At InFocus we provide a comprehensive, systematic and interdisciplinary approach when helping patients recover from a concussion. Over the last 15 years we have built an amazing team of professionals to whom we can refer. We work together to return patients to work, school and activity as quickly and as safely as possible. At InFocus we communicate frequently with employers, schools, coaches and physicians to ensure seamless transitions and successful return to function.
We provide:
- Physiotherapy assessment & treatment for associated orthopaedic injuries
- Full Vestibular Assessment & Rehabilitation
- Physical Reconditioning & return to sport training
- Balance Testing
- Referrals to Vision Therapy as needed
- Academic Accommodation Forms & notes for return to sport
- Abilities Forms for employers as requested
What is a concussion?
The working definition used today for concussion is “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces” (developed by the consensus panel at the 3rd International Conference on Concussion in Sport that was held in Zurich, 2008).
A concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an “impulsive” force transmitted to the head. A concussion may or may not involve loss of consciousness. In fact, less than 20% of concussions result in a loss of consciousness.
What happens to the brain during a concussion?
Energy crisis
A direct or indirect blow to the head, face or jaw can cause the brain to accelerate then rapidly decelerate within the skull. This acceleration/deceleration motion can induce mechanical changes to the nerve fibres – causing them to stretch – and in turn, alter several important metabolic pathways.
Though injury is apparent given the spectrum of symptoms experienced by a concussed athlete, no structural damage is caused to the brain itself. That is, unlike other sports injuries (like a fractured wrist or dislocated shoulder) nothing appears “wrong” or abnormal on standard imaging studies like CT, or MRI. Instead, these imaging methods are used to rule out more severe trauma such as bleeding within the brain or skull or fractures of the skull or neck. We understand now, more than ever, that just because we can’t see the injury, it doesn’t mean that something’s not wrong.
Current evidence suggests that the rapid stretch of nerve fibres within the brain during a concussive trauma results in the release of various neurotransmitters (signalling molecules within the brain), which trigger the initiation of a complex neurometabolic pathway. Ultimately the brain is unable to produce the energy required to sustain its normal processes, creating a generalized metabolic depression. These changes take place within minutes of the injury and can last for hours or days before normalization occurs. It is thought to be this metabolic imbalance, along with other impaired physiological processes that contribute to the physical, cognitive, behavioural and emotional signs and symptoms typically seen in a concussed individual. [/accordion_content]
What is the recovery timeframe after a concussion?
Some seem to recover quickly and others do not
The majority (80-90%) of concussion-related symptoms are thought to resolve in a short (7-10 day) period; however in some, symptoms may persist beyond 10 days:
- Children & adolescents
- Players suffering from multiple concussions in a close timeframe
- Persistent headache (>60 hrs) or high symptom load
- Athletes with history of migraine, depression, ADHD, learning disabilities or sleep disorders
Why some athletes seem to recover quickly and others do not remains unclear. Even when symptoms resolve quickly it is advisable that a proper gradual return-to-play protocol be carried out. The whole recovery process therefore may take upwards of 3-4 weeks to prevent premature return to sport.
Evaluating recovery
Concussions can produce a wide array of symptoms, which poses a challenge for coaches, trainers, parents, and health professionals involved in the care of an injured athlete. The time-course for recovery also varies widely from athlete to athlete, making it impossible to employ a “cookie-cutter” approach to concussion rehabilitation and return-to-play timelines. Currently, there is no reliable diagnostic test or marker that can be used to identify a concussion when it’s occurred, or similarly, determine when a concussion has resolved.
InFocus believes that no single concussion test or exam should be used in isolation.
That is why InFocus offers a comprehensive assessment and has a group of amazing professionals to refer to as needed.