What is Post Concussion Syndrome?
A concussion is defined as a mild traumatic brain injury induced by biomechanical forces occurring to the brain. A concussion will result in transient impairment to neurological function, with symptoms resolving within 2 to 14 days of the initial injury (Cnossen et al., 2018).
Post-concussion syndrome (PCS) occurs when symptoms of a mild traumatic brain injury are present for more than 1 month after (Iverson et al., 2019). In mild traumatic brain injury patients, this accounts for 10-25% of people (Polinder et al., 2018). Due to varying nature of the condition, post-concussion syndrome can be hard to diagnose and therefore may be under-represented through statistics (Iverson et al., 2019).
Causes of Post Concussion Syndrome
The initial mechanism of a mild traumatic brain injury is often well recognised. These injuries may result due to a sport related injury, concussion or other non-penetrating head trauma.
A strong predictor of persistent concussive symptoms is the mechanism of the injury. This includes the initial impact force, any loss of consciousness, duration of loss of consciousness, amnesia or memory disturbances and the presence of abnormalities of the brain. Medical imaging can be used to determine the extent of a concussion and rule out any complications such as bleeding on the brain (Cnossen et al., 2018).
Other risk factors that are linked to post-concussion syndrome include:
- Post-concussion seizure
- Female gender
- Age
- Other co-existing health conditions
- History of mild traumatic brain injury
- History of depression, anxiety or migraine
(Cnossen et al., 2018)
What are the Symptoms of Post Concussion Syndrome?
Post-concussion syndrome may include a variety of physical, cognitive, behavioural and emotional symptoms.
These include:
- Headaches or migraines
- Dizziness and/or nausea
- Fatigue
- Anxiety
- Depression
- Blurry vision or double vision
- Ringing of the ears
- Difficulty with concentration and memory
- Noise and light sensitivity
It is important to note that each individual with post-concussive syndrome may present differently (Polinder et al., 2018)
What is the Medical Management of Post Concussion Syndrome?
The management of post-concussion syndrome may involve neurologists, general practitioners and physiotherapists which may assist in rehabilitation. A general practitioner and trained physiotherapist can identify concussion using diagnostic tools (Australian Institute of Sport, n.d.). Referral to a neurologist may assist with medical testing, medical imaging and diagnoses to guide rehabilitation.
Rehabilitation for Post Concussion Syndrome
Physiotherapy management of post-concussion syndrome considers biological, environmental and psychosocial factors of the individual. The physiotherapist will conduct an initial assessment to establish the relevant history, mechanism of the injury and symptoms.
A physiotherapist can assist with return to exercise and daily activities after the initial 24-48 hours period of rest (provided symptoms are not severely exacerbated). This may include graded return to sport and return to learn learning for children and adolescents (Australian Institute of Sport, n.d.).
Vestibular and oculomotor dysfunction can also be included in the management of post-concussion rehabilitation. This includes assessments of eye and head movements, and determining if any symptoms of dizziness, nausea, headache or fogginess are reproduced (Australian Institute of Sport, n.d.).
References:
Australian Institute of Sport. (n.d.). Concussion in Australian Sport. https://www.concussioninsport.gov.au/physiotherapists#how_to_manage_concussion
Cnossen, M. C., van der Naalt, J., Spikman, J. M., Nieboer, D., Yue, J. K., Winkler, E. A., Manley, G. T., von Steinbuechel, N., Polinder, S., Steyerberg, E. W., & Lingsma, H. F. (2018). Prediction of Persistent Post-Concussion Symptoms after Mild Traumatic Brain Injury. Journal of neurotrauma, 35(22), 2691–2698. https://doi.org/10.1089/neu.2017.5486
Iverson G. L. (2019). Network Analysis and Precision Rehabilitation for the Post-concussion Syndrome. Frontiers in neurology, 10, 489. https://doi.org/10.3389/fneur.2019.00489
Polinder, S., Cnossen, M. C., Real, R. G. L., Covic, A., Gorbunova, A., Voormolen, D. C., Master, C. L., Haagsma, J. A., Diaz-Arrastia, R., & von Steinbuechel, N. (2018). A Multidimensional Approach to Post-concussion Symptoms in Mild Traumatic Brain Injury. Frontiers in neurology, 9, 1113. https://doi.org/10.3389/fneur.2018.01113
