Concussion

• An injury to the brain that occurs after a blow or trauma to the head, including:
  • Direct impact to the head
  • A fall
  • Impact to another part of the body causing whiplash due to a quick back-and-forth motion of the head   
• Does not have to be accompanied by a loss of consciousness 
• Often, patients may minimize or fail to report symptoms 
• Symptoms can last for as little as a few days to weeks or months

Common symptoms 

Long term effects may include:

• Attention deficits
• Nerve damage
• Brain damage 

Evaluation

• Obtain occupational profile 
• Ask about symptoms including specific physical, cognitive, emotional, and sleep symptoms (see above)
• Obtain survey of baselines for current activity tolerance 
  • For example: How long can you read before you feel an increase in symptoms? How long can you engage in a conversation before you feel an increase in symptoms?
  • Baselines are used to gradually increase duration and intensity of activity until safe to resume to regular activity without symptom exacerbation

Treatment 

• Rest is important initially 
• Avoid strenuous or challenging physical or cognitive activities 
• Refrain from activities requiring physical contact to decrease the risk of another incident resulting in a concussion
• Repeated concussions have a greater impact and may require longer recovery times
• After about 7-10 days of rest, it is important to increase activity engagement without risking symptom exacerbation 
• Survey of baselines for activity tolerance
  • The goal is to increase activity engagement while also decreasing the frequency of symptom exacerbation in order to support the brain’s ability to recover and heal 
  • Baselines are used to gradually increase duration and intensity until safe to resume regular activity without symptom exacerbation
• Increase awareness of triggers during activity engagement 
• Gradually increase sensory exposure to decrease risk of sensory sensitivity and to build activity tolerance 

Chronic Traumatic Encephalopathy

• Progressive degenerative disease seen with patients that have a history of repetitive brain trauma, concussions, or hits to the head
  • Symptoms may include:
    • Symptoms of dementia 
      • memory loss
      • aggression
      • confusion
      • depression
    • Symptoms generally appear years after the trauma 

References: 

• Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction 8^th Edition (pp. 842-843)