Understanding Concussion and Promoting Recovery  

- Overview of the Brain and Concussion
- Common Symptoms of Concussion
- How to Promote Recovery after Concussion
- What to do if Concussion Symptoms Persist

The Brain... It's electric!

The brain is made up of billions of specialized cells called neurons. Each brain cell has a cell body which processes information. Each also has a wire-like structure (axon) that branches at the end to connect to other cells. Once a cell is activated, an electrical signal travels down the axon to send a message to other cells it connects to. The connection point between the wire and the next cell is called a synapse. The brain works using electricity and chemicals. When an electric signal reaches the end of the axon it does not actually touch the next cell. It transmits its message by secreting chemicals (neurotransmitters) into the synapse. The type and quantity of neurochemicals in the synapse tell the next cell what to do.

A concussion is a disturbance in brain functioning that occurs following either a blow to the head or as a result of the violent shaking of the head. This is most often related to a motor vehicle accident, fall, or sports injury. 

A concussion occurs as a result of the rapid acceleration and deceleration to the brain during a blow to the head. There are two processes that can occur in the brain to cause concussive symptoms:

1.     Shearing or tearing of axons which affects the electric signal.
2.     Release of neurochemicals. The rapid change causes a flooding of neurochemicals, and the brain cannot handle the overwhelming amount of information.

As a result of either of these processes, initial symptoms can include: Confusion, Disorientation, Attention and Memory disturbance, Loss of consciousness.

Symptoms of Concussion

Until the brain has healed, people may struggle with symptoms in four main areas – physical, thinking, emotional, and sleep. This is a normal part of the recovery process of concussion and for most people symptoms resolve within the first few weeks. A minority of people take longer to recover from a concussion. Persistent symptoms of concussion are most often related to a large amount of torn axons that will require further assessment and treatment as noted later.

Think about it like this: The excess of neurochemicals in the brain after a concussion is similar to the process that happens if you exercise strenuously for a long time. Your muscles will develop a buildup of lactic acid which causes soreness. If you rest for a few days, remain active, and do some stretching, the body reabsorbs the chemicals. You can then resume normal functioning. For the vast majority of people, the brain has the ability to reabsorb chemicals to normal after a concussion. You can help provide the conditions that help the brain to recover by remaining active but carefully creating a plan that will not cause re-injury to your brain.

How to Promote Recovery

Whenever you use your brain for an activity, communication between the brain cells involves a release of chemicals.  Pumps that reabsorb chemicals from normal brain activity require energy. Remember that after a concussion you need more energy (blood) supply to the brain. If you use your available energy doing daily activities, there will be no energy left to reabsorb the chemicals released during the concussion. If you use more than your available brain energy during a day, you will be in an energy deficit – often symptoms will get worse and eventually force you to rest till your brain pumps can catch up.

To recover more quickly from a concussion you need to learn how to balance brain activity and rest so that you have an energy excess each day that the brain can use to heal and reabsorb chemicals.  If you are always in deficit your recovery will be prolonged.

 Balancing Rest AND Activity is Very Important

Think about it like this: If you were a runner and sprained your knee, your doctor would not prescribe that you lie in bed for a few months. Without activity, recovery would be slow and incomplete. Nor would the doctor say to resume training at your normal level. What they might recommend is to gradually increase your activity and use indicators like pain or swelling to let you know when you are exercising too much. Current research indicates that your brain should be treated the same – gradually increasing activity. Use your level of fatigue and other symptoms as indicators of how to pace increases in stress and activity.

Important Note:  Return-to-Play, Return-to-School and Return-to-Work decisions should be made by a student’s physician or neuropsychologist. Returning too early can prolong recovery and may even cause permanent damage. 

Get in the Zone

After a concussion, some people will feel okay and try to do all the things that they normally do (school, sports, work, etc). They keep going even after they start feeling tired and “push through” unpleasant symptoms. After a while their symptoms get so bad that they are forced to stop. It may take a day or two of total inactivity to feel okay again.  AVOID THIS PATTERN! Your brain cannot heal if you do this. Excessive Stress on a healing brain results in even more damage and a prolonged recovery time. Your treatment team will help you get into a zone where your level of activity will maximize your recovery. If you keep in the zone almost all people notice that over time the amount of things they can do each day increases. Stay away from the roller coaster and get into the zone!

How do you know if you are in the zone?

Your body will usually signal you when you are doing too much.  For most people this means that they start feeling fatigued or develop other concussion symptoms. Before a concussion, most people ignore these signals to “push through” and “get the job done.”  This is not going to work after a concussion. By increasing your awareness of body signals and increasing your ability to predict which activities will result in fatigue, you will develop skills in staying in the zone. Your clinician will give you weekly tracking sheets to record your activity levels and also levels of energy. You will be able to discuss with your clinician what activities or experiences are draining for you (they are different for everyone) and develop skills in planning your weekly schedule.

What should a person do if concussion symptoms won’t go away?  

Unfortunately, in 10-15% of those that have a concussion, symptoms may persist. These symptoms can affect school and work and relationships. If symptoms do not go away after one month then further assessment and treatment is required. Athletes should not return to their sport and students should not return to full time school until they are cleared. Accommodations for school or work can be developed using neuropsychological testing to create a treatment plan. Use the following post concussion symptom scale to determine if you may have ongoing symptoms. If you do, please contact your physician or a neuropsychologist and take this form with you.

Download and Fill out this assessment

What should you do now?

If you have had a concussion, there are several simple steps to best ensure your brain heals as quickly as possible.
1) Seek professional attention. You may need a brain scan or more serious treatment.
2) Rest and Recovery. Make sure to avoid sports and school or work. The brain needs to heal.  
3) To determine the length of time that rest is necessary, you should be evaluated by a neuropsychologist or someone qualified to make that decision.

We use a combination of clinical assessment and psychometric testing to assess the impact of concussion on the brain. While comprehensive neuropsychological assessment can be utilized, it may not be required. For concussion management, we use ImPACT™, related to sports activities and for other mild traumatic brain injuries. If more in depth cognitive assessment or neuropsychological testing is needed, we can provide this as well.

Please, contact us with questions.

References:

• NIH Toolbox
• Impact Concussion Management 
• CHOP Concussion website
• Promoting Recovery after Concussion