It’s possible to have a concussion and not even realize it, however most people do fully recover with rest or by attending physical or occupational therapy. To tell us more about how to know if you have a concussion and the steps to take to recover are a UVM Medical Center physical therapist, Timothy Bissonette, and occupational therapist, Nicki Hawko.
Listen to the interview at the link below or read the transcript that follows.
Learn more about Injury Prevention and Safety Programs at the University of Vermont Medical Center. Or, read “Concussions: When to Visit the UVM Medical Center Post-Concussion Clinic.”
UVM Medical Center: Most people are familiar with concussions. Maybe your son or daughter had a collision at a sports game or a friend was in a car accident. Concussions can be confusing. They come in different forms with many different symptoms. Some concussions may cause you to lose consciousness, but most do not. Lots of people aren’t sure what to do if they think they might have one, and it’s possible to have a concussion and not realize it. However, most people do recover fully after a concussion, either with rest or by attending physical or occupational therapy.
To tell us more about what happens when you get a concussion and how to recover safely, we have occupational therapist at the UVM Medical Center, Nicole Hawko, and physical therapist at the UVM Medical Center, Timothy Bissonette. Thanks for being with us today.
Timothy: It’s great to be here.
Nicole (Nikki): Thank you for having us.
UVM Medical Center: Let’s start with the basics. What can cause a concussion?
Timothy: The main cause for a concussion is a direct blow to the head, face, or the neck.
UVM Medical Center: What sort of activities might you be doing where that would happen?
Timothy: It could be stemming anywhere from a sporting activity to a fall or a motor vehicle accident.
Nikki: It can also be other simple things, like standing up and hitting your head on a shelf or colliding heads with somebody, something like that.
UVM Medical Center: What are the symptoms of a concussion?
Nikki: The symptoms of a concussion, there are many different ones, and not everybody’s going to have all of them but, generally, the most common one is a headache. Sometimes people can have loss of consciousness, but it’s not always a sure thing to have that. People will often report confusion, behavior or personality changes. There’s often nausea associated with it, some balance problems or dizziness. There can be decreased coordination. Often people will come to us with vision changes or ringing in the ears, and often they feel sluggish or slowed down. They feel like they just can’t process information as well as they used to, and they can have sensitivity to lights, noise or movement.
UVM Medical Center: How do patients or parents or coaches know when it’s time to head to the hospital or to urgent care, maybe, and how would you suggest somebody choose between the emergency room or their local urgent care office?
Timothy: I think if it’s an injury that’s sustained, say, on the playing field, oftentimes, again, the athletic trainer will make some recommendations and, in that case, may recommend them to go to the emergency room and get some tests or get worked up by a physician. From that, 80 to 90 percent of the concussions resolve in seven to ten days, so you primarily want to rest and not do any activity that’s going to exacerbate any of the symptoms. If the symptoms last longer than that seven to ten day period, that they follow up with their physician and look at scheduling additional physical, occupational therapy to look at those symptoms.
UVM Medical Center: When you talk about rest and recovery, what does that look like? Does it look like not playing sports? Does it look like not going for a walk? Is it noise, light, maybe not going on the computer?
Nikki: I think a lot of it depends on the severity of the concussion. If someone’s having a lot of symptoms, if they’re having any kind of sensitivity to light, to noise, if they’re feeling nauseous or anything like that, you really want to promote cognitive and physical rest. Definitely no computer, no smart phones, no physical activity in terms of exercise, sports, that part of it. You don’t want to do that for too, too long, so you really want to focus on keeping that physical or cognitive rest to a seven to ten day window. If your symptoms haven’t resolved after that, that’s when you want to follow up with your medical provider and see, is there something else going on? Are there other symptoms that are continuing and should they be looked at and what’s going on?
UVM Medical Center: What are the risks of not going to the doctor at all?
Nikki: Your recovery is longer and you often will need, you’ll need a longer period of support to get back, or if you have any kind of risk for anxiety or depression, it’s just going to feed into that, and it really slows down how you can transfer back into your daily stuff.
Timothy: The anxiety and depression piece can be driven from the frustration that someone isn’t able to return to their normal activities and they’re having all these symptoms that are preventing them to make it through their daily life or get back on the sports field, and that’s going to lead to that anxiety and depression. Then it can snowball and just get worse and worse, to the point where, even if they attempt to try to increase their activity, their symptoms are going to be exacerbated so much by it that it’s going to be very debilitating for them.
UVM Medical Center: Today on Health Source, we’re talking about concussions with physical therapist at the UVM Medical Center, Timothy Bissonette, and occupational therapist at the UVM Medical Center, Nicole Hawko.
Let’s talk about how your two jobs are different. If a patient comes here, how might they interact differently with a physical therapist versus an occupational therapist after a concussion if they do decide they need some longer term support?
Timothy: The main role that physical therapy is going to provide is on overall balance, strength, mobility, any type of dizziness from vertigo. Oftentimes in this case, if there’s been a blow to the head, there’s neck pain and neck issues that we’re going to look into, gradually help people resume activities when they’re not causing any of those symptoms.
Nikki: The role of the occupational therapist sometimes does overlap with a physical therapist but, generally, what we try to do is, we try to work with people to get them back to doing things in their daily life that they were doing before. It can be something as simple as your basic self-care needs, your dressing, bathing, feeding, anything like that, doing activities around the house, like cooking or cleaning, or being able to read or use a computer. It can also even look at returning to driving or returning to work or school.
When a person is referred to us, our first day, we’ll focus on what is giving them a hard time and why. We’ll look into their vision skills to see what’s giving them a hard time. We specifically look at a lot of their ocular motor skills, convergence and divergence, eye teaming, depth perception and a couple of other things. From there, we’ll look at some of the thinking skills and, most notably, what we’re finding with people who have had concussions is that we focus mainly on the areas of memory problems, attention problems and their processing speed. From there, we work with a person to figure out, how is this affecting their functions, and how can we work to help the person modify their activity or their environment to make things easier?
They can do simple things right away, like using a filter lens so they’re not getting too much light in. They could use ear plugs to filter out the sounds. There are features that you can put on your computer so that there’s not as much blue light coming at you. We show them some other ideas on things that they can do to modify either what they’re doing or the room they’re doing it in.
One area of concern, though, is really with the driving piece. A lot of the symptoms that you have when you’re driving trigger nausea or dizziness or even reaction time, coordination. Sometimes, all that pulled together is really hard. We really try and work on some of the tests to see when they’re safe to transition back to driving and, often, we’ll communicate with a doctor to try and figure out how to do that safely.
Timothy: We don’t realize how much our brain has to absorb on a daily basis until there’s an issue with that process, and activities are over-stimulating. A lot of what we do is try to modify the activities to a manageable level and then gradually increase them as people are able to tolerate it. Some specific things that we can do are a treadmill walking test to identify at what point of exercise is starting to aggravate the symptoms and that way, we can give some parameters on how much they should exercise, when they should stop. We’ll work on balance, try to incorporate everyday activities and tasks and gradually increase them.
UVM Medical Center: Do you treat a lot of, would you say, high school or college athletes, or people just who hit their head, or is it a lot of a mix?
Nikki: Been a big mix, I think. We’ve seen a lot of high-schoolers recently, some athletic and some not getting their concussions in a game or a sport. Car accidents, we see quite a few people who’ve come in having had car accidents.
Timothy: We have a wide range here, certainly not one type, and then the spectrum, say the athlete, we see a lot of elderly that just fall and they suffer a concussion and have a lot of the same issues, or like, Nicky said, car accidents. Everybody considers, when they hear concussion, they think sports, that athletes are the ones that are getting the concussions but, actually, it’s a more widespread problem.
UVM Medical Center: Do you find that there are certain aspects of recovery that are more difficult for a lot of people? What do people really struggle with?
Nikki: I think it depends on the person that’s coming in. If it’s an athlete coming in and we’re telling them they can’t use their screen, they can’t exercise, it’s pretty oppressive for them to have to follow all of this. I think sometimes it’s easier for people, they can have the supports to help them with it and, other times, it’s just a little bit harder. I think it just depends on the demographic we’re getting.
Timothy: One thing that’s the same across all demographics, it’s just mainly over-stimulation. And I think people get very frustrated after a concussion if they are having significant symptoms, how easy they can get over-stimulated and how much they have to modify their activities in order to allow their brain to rest and recover.
Nikki: One of the best things they can do is start tracking their symptoms, and we teach them how to grade it on a scale from zero to ten, and really paying attention to what the triggers are. Once they can figure out what those triggers are, they can start modifying their day to not over-stimulate themselves or to not do something for longer.
An example would be, one lady I had didn’t realize that her smart phone was a trigger for her, so when she was doing her rest, she was scrolling through Facebook, which was really over-stimulating her visual system and it wasn’t allowing her to have the rest and she would get sick by the end of the day. She just couldn’t do everything at once. Once she figured that out, she took off the screen time when she was doing her rest. It made her day a lot better.
UVM Medical Center: Does the night function on an iPhone or some other phones, does that make a difference in terms of the colors of light that bother people, or is it really just too much flashing at you, too much coming through, and you shouldn’t?
Nikki: It can be both. The night function is nice because it does take out some of the blue light that’s coming, because that’s often one of the lights that’s hard for people. There’s a program that you can load onto your computer called f.lux (F-L-U-X), and that takes out some of the blue light as well. You can monitor that throughout the day to adjust it to whatever light’s around you. A lot of people find that very helpful.
UVM Medical Center: Have either of you had a concussion?
Timothy: I’ve never had a concussion. Earlier, I have been, probably, a brief loss of consciousness. Years ago, this was never considered a huge problem or anything that you followed up, especially on the athletic field, you “get your bell rung” and you shake it off and you just keep going. Now we’re finding that there’s more issues and problems that can come from that.
Nikki: One of the big things, too, is multiple concussions is really bad. When you’ve had one, you really want to not jump back too quickly to a sport, because if your balance is off or you’re dizzy, you’re more apt to have a second concussion because you’re apt to fall. First of all, you want to rest to get better, but you also want to make sure you don’t have another concussion.
UVM Medical Center: Do you find that people are more aware of concussions as an issue today, maybe than they would have been ten years ago?
Timothy: I think there’s definitely an increasing awareness, locally and nationally, with the impact of concussions, mild traumatic brain injuries. I certainly think there’s a direct link with the number of people that are seeking care for it.
Nikki: There’s a lot more awareness right now, which is good. Especially with young kids, you don’t want them to have multiple concussions. You want them to heal from these as best as they can.
Timothy: In order to treat a concussion often takes multiple disciplines to effectively treat it, so to go and just receive physical therapy for balance issues might not be addressing all the issues of having a successful recovery from it. Here at the rehab therapy center, we offer occupational therapy, physical therapy, speech language pathology, we work very closely with neurology, physical medicine and rehab and, oftentimes, psychology plays a role also.
Nikki: We have a nurse on staff, so when people are having a hard time managing their medication or if they’re not able to follow all the instructions, she’s often able to help us. She also finds a lot of resources in the community. There are a lot of support systems that are out there. There’s a phenomenal program called Love Your Brain Yoga, which Ken Pearce had started after his head injury. It’s for people who have had head injuries or concussions to go to and learn. I think there’s a six-week program to learn. It’s worth looking into if you’ve had a concussion or a head injury. It’s a wonderful system to connect with people who’ve had something like that as well, and also to learn some mindfulness. That’s a big part of this, is really trying to calm your mind, focus and get back to what you’re doing.
Timothy: Typically, there’s a period of time where you would not do yoga initially after the injury. You would have to allow a healing phase into where you can get back to some exercise without aggravating your symptoms. There’s a certain point where working with your medical provider to determine when is appropriate to start that program.
Nikki: I do want to come back to what Tim was saying. It’s really good if you are having post-concussive symptoms and you are going to seek care, really consider where you’re being referred to. If you’re having more than just balance things, you really want to go a place where they have comprehensive services. Like he was saying, the OT, the occupational therapy, physical therapy, speech language pathology, nursing, psychology services, we have them all on-site. We have meetings where we’ll work to make sure we’re getting the best care for the patient, we’re all on the same page and we’re all working towards the same goals. There’s a TBI support group that the University of Vermont Medical Center runs, right?
Nikki: They meet monthly and it can be from a severe TBI to a concussion. I think when people go through this, they really feel isolated and alone and like nobody really understands. The problem with concussion is, you can’t see it and it’s hard for people to really verbalize what’s going on. Often, when they come to us, they don’t really know, they just know they’re off.
Timothy: If you’re having a lot of those symptoms, the sooner you can get into the therapy team, we can help walk people through that process of finding out what exactly is going on and get them to the right provider.
UVM Medical Center: Our guests today on Health Source have been occupational therapist at the UVM Medical Center, Nicole Hawkoand physical therapist at the UVM Medical Center, Timothy Bissonette. Thanks very much for joining us.
Nikki: Thank you for having us.