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.
