Concussion injury can cause numerous issues to a variety of different body systems. These include headache, dizziness, fatigue, light sensitivity, tinnitus, neck pain, poor concentration and confusion.
Diagnosis of Domains of Dysfunction is crucial to address all the areas effectively, thus enabling the most successful and speedy recovery.
Post-concussion syndrome occurs when a number of the common concussion symptoms continue for longer than six weeks, the usual maximum period of time for recovery. This is the generally accepted time period for the ‘energy’ dysfunction in the brain to recover.
Ongoing symptoms can be caused by any of the 8 Domains of Concussion Treatment outlined below:
Cervical spine (neck)
The actual concussion injury does not require a ‘knock’ to the head. Any whiplash type injury can also cause a concussion. If someone has sustained a concussion, we know there must have a whiplash injury to the neck as well. The neck can be a source of headaches, dizziness, eye or balance problems. Treatment focuses on restoring normal function of range and strength. Sydney Concussion Centre uses the Watson Headache® Approach to treat dysfunction in the upper neck to address these issues.
Vestibular, vertigo, dizziness
The vestibular system in the ear can be affected by the acceleration/deceleration injury which causes concussion. This involves the release of ‘crystals’ called otoconia from the utricle into the semi-circular canals of the vestibular system affecting its function. Known as Benign Paroxysmal Positional Vertigo (BPPV), the result is vertigo where people feel like the room is spinning with a change of position, eg rolling over in bed or rising from lying. Nausea and vomiting can be associated with vertigo. Specialised assessment and treatment are required to restore the system to normal.
Oculo-motor. eye movement control
The burst of activity in the brain that results in an ongoing fatigue state, affects its ability to control normal body functions; the eye muscles are one of those areas. When eyes aren’t tracking properly, it affects our ability to read and concentrate on tasks.
Balance, equilibrium
Our balance is controlled by a very refined system in our brain. Information from the three previous areas, the neck (muscle/proprioception), vestibular system (ears) and eyes (vision) is processed in the brain to help us maintain our balance. The disruption to the brain of a concussion can affect this processing system, leading to a feeling of disequilibrium or ‘floating’. This is often described as walking on a trampoline or boat. Specific exercises can target this problem however treatment may be required to attend to any dysfunction in the individual areas first. These are often a combination of eye movement exercises, neck treatment and balance retraining.
Physiological fitness and fatigue
A concussive episode can impact on a person’s physiological fitness in a number of ways. The initial period of inactivity is enough to start the process of losing physical fitness. Complicating this, concussion can often cause a disruption to the Autonomic Nervous System which controls how we respond to exercise. The Autonomic Nervous System looks after the increased blood flow to the areas that need more oxygen and removing waste products out of the system – we don’t have to think about it! When the body doesn’t respond appropriately to the required demands, our ability to exercise is significantly affected. This is the case in concussion – a person’s ability to exercise can be diminished very quickly.
Cognitive, Concentration, thought processes
Disruption to the brain function also affects our ability to think clearly. Often described as ‘brain fog’ it is characterised by its impact on executive function, ability to learn, memory & recall, ability to focus and slowed processing of information. Some recent research suggests post concussive amnesia may lead to more cognitive issues during recovery.
Anxiety, mood, psychological disorders
It is believed that symptoms of psychological (mood and anxiety) disorders have a contribution from the Limbic system, which includes the emotional centres of the brain. A concussion can potentially cause further disruption to this part of the brain, leading to an aggravation of symptoms that may already be present. Anyone with pre-existing symptoms of a psychological nature should be aware of this possibility and seek follow-up with their GP or trusted psychological health professional. Even without a pre-existing condition, some people who are rehabilitating from a concussion will benefit from psychological intervention, especially if symptoms persist for an extended period of time.
Post traumatic migraine
Migraine is a severe headache involving significant neurological dysfunction and hypersensitivity, similar in many ways to concussion. This type of headache often has a strong genetic predisposition. There are 40 genetic factors associated with migraine, a majority only being isolated in recent years. Consequently, it is not surprising that a concussive episode can either trigger or exaggerate a person’s migraine frequency or intensity. There has been much debate in the medical literature as to the association between concussion and migraine are becoming more obvious.
The program carried out at Sydney Concussion Centre uses best practice techniques, established by the latest research to assess the Domains of Concussion This involves a wide range of assessments to determine where your concussion symptoms are originating. Once the areas of dysfunction are determined, a specific treatment and exercise program is developed to address the issues and expedite recovery.
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