Category: Uncategorized

Written by Dr. Riley Sjodin, Chiropractor

 

Concussions used to be thought of as a product of a high-impact sport or major accident, however, a concussion can actually be caused when there is no impact to the head at all. To learn a bit more about concussion management, read this summary below! 

What Is a Concussion?

A concussion is a functional brain injury where a sudden acceleration/deceleration to the head, neck, and body results in forces being transmitted to the brain. This causes a shearing or twisting of the brain cells which ultimately leads to a concussion.

Symptoms of a Concussion

There are upwards of 20 different symptoms that can occur from concussion, but the most common symptoms are headache, pressure in the head, neck pain, trouble concentrating, fatigue, nausea, and dizziness. 

Concussions are simply diagnosed by a mechanism of injury that has significant deceleration or acceleration of the body, followed by immediate symptoms or within hours of the injury. There is no such thing as grading a concussion (mild, moderate, severe) in the early phase. We always err on the side of caution so a patient does not put themselves at risk by going back into a dangerous sport/activity/environment.

The main signs of a concussion are a blank/vacant stare, delayed verbal & motor responses, confusion, inability to focus attention, disorientation, slurred speech, gross observable incoordination, inability to walk in tandem, memory deficits, or being knocked unconscious. 

When Should I Seek Medical Attention?

If you suspect you have had a concussion you should monitor for deteriorating symptoms and go to emergency if you have any of the following:

• Severe or worsening headache
• Short-term memory loss or increasing confusion, 
• Multiple episodes of vomiting
• Fluid coming from ears, nose, mouth, eyes
• Numbness or weakness in arms
• Lack of motor coordination, slurring speech

If you do not have any of these, then rest for 24-48 hours with no strenuous activity, take naps throughout the day as needed, have a proper balanced diet, and get assessed by a healthcare practitioner as soon as possible to ensure the proper recovery going forward.

The primary things to avoid if you suspect you have a concussion are:

• Do not play sports or return to activity before being cleared by a healthcare practitioner.
• Do not do any intense cognitive activity for 24-48 hours which may involve taking some time away from work/school.
• Do not take pain medications as this can “mask” your symptoms and make it difficult to assess your concussion. Talk to your medical doctor first.
• Do not drive for 24 hours just to ensure you are medically stable before getting behind the wheel.

How Long Will My Concussion Last?

In 60-70% of people, symptoms will resolve within 3-4 weeks, but for 30-40% of people, they can be longer. Fortunately, early treatment and assessment after an acute concussion greatly reduce this timeline.

The best way to ensure someone has fully recovered to their pre-injury levels is to have a baseline measure. This is very helpful in making informed and safe return-to-play decisions and is why Baseline Concussion Testing is recommended for anyone undergoing a high-risk sport (10 years of age or older). Whether you are an athlete or not, there are a multitude of tests & protocols to return someone to their daily routine safely.

Rest is no longer considered the only way to manage a concussion. Although it may be required in the initial steps, we often want patients doing low-intensity (sub-symptom threshold) activity around the house for the first few days. From there, we treat concussions in many ways and can include exercise physiotherapy, manual therapy (soft-tissue therapy, acupuncture, mobilizations), visual/vestibular therapy, diet/nutritional interventions, and education & reassurance.

Concussion Testing

If you or someone you know participates in impact sports, you may want to consider a Baseline Concussion Screen for accurate and personalized return-to-play guidelines should you sustain a concussion. If you are experiencing concussion symptoms and have not yet been assessed by a healthcare professional, we encourage you to do so as soon as possible. 

Written by Physiotherapist Emma Bolt 

 

“Hey Emma, what are therapy intensives and why do some of these kids seem to live in the clinic for a few weeks?”. Thanks for asking! In this blog post, we’ll be talking about all things therapy intensive. The why, the how long, and the when.

What Are Therapy Intensives?

Therapy intensives are blocks of time where a child participates in a high-frequency therapy program – think of it like a bootcamp. I have met and worked with families from all across Canada, as well as the United States, and even as far as Croatia, who have sought out therapy intensives for their child. 

As an intensive completion present, the family is provided with a comprehensive and customized home exercise program so that the gains made during the intensive can be maintained and progressed at home. Typically, the final few sessions are dedicated to the teaching and coaching of the exercise program to ensure the family is comfortable with the program prior to the intensive end date.

How Long Should a Therapy Intensive Be?

At Peak Health & Performance, we offer therapy intensives of 2 or 3 weeks in duration where the child participates in 1 to 2 hours of physiotherapy each day. I like to explain the 2 to 3-week reasoning, based on my clinical experience, to families like this: 

• Week 1: The first week is for the child to get to know me and for me to get to know the child. What do they like? What do they dislike? What is the primary focus of this intensive to achieve the family’s goals?
• Week 2: This is when I begin to hone in on the child’s current skill set. If you were to go to a boot camp for a week, would you show the trainer your maximum effort on day one knowing full well that they’ll make things extra hard for you as a result? Probably not. A lot of kids I’ve worked with try to play a similar trick. “Let’s pretend I can’t do X, Y, or Z so this lady I’ve never met before makes things easier for me”.
• Week 3: The primary focus of the intensive, and the child’s true current skill level, has been identified which means the final week is dedicated to building a comprehensive home exercise program based on the child’s full achieved potential during that intensive.

It is important to point out that even after a 2 week intensive, a comprehensive home exercise program can still be created. This is especially true when the child and the therapist providing the therapy intensive have a pre-existing relationship. 

The number of hours each day is dependent on the child’s age, level of endurance, goals, and familiarity with an intensive therapy structure. If a child is younger with no previous experience of intensive therapy, or DMI therapy, it would be preferable to start with 1 hour a week. If the child is on their 6th intensive, or if the family feels confident that their child could participate in 2 hours of therapy each day, then a greater number of hours is appropriate.

A great way to help support the decision-making process of how many hours per day your child’s therapy intensive could be is to try a few DMI sessions prior to booking your intensive. This decision would be based on how your child participated during the session, as well as how they recovered following the session in regards to mood, energy, and sleep. 

When Is The Ideal Time To Do An Intensive?

If your child has been close to achieving a new gross motor milestone, but hasn’t quite seemed to figure it out, a therapy intensive might be for you. If your child has just been cleared for physiotherapy after a surgery and is deconditioned, a therapy intensive might be for you. If you feel the town or city where you live does not have knowledgeable or skilled physiotherapists to work with your child and are interested in receiving DMI therapy, an intensive might be for you!

If your child’s condition is progressing requiring frequent hospitalizations, or if they have had a recent change in their baseline resulting in increased seizure activity, increased fatigue, reduced appetite, or reduced sleep quality, a therapy intensive may not be right for you at this time. If your child is participating in a research study, please discuss whether a therapy intensive would be appropriate with the research team. 

Key Takeaways

A therapy intensive is like a bootcamp for gross motor milestones. An exercise program is developed and provided to the family to support maintenance and progression of the gains made during the intensive. While almost any time is a good time to have a therapy intensive, it is hard work! Any child starting an intensive should be in reasonably stable medical health to ensure their safety and to optimize the gains made during the intensive. 

Written by Scott Cyr, Physiotherapist

 

When it comes to concussion management, the most common question we hear is about the return to sports and when athletes can get back into the game. Although that will greatly depend on the case, we can offer some general information that might help you understand what goes into the post-concussive rehab decisions! Here are 5 quick questions and answers for you regarding concussions that I am working on Physiotherapy in Calgary South working in post-concussive care.

How Long After a Concussion Can I Return to Sport?

 

Timelines for concussion recovery can vary from person to person! In order to return to full sport, it is recommended you progress through a stepwise graduated return to sport protocol. Each step is to have 24 hours between to ensure no recurrence of symptoms with increased activity. If you experience symptoms at a specific stage, you must go back to the previous stage. 

The return to sport protocol consists of 6 steps, therefore a minimum of 7 days is required to advance through the protocol, as long as there are no setbacks. It is advised that medical clearance is provided prior to re-engaging in any contact drills. It is not uncommon for recoveries to last between 14-21 days on average.

What Happens If You Return to Sport Too Soon After a Concussion?

Coming back too early from a concussion can lead to detrimental effects. It is highly important that an athlete be asymptomatic and progress through a graduated return to ensure they are safe to return to sport. By returning too early, an athlete puts themselves at significant risk. These risks include worsening symptoms, further injury to the brain/other body parts or even second impact syndrome – something that can have detrimental effects and is life-threatening.

Can You Play Sports After Two Concussions?

Yes! Although once someone has a concussion, it is more likely they will sustain another compared to their peers who have never had a concussion. Returning to sport after two concussions is the same protocol and step progressions after your first. You should no longer have symptoms and once you have received medical clearance, you may return to sport!

What Is The “3 Concussion Rule”?

The 3 concussion rule is an outdated “rule” that was developed in the 1940s. This arbitrary rule stated that if you were to get 3 concussions in a sporting season, you would sit out for the rest of the season.

No literature has been developed to support these claims. If you have sustained multiple concussions, especially in a single season it is important to have discussions with your medical team for further planning on recovery or potential referrals that may benefit you.

Can I Play Sports With A Concussion If It Is Only A Mild One?

NO! A concussion is a concussion and they are no longer graded or categorized (mild – severe). If you have a concussion, you should report to your medical team and complete a graduated return to sport, regardless of how minimal the symptoms are! That way, you can ensure your safe and effective return to sport.

Final Words

 

In any case, it is absolutely best to seek medical attention if you suspect that you or someone you know has suffered a concussion. The sooner that you can seek professional advice, the sooner you will get back to doing what you love! To book a concussion assessment today, click HERE.

 

For further information on concussions including signs and symptoms, return to school/sport and a breakdown of the recommended step-by-step protocol, please access the following resource:

parachute.ca/en/injury-topic/concussion/