I just got back from a most informative and exciting course on Post Concussion Syndrome with Jacquie van Ierssel PT, a physiotherapist who has developed “R2P”, a systematic and evidence- based approach to identify causes of concussion symptoms and create a treatment plan. It was great to see how much physiotherapy can do to help. Thank you Jacquie!
I want to share some of my learning with you, and in the next few blogs I plan to do just that.
First of all:
What is post concussion syndrome, or persistent post concussion symptoms as it is now being called?
Up to 15% of people with concussion may have persistent symptoms. The Ontario Neurotrauma Foundation guidelines recommend a referral for a specialized assessment if symptoms persist at one month post injury. (1)
The diagnosis is based on symptoms (see below) and your Doctor may use diagnostic criteria from the World Health Organisation and/or the Diagnostic and Statistical Manual of Mental Disorders. Because symptoms can be the same as in a variety of other conditions, obtaining the correct diagnosis can be difficult.
The following are common symptoms: (from Willer and Leddy (2))
Physical: headache, nausea, vomiting, blurred or double vision, seeing stars or lights, balance problems, dizziness,sensitivity to light or noise, tinnitus.
Behavioural or emotional: drowsiness, fatigue or lethargy, irritability, depression, anxiety, sleeping more than usual, difficulty falling asleep.
Cognitive: feeling “slowed down”, feeling “in a fog” or “dazed”, difficulty concentrating, difficulty remembering.
Symptoms do vary. Some people experience three or four while others may be dealing with more, and they can persist for months and even years.
What happens in treatment?
Education is a key component. Treatment will focus on addressing the physical/cognitive/psychological challenges arising from the concussion. A team approach works best for managing persistent post concussion symptoms.
What can the physiotherapist do to help?
The physiotherapist can help treat post traumatic headaches, dizziness and poor balance (vestibular problems), fatigue, and vision (ocular motor). After an in-depth assessment the physiotherapist can provide a program specifically designed to address your problems. Appropriate exercises will help to improve sleep and mood, as well providing physical benefits such as increased strength, better balance and posture and improved exercise tolerance. The physiotherapist will also work with other healthcare providers as needed.
I will go into more detail about treatment in my next blog.
(1) onf.org/documents/guidelines-for-concussion-mtbi-persistent-symptoms-second-edition
(2) https://www.ncbi.nlm.nih.gov/pubmed/16901381
R. Sian Owen PT
Registered Physiotherapist