan, DPT, and acupuncturist Mila Mintsis, LAc, we work together to carefully identify all symptoms that may be caused by the injury in order to determine what areas or systems of the body have been impacted. From here, we decide which interventions are best for the particular concussion, and then get the patient started immediately on their treatment path to a complete recovery.
So if you or your child experiences an injury to the head that could be a concussion, we strongly encourage you to contact Dynamic Sports Physical Therapy at (212) 317-8303 to schedule an appointment as soon as possible. Since time is of the essence, doing so will get the ball rolling on a comprehensive treatment program right away and reduce the chances of dealing with any concussion-related complications in the process. You can also click here to read the next article in our series on concussions to learn about treatment for neck-related issues.