Life After Concussion:

Transcription

1 Life After Concussion: Self Management Strategies Kira Heaton, Occupational Therapist Jamie Dunnett, Physical Therapist

2 Presenters: Jamie Dunnett Kira Heaton Doctor of Physical Therapy CBI Health Group Clinical: Concussion Vestibular Masters of Occupational Therapy CBI Health Group

3 Concussion (mild Traumatic Brain Injury)

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5 Concussion After 3 months 2/3 of people recovered fully 1/3 persistent symptoms

6 The best practice is to prioritize and treat the symptoms using interdisciplinary interventions. Consensus Statement on Sports Concussions, 2016 Ontario Neuro-trauma Guidelines for m-tbi, 2013

7 Symptoms rated as severe at 3 months 1. Sleep disturbance 14% 2. Headache 13% 3. Fatigue 12% 4. Dizziness 12% 5. Impaired cognition (memory) 10% (Roe et al. Disability and Rehabilitation, 2009)

8 Sleep disturbance Following mtbi (or concussion), approximately 50% of people suffer from sleep disturbance Stress and racing brain is leading cause of insomnia With insomnia you must treat the cause not the symptoms 90% of insomniacs can be cured by self care (McArdle et.al. 1996) Melatonin + magnesium can result in vivid dreams, drowsiness and disrupt circadian rhythms (University of Maryland Medical Center)

9 Symptoms of decreased sleep Grogginess Lack of coordination Lapse of memory Decreased concentration Decreased alertness Erratic behaviour Mood swings Decreased self-esteem Decreased sleep weakens body immune system and decreases recuperative powers = cycle

10 What do you do Sleep Hygiene Identify the Cause Physical Behavioural Psychological Environmental - Exercise - Hot bath - Pillows - Positioning - Nutritional -Association - Routines - TV/Phones - Anxiety Strategies - Sleep Apps -CBT-I -Dark/Cool Room - Others Routines

11 Headaches Post Traumatic Headaches MIgraine Cervicogenic Tension Type

12 Headaches Type MIgraine Tension Cervicogenic Self management strategies Lifestyle hygiene Trigger diary and management Environment modifications Application of heat/ice to head Scalp massage Tight scarf around head Application of heat or ice to neck. Neck stretching/movements Positioning Posture Medical management strategies Prophylactic meds Abortant meds Neurologist Analgesic meds Neurologist Neck therapy Physio, chiro, RMT

13 Fatigue Mental fatigue is when your brain is tired. It may feel like your brain becomes slower and thinking becomes more difficult. Mental fatigue is common after a brain injury It is NOT the same as being physically tired Varies over the course of the day (often people feel better in the morning)

14 Fatigue Energy Conservation Review the 4 Ps (planning, pacing, prioritizing and positioning) Get the client to identify if they are already using EC strategies get examples Review activity log What can change? Doing nothing at all will not promote recovery, but doing too much each day will cause prolonged symptoms

15 Fatigue Managing Mental Fatigue Tips Take advantage of peak times Focus on one thing at a time and minimize distractions Alternate difficult tasks with easier ones Take frequent breaks Don t push yourself - (the term no pain, no gain does not apply) Slowly increase the amount of time you spend on tasks Give yourself plenty of time to complete tasks Try to avoid working under strict deadlines if you can Be aware of how your emotional state affects mental fatigue. Feeling down or depressed may make you feel more mentally fatigued

16 Dizziness Vestibular Vision Vascular Medications Dizziness Migraine Neck Anxiety

17 Dizziness Advice for Self management 1. Clarification of the cause 2. Follow through on the advice of the practitioner 3. Trigger diary and management 4. Be persistent!

18 Impaired cognition Common Complaints Hard to think clearly Feeling slowed down Difficulty remember information Trouble finding the words or expressing thoughts Difficulty solving day to day problems Difficulty organizing your day and schedule Difficulty paying attention to things or people Unable to concentrate/ focus

19 Impaired cognition Neuroplasticity Neuroplasticity: The brain's ability to reorganize itself by forming new neural connections throughout life When we exercise our brain and practice different tasks our pathways regroup and rebuild leading to RECOVERY.

20 Don t forget it s a Gradual Process

21 Cognitive Hierarchy Executive Function Visual Preceptual Information Processing Memory Attention

22 Cognitive Remediation Process Training Cog Rehab Strategy Training Functional Activities

23 Managing Frustrations

24 Summary 1. Persistent symptoms = inter-disciplinary evaluation (MD, PT, OT..) 2. Symptoms are dissected and treated accordingly 3. Treatment should always include active self management strategies 4. You can be successful at lessening or eliminating persistent symptoms post concussion

25 Questions: Jamie Dunnett Kira Heaton

26 Contact: Nanaimo Brain Injury Society 285 Prideaux Street Nanaimo, BC V9R 2N2 Tel: Ext 202 Fax: Education and Community Liaison Adrienne Bennest