In the past, medical advice suggested that if you sustained a concussion, you needed prolonged bed rest with minimal engagement in activities for up to two weeks. However, this approach has changed with emerging studies about concussions.
The latest studies have found that early education and intervention are critical in concussion rehabilitation, along with a gradual return to activities. This evidence-based approach can help prevent prolonged symptoms from occurring and negatively impacting a person’s functional abilities.
In this article, we examine the occupational therapist’s specialised role in concussion management—from helping you manage your post-concussion symptoms to gradually returning to your daily activities.
Table of Contents:
- What is a concussion?
- Signs and symptoms of a concussion
- How can occupational therapy help post concussion?
- Concussion occupational therapy process
- Concussion occupational therapy case study
- Conclusion
What is a Concussion?
A concussion is a form of a mild traumatic brain injury (mTBI) that is caused by excessive, rapid movement of the brain within the skull due to trauma to the head. The trauma can be in the form of a blunt impact to the head, face, or neck or indirect injury that creates enough force that the brain is jolted inside the skull.
This type of injury typically occurs due to motor vehicle accidents, sports injuries, falls, workplace injuries, and assault. In 2019, it’s estimated that over 400,000 Canadians aged 12 years or older sustained one or more concussions[i]
Signs and Symptoms of a Concussion
The signs and symptoms of a concussion can vary from person to person, as well as the severity of the concussion. You do not need a loss of consciousness to be diagnosed as having a concussion.
The most common signs and symptoms include:
- Physical: headaches, dizziness, nausea, neck pain, sensory sensitivities, fatigue
- Cognitive: mental fatigue, brief amnesia, poor memory, decreased attention and concentration, confusion, slow information processing, slowed reactions, and disorganization
- Emotional/behavioural: irritability, anxiety, sadness, anger
- Sleep Disturbances: difficulty falling asleep, difficulty staying asleep
According to the Ontario Neurotrauma Foundation (ONF) guidelines, most people recover from concussion related symptoms within the first few weeks following injury. However a smaller percentage (15-20%) of individuals will experience prolonged symptoms beyond one month.
How Can Occupational Therapy Help Post Concussion?
After a concussion, your life can be significantly affected. For example, you are suddenly unable to perform your household tasks, work, or go to school. You can no longer play the sports you enjoy and struggle with running errands or engaging in community activities. Your post-concussion symptoms prevent you from being able to function because the symptoms can become intensified when you try to perform any of your daily activities.
An occupational therapist (OT) is a uniquely qualified health care professional that is trained to understand how you, your environment, and your occupations interact in various types of illnesses and disabilities.
OTs analyze factors that can affect your ability or inability to engage in an activity and find ways to re-engage in meaningful activities such as returning to work or sports. OTs are also skilled at addressing many of the physical and cognitive symptoms related to concussions that have a negative impact on functioning.
For example, they help you to better manage your post-concussion symptoms to prevent exacerbation of symptoms as you learn to reintegrate back into your daily activities at home, work, school, and the community.
According to the ONF, a referral to an occupational therapist should be made when any of the following occur as a result of a concussion injury:
- You require support to re-integrate back into work, school or daily activities.
- You are experiencing cognitive deficits
- You are experiencing mental or physical fatigue
- You are suffering from sleep difficulties
- There are co-occurring orthopaedic injuries
Concussion Occupational Therapy Process
An initial occupational therapy assessment will be conducted using standardized and non-standardized assessments to gather objective information about symptoms and functional abilities. The OT will work with you to determine the areas of your daily routines that have been negatively impacted by the concussion, as well as external factors that can be exacerbating your symptoms.
Various interventions will then be implemented to address your needs. As post-concussion symptoms vary between individuals, a customized treatment plan is developed for each client.
OT interventions related to concussion management interventions can include, but is not limited to the following:
- Education to the client, their family, and community about concussions
- Post-concussion symptom management strategies
- Fatigue management
- Stress management
- Sleep hygiene and education
- Headache management
- Education and strategies about pacing and following a balance daily routine
- Non-pharmacological pain management strategies
- Education/strategies for a gradual return to school, work, leisure, and social activities
- Support for returning to driving post concussion
- Negotiating modified duties at work and school
- Adapting the physical environment to support recovery
- Prescribing equipment to help manage post-concussion symptoms (i.e., noise cancelling earphones)
- Building tolerance for cognitively demanding activities through cognitive rehab therapy
- Providing functional psychosocial/mental health support
- Interventions to improve functional visual skills
- Making referrals to additional health care providers as needed
Concussion Occupational Therapy Case Study
Michael is a 40-year-old male who sustained a concussion from a motor vehicle accident. He was referred to occupational therapy for concussion management services. He was experiencing the following post concussion symptoms 12 weeks after his injury:
- Physical and cognitive fatigue
- Headaches
- Sensitivity to light and noise
- Poor memory
- Decreased attention and concentration
- Disorganization and planning difficulties
- Increased anxiety and easily overwhelmed
- Poor initiation and follow through with activities
- Poor sleep hygiene
He described himself as “always tired and falling asleep during the day”, having “brain fog” and could never get his daily activities done. He struggled to initiate activities such as household chores that needed to be done and rarely completed them fully. He often cut corners to try and get things done faster however overlooked important aspects of a task leading to errors or unfinished tasks. If he concentrated on a task for too long, he would get a headache.
Other times he was struggling with remembering what was said during a conversation or what he just read in a book or watch on television. His post concussion symptoms were affecting his ability to complete tasks at home, work, and in the community. He was struggling with keeping up with tasks and often had to stop to rest, falling asleep due to his exacerbated cognitive fatigue.
Through OT concussion management services, Michael learned how to recognize and manage his post concussion symptoms. He learned how to pace his daily activities and follow a balanced and structured daily routine so that his daily activities were more manageable to complete within a day.
He also engaged in weekly cognitive rehabilitation therapy sessions which helped to improve his cognitive functioning. He went from being able to complete approximately 10 minutes of cognitive activities before falling asleep mid session to 1 hour of continuous cognitive activities. His focus and concentration during the day improved and his post concussion symptoms became more manageable.
He was no longer experiencing significant exacerbations of his symptoms or becoming overwhelmed with his daily activities, as he was able to better control with activities with pacing strategies and following a balanced schedule. He also was taught how to use various compensatory cognitive strategies and aids such as auditory reminders, noise canceling earphones, whiteboard calendars, etc. to help further manage his symptoms.
Overtime, Michael was able to resume participation in his daily activities at home and the community and eventually returned to work on modified duties.
Conclusion
Occupational therapists skilled in concussion rehabilitation are able to understand and interpret the relationship between the concussion injury and the post-concussion symptoms, as well as the negative impact the symptoms are having on a person’s ability to function. They can analyze and break down activities and tasks, grading them to help clients progressively return to their pre-injury level of functioning.
If you suspect you may have a concussion it is important to see a medical professional for diagnosis, followed by participation in interdisciplinary services such as an occupational therapist experienced in concussion treatment. Early intervention and education are essential in preventing prolonged symptoms from occurring which can negatively impact a person’s level of functioning.
Contact us to learn more about our concussion management services.
References
[i] Champagne AS, Yao X, McFaull SR, Saxena S, Gordon KR, Babul S, Thompson W. Self-reported concussions in Canada: A cross-sectional study. Health Rep. 2023 Jun 21;34(6):17-28.
Basford JR, et al. (2015). Brief overview and assessment of the role and benefits of cognitive rehabilitation. Archives of Physical Medicine and Rehabilitation. Vol 96, issues 6, page 977-980 June 2015
Ontario Neurotrauma Foundation (ONF). Living concussion guidelines. Retrieved from concussionsontario.org
Canadian Association of Occupational Therapists (CAOT). Occupational therapy and concussion.
Canadian Association of Occupational Therapists British Columbia (CAOTBC). Occupational therapy and concussion management. Retrieved from https://caot.ca/document/6994/CAOTBC_OTConcussionManagment_Final.pdf
Journal: Occupational Therapy International. February 24, 2019. Occupational Therapists’ Perceived Confidence in the Management of Concussion: Implications for Occupational Therapy Education by Christina Finn.
Journal of Head Trauma Rehabilitation, Nov/Dec 2019. Addition of Occupational Therapy to an Interdisciplinary Concussion Clinic Improves Identification of Functional Impairments.
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