In his previous post Dr. Shawn Bachorick explained some information about what is a concussion, who is most at risk and prognosis.
Here he continues his discussion and gives us some more in depth information and insight.
In the acute, initial stages of concussion there are a few potentially serious conditions that need to be ruled out for patient safety. Skull fractures and bleeds in the brain are rare but potentially fatal sequelae to concussion injuries. CT is the preferred option for these, with MRI more helpful for detecting bleeds after more than a day or two. fMRI (functional MRI) is commonly able to demonstrate brain activity patterns which can correlate to injury severity and potential for recovery.
Assessment of balance is very important and not just in patients whose symptoms include complaints of dizziness or vertigo. Assessment of inner ear function and movements of the eyes is a necessity. Commonly, concussion patients will have dysfunction of eye tracking (horizontal and /or vertical) as well as poor ability to track a target towards their nose, difficulty keeping their eyes on a target while moving their head and others. I prefer basic cognitive testing in any concussion patient with more advanced evaluation by a trained neuropsychologist performed in cases of delayed recovery. Occasionally neck injuries will mimic concussion. These cases can be much easier to resolve through basic manual therapy treatments like chiropractic and massage, physiotherapy, etc.
There are several nutritional supplements that can be helpful in minimizing neuroinflammation and cell death from injury-related damage. Magnesium, fish oil, turmeric and resveratrol are some of the most commonly used. Other supplements are useful in delayed recovery and post-concussion syndrome. These are often involved with problems in blood sugar, cerebral blood flow, various aspects of gut function and excessive immune activation in the brain.
When you are ready to start treatment, after more serious possibilities have been eliminated, begin in a cautious fashion aiming to minimize symptom aggravation. Ideally we want to see some improvement in abnormal test results (sway less on balance testing, do eye exercises without getting a headache, etc.), but the main goal is to establish limits on how much stimulation the patient can endure. Once that is established, they can be given home exercise/therapy with firm guidelines on when to stop. As the patient demonstrates improved stamina, the intensity, frequency and duration of rehab can be increased gradually. Treatment needs to be individualized for each client. Although different concussions have common features, there can be a wide disparity in how they respond to various treatments. The important point is that treatments need to demonstrate improvement in function (balance, eye movements, cognitive testing, etc.). Relying only on symptoms is not a valid or successful strategy for managing these injuries. Treatment should be performed at a stimulation level that does not significantly trigger symptoms or cause any worsening of test results.
There are several professionals commonly involved in concussion management. These range from chiropractors and physiotherapists dealing with spinal and rehab issues(or, depending on training, inner ear and/or eye movement issues) to neuropsychologists (assessment of cognitive, memory, emotional issues) and rehabilitation optometrists (advanced training in vision rehab). Some concussions resolve in an uncomplicated manner, but others may require the expertise of several or even all of the aforementioned professions.