Unfortunately, when it comes to concussion treatment there is no master plan. As neuro-optometrist Dr. Charles Shidlofsky once mentioned: “When you’ve seen one brain injury, you’ve seen one brain injury.” Each patient is different, both from a psychological and biological standpoint. These differences are part of what makes concussion treatment such a challenge. The critical window of appropriate rest and appropriate return to physical activity has to be determined for each individual patient.
As Dr. Shidlofsky pointed out, when it comes to concussions: “there are often very different recovery trajectories from one person to another. For example, sometimes we have patients who’ve been hit in the head really hard and they come in for six sessions and they’ve actually recovered. But then you can have someone else who’s had a minor fender bender, and they have such debilitating symptoms that just a slight rotation of their chair triggers severe dizziness.”
But, is there a best way to treat a concussion or brain injury? For decades, complete rest for an extended period has been the conventional treatment for concussions. In fact, it’s still what many emergency clinics and primary-care doctors recommend.
New studies, however, are finding that active rehabilitation after a concussion can enhance recovery. The active rehabilitation involves resuming normal activities shortly after the injury. Dr. Danny Thomas, an associate professor in emergency medicine in the Medicine College of Wisconsin explains: “After an operation, you don’t just sit in bed and expect to get better. You’re encouraged to get up and walk and do some light activity. With concussion, we’re moving towards active rehabilitation earlier.”
So, no more spending time for days or weeks at home in a dark room! Nevertheless, resuming to normal activities is only encouraged if the symptoms don’t worsen. The last thing you want is to stress a patient who is suffering from severe migraines, along with dizziness and nausea.
Some concussion specialists are particularly looking at the treatment for the rehabilitation of these brain injuries through specific therapies. For instance, for symptoms such as blurry vision or balance problems, targeted therapies are increasingly being used. Patients with vision problems will undergo ocular therapy. A person with balance or vestibular problems will see a neurophysical or vestibular therapist.
Dr. Shidlofsky explains that about 40% of his neuro-vision practice is dedicated to mTBI (minor traumatic brain injury) treatment through a neuro-visual rehabilitation approach. He explains that the importance of taking on a very individualized approach utilizing the right combination of therapies for specific needs. In addition, he stresses that you need to start very slowly before progressing treatment.
The new research on concussions therefore suggests that active rehabilitation may improve symptoms more than strict rest. Clearly, some sports-medicine practices and concussion clinics have already embraced active rehabilitation techniques. With more studies being conducted, it will be interesting to see if new theories emerge on how to best treat concussions.
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