Concussion guidelines aim to aid return to normal life

New guidelines developed in part at McMaster University focus on helping adults, kids and post-secondary students return to normal life, work, school and play while dealing with post-concussions symptoms.
Demonstration of a test with patients that have suffered concussions. It's likely that concussion risk is greater for female athletes playing soccer, according to new guidelines. (Keith Srakocic/Associated Press)

There is a lot of research and medical advice on how to return to sports after a concussion.

But new post-concussion guidelines developed in part at McMaster University focus on a neglected part of concussion rehab: how to return to normal life.

The new guidelines, released Tuesday by the Ontario Neurotrauma Foundation, are an update from a 2009 report on concussions and traumatic brain injury.

These updated guidelines focus on transitioning patients back to normal life, work, school and play after “any traumatic brain injury,” said Diana Velikonija, a physician at the Regional Rehabilitation Centre at Hamilton Health Sciences involved with creating the guidelines.

“There are currently good sports guidelines about how to return to play. Our guidelines take a broader view,” said Shawn Marshall, an Ottawa-based physician and lead author of the report.

Many people with concussions remove themselves from many regular activities: work, school, fitness activities and socializing.

Too much rest can hurt

Some of that new research shows when symptoms last for more than three months (a typical recovery time) and progress into post-concussive symptoms, said Velikonja, resting for too long can be detrimental to the patient from a physical and emotional standpoint – the patient’s fitness level can decrease and a sense of depression and isolation can set in.

There is also a new section for transitioning post-secondary students back to school appropriately.

“Those decisions have to be made faster if [the student] needs to be pulled out for the academic year or a semester,” Velikonija said. “It has implications on their grades and finances as well.”

Actively treating persistent symptoms is also an important part of the new guidelines.

Lianne Scheers understands how difficult a return to regular routines can be. A year and half ago the 45-year-old mother and high school teacher at Simcoe’s Valley Heights Secondary School slipped on a puddle on her school’s tiled floor and hit her head hard. She was diagnosed with a concussion.

She remembers a couple of weeks later taking her father to one of his medical appointments, in sunglasses, to avoid the painful glare from the lights. Her father's nurse was more concerned about her than her father. The nurse told her to go to the emergency room; she did and later began brain injury treatment at Hamilton Health Sciences.

Scheer’s advice: listen to your symptoms and deal with them appropriately.

Scheer lists off the treatment she’s currently undergoing a year and a half later: physiotherapy for her neck, occupational therapy, visits to the brain injury clinic to monitor her symptoms like headaches, light sensitivity and dizziness, visits to a social worker to deal with depression.

“I’m not who I am and want to be,” she said. “I’m not the mom I used to be. I struggle with multitasking, I need my rest time. That gets old to the kids.”

What’s also new in Tuesday’s release is monitoring similar emotional and cognitive symptoms in children, Velikonja said.

As for Scheers, she began a gradual transition back to work 7 months after her June 2012 accident, but not in her own classroom. At the start of this school year, she’s only back to a quarter of her normal work load and teaching one class. She was hoping to be teaching two, but that was too ambitious, she said.

“I thought there would be a magic time when I’d be done with it,” she said, but that wasn’t the case.

In the meantime, she’s sticking to the guidelines and listening to the symptoms.


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