Concussion recovery: You need a plan

Recently I saw a patient who had been seeing a doctor regularly for a concussion injury. Her concussion had been monitored—but it had not been managed.

What's the difference? It's more than just keeping a patient safe from further injury while the brain goes through its healing process. To a concussion specialist, management means trying to find out how the concussion is affecting each individual patient. There is no cookie-cutter approach. 

To this patient, the difference was much more than that. She was in high school and her grades had taken a serious hit. Her college and career plans had been hijacked by this dirty-fighting concussion. As she told me her story, she started to cry and said, "The last time I was at the doctor, he told me, 'We just need you to get better.' I just stared at him, not knowing what to say." 

We are learning more about concussion all the time. I told my patient that if we could figure out how the concussion was affecting her brain, we could target her symptoms with the right treatment. We could help her. 

In concussion management, the focus is on six key areas: cognitive/fatigue, vestibular (balance/dizziness), ocular (vision), post-traumatic migraine, neck and mood/anxiety.

It turned out that my patient was experiencing problems with the way the visual system in her brain was trying to process the information it was taking in. I referred her to a neuro-optometrist who specializes in concussion management and she is making progress. She has regained hope.

Concussion management gets very complex, very quickly. In the case of a young athlete like my patient, the focus is not just the return-to-play decision. I'm also concerned about the return to learning and what is referred to as returning-to-life decisions. It's important to find a concussion specialist and team who understand this. I tell people that if you want to manage concussions, you need to embrace the concept of a clinic without walls. Our care does not end when the clinic visit is done. That takes a team approach. 

I know how frustrating it can be to have everyone think that you "look normal" when you want nothing more than to "feel normal" again. Within an initial clinic visit, we can often determine the target areas for a patient. Then, we put together an action plan specific to that patient. The plan may include an outline of school accommodations, or a referral to a vestibular therapist, neuro-optometrist, chiropractor or neurologist. In some cases, medication may be needed, but I try to find other options when possible. The point is that the earlier I can see a patient after a concussion, the more I can positively influence their recovery.

I hear many questions regarding concussions, but they all seem to come down to: How do I get back to the life I knew before my concussion? We have the tools to help you get there.