It’s depressing… how could a little fender bender wreak such havoc? Though it’s been months since her accident, Julia still feels dizzy. And she’s exhausted. The focus required in her nursing job wears her out, especially when she’s on the computer. She usually leaves work with a headache, and dragging herself to the gym is hard – even the elliptical makes her dizzy. To boot, she’s gained weight. Will she ever feel normal again?

Julia likely has post-concussion syndrome, and contrary to popular belief a concussion can occur without direct trauma to the head.  Whiplash from a car accident can cause a concussion as the brain strikes forcefully against the skull and shears neurons that descend from the brain. In the same way, a fall can cause a concussion – even without a blow to the head, especially in older adults.

Common symptoms of concussion:

Figure 1. An example of how whiplash injury can result in concussion by causing the brain to forcefully strike against the skull.

Headache Neck Pain Mood Changes
Fatigue Difficulty Sleeping Confusion
Sleepiness Sensitivity to light/sound Balance Deficits
Nausea Double/blurred vision Focus/memory deficits
Dizziness

What is Post-Concussion Syndrome?

Concussion, or mild traumatic brain injury, is trauma to the brain significant enough to cause a brief change in mental status or consciousness. Recovery can take weeks to months. If symptoms do not resolve significantly in four weeks, the concussion is termed post-concussion syndrome and you need rehab.

So why do symptoms persist for so long with post-concussion syndrome? The body and brain find ways for you to keep doing what you have to, by compensating for deficits rather than addressing root causes. For example, when you have a deficit in the part of your nervous system that tells your brain where your body is in space, you compensate by relying on vision for balance. This works okay for a while, but dizziness occurs when your vision is over stimulated, such as when you are trying to look around while hiking, or are in a visually stimulating space such as the grocery store or the movie theater.

Longer-term symptoms of concussion: 

Loss of libido       Low blood pressure      Loss of menustration

Fatigue                Muscle weakness          Growth problems (children)

Weight gain          Early dimentia              Chronic headaches/dizziness

Who is affected?

Concussions can occur in older adults, children, athletes at all competitive levels, and among military personnel who sustain blast injuries. In other words, anyone can get a concussion.

How can Physical Therapy help? When a person experiences dizziness or balance deficits, the affected systems need to be trained with specific exercises at optimal dosages. A physical therapist trained in concussion rehab has treatment strategies to reduce your symptoms. Knowing exactly how much to do and when is a skill and an art. Your physical therapist can guide your return to physical activity so that you continue to improve without exacerbating symptoms.

What to do if you experience a concussion:

  • Decrease your screen time.
    • Try to spend less time looking at a computer screen, phone, or i-pad.
  • Allow yourself rest.
    • After a concussion, most people feel the need to sleep more than usual. This allows the brain to heal. Give yourself permission to spend extra time sleeping.
  • Continue to engage in light aerobic exercise.
    • While vigorous physical exertion may worsen symptoms and delay healing, light aerobic activity can help you heal faster. If you are not sure how much to exert yourself safely, a physical therapist can perform an exertion test to determine how you respond and give you guidelines for how to exercise on your own.
  • Listen to your symptoms.
    • Stimulating environments and even changes in head position can provoke symptoms. If you notice triggers like these, allow yourself to experience mild symptoms but avoid situations that cause symptoms to become severe.

Note:

Depression and anxiety are one of the most common symptoms following concussion. In 90% of cases these symptoms resolve with time. However, in some cases these symptoms can be more severe or persistent, especially if there is a history of depression or anxiety, or presence of stressful life events. Many patients benefit from more in depth care in this arena, such as meeting with a psychotherapist in addition to physical therapy to achieve full recovery.

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