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Concussion Management for Healthcare Professionals: Summary
Cervical Strengthening and Manual Therapy After concussions, there can be neck issues that may mimic symptoms of a concussion such as neck pain, dizziness, and headaches. The idea of strengthening the neck muscles would be to build up the muscles in the neck to help alleviate weakness that might be causing similar symptoms. Prevention exercises can help, but strengthening neck muscles can lessen neck weakness. Manual therapy can be focused on the head, neck, and upper back. Massage, joint mobilizations, stretching, and manual traction can help alleviate neck and upper back pain, which can help alleviate symptoms. The human touch from manual therapy can aid in the healing process. Nutrition Nutrition and sleep can help people heal. Adults need to get between 7-9 hours of sleep while teenagers and children need to get closer to 8-10 hours of sleep a night. Individuals should also focus on staying hydrated, eating vegetables, fruit and protein. Additionally, high doses of Omega 3's can possibly help with concussion recovery. Not all supplements are the same. Medication (Acetaminophen vs. Ibuprofen) Acetaminophen is used to help with the pain from a headache. Ibuprofen is an NSAID (Non-Steroidal Anti- inflammatory Drug) that is used to help reduce pain and swelling. LEARNING TIP! After a post concussive event, using Hyperbaric Oxygen Treatment (HBOT) HBOT combines high oxygen levels and increased pressure, leading to better tissue oxygen levels. Benefits include reducing inflammation, restoring mitochondrial function, improving blood flow through new blood vessel formation, and promoting the growth and movement of stem cells. HBOT is found to be effective even years after the injury. HBOT’s impact on PPCS in children hasn't been studied yet. Q-Collar This tool is used to help increase blood flow to the brain while wearing this device. The thought is that with more blood flow to the brain there’s less chance of a brain injury. Ibuprofen can lead to further complications due to the thinning of the blood through the anti-inflammatory properties. If a patient has a severe concussive episode and they use IBU, it could potentially lead to a brain bleed.
MANAGEMENT
Rest/Active Rest There are many people who feel that rest is the gold standard for someone to recover from a concussion. However, new approaches of thought are going back to the old ways of thinking that early mobilization and blood flow lead to faster recovery. Early, minimal activity to increase the heart rate is a good idea as opposed to waiting until symptom free. Activity that increases an individual's heart rate should not be started until an individual is symptom free after a concussion. Additional early management should focus on: • Rest • Limiting screen time (computer, phone, television, tablet, etc.) • Talking on the phone vs texting • Staying away from listening to loud music • Staying away from bright lights • Avoiding NSAIDs and use of acetaminophens in the acute phases Return-to-Learn (RTL) RTL focuses on returning to preinjury learning activities with no new academic support, including school accommodations or learning adjustments. The vast majority of athletes of all ages have a full RTL with no additional academic support by 10 days. When adjustments need to be made, the 4 categories that are focused on are: • Environmental Adjustments : Modified school attendance, frequent rest breaks from cognitive/ thinking/deskwork tasks throughout the day and/or limited screen time on electronic devices • Physical Adjustments : To avoid any activities at risk of contact, collision or falls, such as contact sports or game play during physical education classes or after- school activities, while allowing for safe non-contact physical activity (e.g. walking) • Curriculum Adjustments : Extra time to complete assignments/homework and/or preprinted class notes • Testing Adjustments : Delaying tests/quizzes and/or permitting additional time to complete them Five Stages of Grief LEARNING TIP!
The 5 stages of grief include denial, anger, bargaining, depression, and acceptance.
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