Treatment

If someone has sustained a concussion injury, we know they must have a whiplash injury to the neck as well. The neck can be a source of headaches, dizziness or balance problems.

Treatment: Focus is 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.

For further information, visit www.WatsonHeadache.com. There are also a number of exercises to improve neck strength and function which may be required to restore all normal activity levels.

The vestibular system (part of our body's balance system) in the ear, can be affected by the acceleration and/or deceleration injury which causes concussion. This involves the release of ‘crystals’ called otoconia from the utricle into the circular canals of the vestibular system in the ear, which affect its ability to function. Called 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.

Treatment: Specialised assessment and treatment is required to restore the system to normal. The assessment procedures are called the Dix-Hallpike manoeuvre and the Roll Test. A previous history of vertigo (BPPV) makes you more likely to suffer from this issue after a concussion.

The burst of activity in the brain that results in an ongoing fatigued state, affects its ability to control normal body functions — the eyes are one of those areas. When our eyes aren't moving or focusing properly, our ability to read and concentrate on tasks is affected.

Treatment: A variety of tests are performed to establish what is being affected by the concussion. Once the various problems are isolated, specific exercises are performed to restore normal brain control over these aspects of eye function.

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 maintain 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 like walking on a trampoline or boat.

Treatment: Physiotherapists and other health professionals, world-wide, have been developing techniques to improve this problem for many years. 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.

A concussive episode can impact 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. Usually, we don't need to think about increasing our heart rate when we exercise — the Autonomic Nervous System looks after the increased blood flow to areas that need more oxygen and removing waste products out of the system. When the body doesn't respond appropriately to the required demands, our ability to exercise is significantly affected.

Treatment: A team of researchers from Buffalo, New York, has been assessing the impact of concussion on physiological fitness. Their latest research has proved that exercise, starting as early as two weeks after a concussion, can help improve recovery time compared to rest. A special test called the Buffalo Treadmill Test is used to assess the required level of exercise intensity required for rehabilitation.

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 and recall, ability to focus and slowed processing of information. Some recent research suggests post-concussive amnesia may lead to more cognitive issues during recovery. Recovery can also be affected by sleep, mood, daily stresses and headaches.

Treatment: Assessment of cognitive function can be performed using a variety of testing procedures, often online. Results can give direction for treatment which is often best performed by a psychologist, especially in cases where improvement is slow.

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.

Treatment: 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 rehabilitating from a concussion, will benefit from psychological intervention especially if symptoms persist for an extended period of time.

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 migraine frequency or intensity.

Treatment: From the chemical changes at a cellular level, through the progression of neurological dysfunction, to the signs and symptoms of both headache and migraine, the similarities are evident. It has been our clinical experience that migraine sufferers often have an aggravation or change of migraine presentation after a concussion.