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Concussion Management for Healthcare Professionals: Summary
It is important to understand these stages when talking about injuries. A common theme often related to concussions is that they are not a real injury because you cannott visibly see them. One of the hardest aspects is getting patients and those around them to recognize that a concussion is an injury. Helping the patient understand the process and educating the patient goes a long way. Mental Readiness It is important for patients to not be afraid to go back to the same activity as before. Testing individuals in their environment before releasing them back to activity is crucial. This can be done in various ways, including using virtual reality to incorporate real life activities. Mentality is very important to help determine if someone is ready to return to full activity. Showing confidence that they are ready to return is vital. If the patient is afraid to return to activity too soon, this can increase risk of injuries. Research suggests that psychological progression should mirror physical progression to promote optimal readiness to return to performance following a concussion. Confidence, control, and commitment emerged as main factors for psychological readiness to return to performance following a concussion. Returning to Sport Each phase should take at least 24 hours to make sure that an individual is symptom free before returning. If symptoms return while performing one phase of the return-to-play, the rehabilitation process needs to go back to the beginning stage until the patient is symptom free. A higher incidence of lower extremity or musculoskeletal injuries occur when returning from a concussion. This suggests that in order for someone to continue participating in sport, they also need to be mentally prepared. POST CONCUSSIVE SYMPTOMS Post concussive symptoms are defined as any symptoms lasting from 14 days post-concussion up to years afterwards. Post concussive symptoms are typically the effects of cumulative concussions. Around 70–90% of concussions see spontaneous improvement and resolve within 30 days, yet some individuals experience lasting symptoms. These conditions are referred to as: • Post-Concussion Syndrome (PCS) if symptoms endure beyond 14 days • Persistent Post-Concussion Syndrome (PPCS) if they persist beyond 3 months PCS is a constellation of physical, cognitive, behavioral, and emotional symptoms occurring after TBI. These symptoms include headache, fatigue, vision changes, disturbances in balance, confusion, dizziness, insomnia, neuropsychiatric symptoms, and difficulty with concentration. About 15% of mild TBI patients will suffer
from PCS, and a small minority of those patients will experience persistent PCS requiring further evaluation and treatment. Mild TBI resulting in persistent PCS has lasting effects on: • Cognition
• Memory • Learning • Executive function
PCS is diagnosed with the presence of cognitive deficits in attention or memory and at least 3 of the following: • Fatigue • Sleep disturbance • Headache • Dizziness • Irritability • Affective disturbance • Apathy or personality changes that persist for 3 months or longer Secondary Impact Syndrome This usually occurs when someone goes back to competition before their brain heals and they sustain another concussion. LEARNING TIP!
It is most common in patients 25 years and under and can lead to severe effects, including death.
PREVENTION OF CONCUSSIONS
Strengthening Strengthening the neck, upper back, and spine helps to disperse forces throughout the muscles as opposed to the brain. If the forces of rotation, direct or indirect forces occur on the body and the muscles are strong, there will be minimal effects. However, if the muscles can't withstand the forces placed upon them, the brain will likely experience damage. Examples of exercises could be isometric holds of flexion, extension, rotation, etc. Weight training for the upper back and spine such as push-ups, chin-ups, rows, and scapular stabilization exercises are also effective. Stretching/Mobility Stretching and mobility are important so that the muscles, ligaments, and tendons have the flexibility and elasticity to be able to have a full range of motion. A full range of motion is important so that the neck can move freely and not be restricted. If the neck and upper back have too much rigidity, external forces might cause damage to the brain. Mobility of the neck is an important aspect to help absorb forces.
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