The above article is associated with World Rugby and their new announcement requiring all athletes that have been diagnosed with a concussion being sidelined for a minimum of 12 days. Formerly this minimum requirement was 7 days across the world, a standard practice regardless of sport. At Dr. Fitzgerald & Associates Vision In Motion clinic, we see numerous athletes, of all ages, that did not think their head impact was “a big deal”. It was only when they began realizing, days later, that they had a headache with certain tasks of daily living, or that they became dizzy when they sat up from lying down, and that they forgot their neighbor’s name across the street. Just like with delayed onset muscle soreness (DOMS) after exercise, symptoms of a concussion can also be delayed. It is important to gain a thorough history of mechanism of injury, symptom provocation, and discuss nutrition, exercise habits, and sleep hygiene when evaluating and treating a concussion. It is equally as important to utilize the return to play protocol appropriately, and monitor the athlete’s heart rate throughout each phase, since symptom provocation may be delayed up to 24 hours, heart rate will tell you immediately if the athlete will have a side effect from any physical or cognitive activity.
Happy Friday! 3 weeks until we host our Train Your Brain to See Again Clinic, July 8-9. We will be covering a wide variety of material related to concussion/TBI, stroke recovery, and multi-sensory systems therapy (aka, our Pinnacle Program). This clinic is open to optometrists, physical therapists and assistants, occupational therapists and assistants, athletic trainers, and doctors. If you plan on staying overnight, hotels near us include the Tru Hotel and the Marriott. Both of these have blocks reserved for this clinic, all you have to do is drop the Dr. Fitzgerald & Associates name and request to be put in that block of rooms! The clinic will run from 8-5 with a lunch and learn built in, so be ready to “drink from a firehose” as we call it here at the office. This will also be a great opportunity to build connections with other healthcare providers and build a team of professionals to refer to and work with.
Symptom provocation after suffering from a concussion/TBI is different among each individual I see. Each day I see someone, I start out with a history of what they have been up to, how much water they’ve been intaking, what they’ve been eating (many times people are not getting enough calories), what their sleep quality is like, and then end the subjective portion of my session with them filling out a symptom survey. This symptom survey is especially important for objective documentation because it gives you, the clinician, and insurance an idea of how the patient is processing their symptom provocation. I do all of this before I even consider what their session will consist of that day. When someone approaches me with significant headache, nausea, or dizziness those are the “Big 3” red flags that tell me this person is not going to benefit from initiating visual, vestibular, or cognitive skills right away; they need symptom management first so their brain and body benefit from the therapeutic exercise. It is not until someone reports to me asymptomatic and with complaints of visual dysfunction, difficulty focusing, memory loss, etc. that I begin a session with therapeutic exercise. This is when it is appropriate to push their brain and body to work effectively together as one system.