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Concussions and Vestibular Rehabilitation

What is a concussion?

A concussion is a traumatic brain injury (TBI) that is caused by a blow to the head or body or a quick acceleration/deceleration of the head with no contact to any surface.

What are symptoms of a concussion?

Dizziness, balance problems, headaches, vomiting early on, confusion, and blurred vision can all be signs of a mild concussion. More severe symptoms that require immediate medical attention to rule out serious brain trauma may include: loss of consciousness, a severe headache that doesn’t resolve, continued vomiting, seizures, hearing loss +/or tinnitus, unequal pupils, slurred speech, decreased coordination or mental function and persistent dizziness.

A labyrinthine or inner ear concussion is characterized by symptoms including hearing loss (HL), tinnitus, and dizziness after head trauma. If HL is present an otology consult is necessary.

How long do symptoms last?

Acute symptoms can last for a few weeks following a concussion. Some of the symptoms appear right away and others may not become apparent for days or months after the injury. Prolonged symptoms lasting 4-6 weeks in some people develops into Post Concussion Syndrome(PCS). PCS symptoms can include headaches (tension or migraine), dizziness, disequilibrium, fatigue, irritability, anxiety, blurred vision, tinnitus, sensitivity to noise and light, loss of concentration and memory, sleep problems and depression.

How do you treat a concussion?

Initial consult should be with your primary care physician, neurologist or otologist if indicated.

Early on, the most important treatment is brain rest, limited activities and hydration. This includes limiting visual activities ie. smart phones, computers, tv’s and avoiding florescent lighting. After the “brain rest” period, a comprehensive vestibular evaluation from an Occupational or Physical Therapist trained in assessing and treating vestibular dysfunction is extremely helpful. Treatment consists of customized exercises for balance, visual, vestibular and proprioceptive systems. The focus is on providing symptom relief and help with managing your condition. The therapist can also provide recommendations and modifications if necessary to enhance your ability to return to school, work and home/life activities.

Other treatment may also include a CT or MRI of the head. Cognitive Behavior Therapy, a Psychiatric consult, Neuro Ophthalmology consult, Vision Therapy, Massage Therapy and Physical Therapy for whiplash or neck injury if indicated.

How can I avoid another injury?

Research has shown that nerve signals in the brain are disrupted for 30 days after a single concussion. A person is more likely to have another injury if engaged in a sporting activity within that 30 day time period because their reaction time and brain processing are not normal. Full recovery from a concussion means NO symptoms with ANY activities at rest or upon exertion. If a second concussion occurs the symptoms are typically much worse with an increased recovery time.

Prevention also includes using a seatbelt, wearing a helmet and avoiding falls (using hand rails, good lighting and removing throw rugs)

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