A concussion isn’t always as simple as a bump on the head. Symptoms can vary widely from person to person and identifying the specific challenges a patient experiences can help guide treatment and recovery, according to Dr. Michael Collins, professor and Arthur J. Rooney Sr. Chair in Sports Medicine at the University of Pittsburgh.
Collins spoke to CCHS faculty, residents and medical students about the assessment, management and treatment of concussions during the Ernest Cole Brock Endowed Lecture.
“A concussion is an energy crisis,” Collins said, explaining that the condition temporarily disrupts the brain’s ability to meet the energy demands of its cells. With appropriate clinical management, the effects of a concussion can be treated and recovery is possible.
Concussions can affect people in different ways, with symptoms and recovery varying from one person to another. Collins described five clinical profiles that help providers understand how a concussion affectsaffectinan individual and determine treatments might be most helpful. The profiles include anxiety/mood, migraine, vestibular, ocular-motor and cognitive symptoms.
Anxiety/mood may involve sleep disturbances, irritability, sadness, increased emotionality and anxiety. People with a migraine may experience headaches, nausea and sensitivity to light or noise. Vestibular symptoms can include dizziness, balance problems, motion sickness and difficulty tolerating busy environments. Ocular-motor symptoms can involve blurred or double vision, eye strain, headaches and difficulty reading, while cognitive symptoms may include fatigue, forgetfulness and difficulty concentrating.
Collins said the profiles can overlap following a concussion, meaning a person may experience symptoms from more than one profile. Identifying the primary symptoms can help providers prioritize treatment and develop a recovery plan tailored to the individual.
“Concussions are characterized by diverse symptoms and impairments in function resulting in different clinical profiles and recovery trajectories,” Collins said.
Because concussion symptoms can vary, a comprehensive evaluation is important. Tools such as the Vestibular/Ocular-Motor Screening, or VOMS, can help assess symptoms related to eye movement and balance. Computerized neurocognitive testing and clinical profile screening can also help providers identify areas that may need attention.
Recovery can also be influenced by factors that existed before the injury. A history of anxiety, migraines, motion sickness, certain learning or developmental conditions and previous injuries may affect a patient’s recovery. Anxiety is particularly important to consider because it can interact with vestibular symptoms and contribute to a longer recovery.
Treatment should be tailored to the individual rather than relying on prolonged rest, according to Collins. Active rehabilitation may include exercise, vestibular rehabilitation, vision therapy, behavioral strategies, psychotherapy or medication, depending on the patient’s symptoms and clinical profile.
“Matching targeted and active treatments to clinical profiles may improve recovery trajectories following concussion,” Collins said.
Gradually returning to physical and cognitive activities is an important part of recovery. Collins encouraged patients to resume appropriate daily activities and use exposure and desensitization strategies to help the brain adapt to symptoms and environments that may initially be difficult.
Early evaluation and specialty care can also play an important role in recovery. Timely assessment can help identify a patient’s clinical profile and connect them with targeted treatment before symptoms become prolonged.