What is a concussions?

A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.

Anneliese Ruggeri

Anneliese Ruggeri

Physiotherapist
Middlebury, CT
Mr. Trevor Kwolek

Mr. Trevor Kwolek

Physiotherapist
Fonthill, ON
Chritine Bridle

Chritine Bridle

FCAMPT, CAFCI
Physiotherapist
St Catherines, ON

Quiz: Do You Understand Concussion?

Test your knowledge by answering the following questions:

Questions
True
False
1

Mild concussions aren't serious.

Explanation:
Concussion causes immediate, but usually temporary, brain dysfunction. Concussions can be mild or severe, but they’re always serious.
2

It’s common for patients to have permanent injury from a single concussion.

Explanation:
Most people will recover from a concussion, and it’s rare for patients to have permanent injury from at least a single concussion. But patients can be disabled by concussion symptoms for many weeks or months after the initial concussion.
3

Changes in mood can be a symptom of concussion.

Explanation:
Common symptoms of concussion include headache, poor sleep, neck pain, dizziness, ringing in the ears, blurred vision, nausea and vomiting and changes in mood.
4

The primary concussion treatment centers around rest.

Explanation:
Although research is progressing around concussion, there remain very few proven treatments. The primary treatment centers around rest - not just physical rest, but also intellectual or cognitive rest.
5

Concussion causes physical symptoms but not emotional ones.

Explanation:
Treatment of the emotional symptoms associated with concussion is often neglected, and there is some evidence that psychological therapy, like cognitive restructuring and reattribution can be quite effective in treating patients’ emotional symptoms.
(Answer all questions to activate)

Melissa Hansen, BA, MScOT, OT Reg (BC), discusses how an occupational therapist can help patients recovering from a concussion.

Occupational Therapy and Concussion Recovery

Concussion is a brain injury that is induced by biomechanical forces. It can be caused by a hit to the head, a hit to the face, a hit to the neck. It can also be caused by a hit to somewhere else in the body with an impulsive force transmitted to the head.

It disrupts the brain’s processing at a cellular level, so it can cause a whole host of symptoms: cognitive, physical and emotional, and sleep as well. OT comes in to help people get back to doing all of the things that they want to do and need to do.

So usually, you can do all of the things that you want to do in your life, but when the system breaks down from within, suddenly you can’t function, you can’t go to work, you can’t go into a grocery store, you can’t look at your computer for 5 minutes.

So in the context of this injury, how do you manage your life? And that’s where OT will come in to help. We start with identifying client-centred rehabilitation goals, meaning we ask the client “What is it that you want to get back to doing?” And for most people, it’s getting back to work or school.

We always recommend returning to work gradually. The gradual return is really the most important factor in supporting a safe and sustainable return to work. And so, we will create a plan with our clients. We’ll sit down and outline 6 to 8 weeks, what does this gradual return-to-work process look like?

For a lot of clients, they think that once I get back to work that means that I’m back to my life, I’m done with my treatment, but it’s really a part of the rehabilitation process, and it’s a pretty critical phase of their recovery. OTs will support clients through that phase of their recovery by coordinating with the workplace, going into the workplace even and doing a visit with the client, and come supporting them throughout that plan as it’s carried out.

And so even though work is really the most important issue for most clients and they’re very eager to get back, we often have to have a conversation about addressing the foundational issues first. For example, a lot of people have problems with sleep after a concussion, and when your brain isn’t having opportunity to rest through the night, it can really get in the way of that recovery process.

OTs will use tools like sleep hygiene, which is essentially cleaning up your sleep habits to support restful sleep. Some of the strategies we use around that include sleep diaries, so we gather a lot of information about the sleep habits and lifestyle factors that can contribute to whether the client is getting a good sleep or not, and so for example, many people benefit from implementing some routine around their sleep, and it’s what we like to call AM/PM routine.

So having something that you do at the same time every day in the morning, and at the same time every day at night, and having that routine can really support your recovery process by providing that foundation that you need.

Another example of a foundational issue that we will address prior to the return-to-work process is something that we refer to as energy conservation. So, we like to talk about energy conservation by talking about the 4 Ps: Pacing, Planning, Prioritizing and Positioning. Pacing is essentially not doing too much in one day or in one period of time. Planning is looking ahead, being organized.

Prioritizing is taking a look at what the most important things that you have on your list are, and asking for help or delegating wherever you can. Positioning is looking at where my body is in space. Where am I in this room? And how can ergonomics help me to do what I need to do in a way that doesn’t provoke symptoms?

These strategies sound really simple, but in the context of busy lives, it can be really challenging to slow things down and incorporate time for recovery into your life. A lot of the parents that I see can certainly attest to that, but it is one of the most important components of rehabilitation, is taking that time to slow down. Local Physiotherapists 

If you’ve sustained a concussion or know somebody who has, call an OT to help you get back to all of the things you want to do, need to do and love to do.

Presenter: Ms. Melissa Hansen, Occupational Therapist, Vancouver, BC

Local Practitioners: Occupational Therapist

Larissa Roux, MD FRCP Dip Sport Med, MPH, PhD, discusses How do Hockey Concussions Effect You

The Patient's Role in Recovery from Concussion

A key component of treating concussion has to do with a patient’s engagement in rehabilitation. That active engagement in rehabilitation is crucial to achieving the successful outcomes that absolutely can be achieved in concussion rehabilitation.

Some of the barriers to that active engagement can often be mood, and those mood-related issues can come about because of challenges that have come up for an individual, a sense that they should be able to handle the things that are their norm in their day-to-day function. Sometimes it’s loss or grief at what things they’re missing out on with this injury in play.

But bottom line is that active engagement in rehabilitation is crucial, and if needed that’s a key component of the interdisciplinary treatment model, in order to make sure that mood is not overlooked as a component of the rehabilitation plan, but also to make sure that it’s not assigned outside the injury, where it doesn’t belong. That is a symptom of concussion, it is a treatable part of concussion, and part of actively engaging in your rehabilitation and achieving what you can in your recovery. Local Orthopedic Surgeons 

The science of concussion treatment has moved far beyond cocoon therapy, or the passive watchful waiting that’s gone on for weeks at a time. If you’re not getting better and you’ve been doing one thing or doing nothing waiting for your concussion to recover, it’s time to seek interdisciplinary care with a treatment team that can address all the component parts of concussion and help you get better. Local Orthopedic Surgeon.

Presenter: Dr. Cirelle K. Rosenblatt, Psychologist, Vancouver, BC

Local Practitioners: Psychologist

Hilary Johannsen, MPT, Physiotherapist, talks about what brain systems are affected in concussion.

Audrey Spielmann, MD FRCP(C), discusses head MRI scans.

How do Hockey Concussions Effect You

A concussion is essentially a head injury that results in neurologic impairment, and in hockey, this is generally the result of trauma: a forceful blow to the head or a jarring event.

Concussions are always serious, no matter how mild or severe they seem at the time. All concussions must be seen immediately by a medical team.

They’re serious because evidence shows that multiple concussions, even if they’re little, can lead to long-term impairment in neurological function. Skaters will not be able to go back out and play hockey, you may not be able to go back to school, and you may not be able to return to work.

A player who presents following a concussion will experience a whole range of symtoms. These might include headache, dizziness, nausea, a sensation of feeling dazed, and they may have poor concentration.

In terms of signs to look out for, vomiting, slurred speech, a change in personality might ensue. With respect to concussion treatment, the number one thing that a player must do is not return to play if they’ve suffered a concussion. The helmet must be removed and the patient or the player must rest and achieve full recovery before going back out there.

Treatment for concussion requires the participation of a primary care sp, the commitment of the athlete as well as the coach. It is a progressive, step-wise solution to the problem. At each step of the way there should be no signs and symptoms incurred. Local Orthopedic Surgeon

Research shows that concussion is three times more likely among hockey players who engage in body checking. It also shows that wearing a well-fitted helmet with a full face shield will reduce the time away from hockey by half.

If you have any further questions please don’t hesitate to consult your primary care sports medicine physician.

Presenter: Dr. Larissa Roux, Sports Medicine Physician, Vancouver, BC

Local Practitioners: Sports Medicine Physician

Dr. Cirelle K. Rosenblatt, PhD, CIC, Health Psychologist, Neuropsychologist, talks about the patient’s role in recovering from a concussion

What Are Your Concussion Treatment Options?

Although research is progressing our understanding of concussion, there remain very few proven treatments for concussion.

The primary treatment centers around rest, as well as avoidance of reinjury and treatment of symptoms. Rest as a treatment for concussion needs to involve not just physical rest, but also intellectual or cognitive rest.

Patients must avoid excessive stimulation from overuse of computers, for example. Returning to work too quickly can slow the recovery of concussion, just like returning to sports too quickly can slow recovery.

Treatment of the emotional symptoms associated with concussion is often neglected, and there is some evidence that psychological therapy, like cognitive restructuring and reattribution can be quite effective in treating patients’ emotional symptoms.

Therapy for concussion often needs to be tailored to an individual patient. Patients who require more psychological therapy, for example, may benefit by treatment from a psychologist.

If you have further questions about concussion treatment, you should discuss that with your doctor. Local Orthopedic Surgeon.

Presenter: Dr. Dean Johnston, Neurologist, Vancouver, BC

Local Practitioners: Neurologist

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