What is a concussion?
A concussion is a mild traumatic brain injury that is caused by a direct or indirect impact to the head. Concussions can be experienced from many different causes ranging from motor vehicle accidents, blast injuries, and falls, to sports-related concussions. The high school sports that report the highest number of concussions include football, boy’s ice hockey, and girls’ soccer.
Concussions can present differently for people of different ages. Traditionally, it was thought that having a concussion at a younger age, where the brain has more plasticity, would allow for a quicker and easier recovery. However, according to current research, the immature brain is more vulnerable to diffuse injury. A diffuse injury is categorized by any general disturbance in the function of neurons that begin immediately at the time of injury. Diffuse brain injuries account for the majority of childhood brain injuries. Research shows that this may be because skills are not as well established, the brain’s capacity for skill acquisition can be affected, and functional recovery is more difficult when adolescents have fewer acquired skills. Research also indicates that a concussion can interfere with normal brain development.
The current treatment for concussions of initial rest and a slow re-integration into activities such as school and sports has proven to be effective for many adolescents. However, there are a number of individuals who have a more difficult time transitioning into the routines of their daily lives especially if they are still recovering from post-concussive symptoms. These individuals require a more individualized, client-centered approach to rehabilitation. They may experience difficulties transitioning back to activities such as work, school, and play which can be addressed by an Occupational Therapist.
Here’s the Data:
– 1 in 5 high school athletes will sustain a sports related concussion during the season
– In 2012, there were 3,800,000 reported concussions
– 90% of concussions do not involve a loss of consciousness
– The number of reported concussions has doubled over the past ten years
– Emergency room visits for concussions for kids ages 8 to 13 has doubled
– Concussions have risen 200% among teens ages 14 to 19 in the past 10 years
– “Cumulative sports concussions are shown to increase the likelihood of a catastrophic head injury leading to permanent neurologic disability by 39 %” (CDC, 2013).
Common Difficulties for children/adolescents with concussions:
Most adolescents are quick to recover after a sports-related concussion. Others have a harder time returning to their activities of daily living. The expectations of adolescents in school can contribute to the difficulty of returning to life. Children in schools are continually expected to acquire new information and skills and are expected to be able to do so independently. These neurobehavioral skills are often what are most affected in a mild traumatic brain injury. Some of the difficulties these adolescents might be struggling with may be:
- Ability to focus
- Sustained attention
- Rapidly processing information
- Holding information in mind while generating a response
- Visual-perceptual deficits such as visual tracking which causes difficulty reading and focusing on words
- Increased eye strain and headache when attempting to read
- Sensory processing– light and sound sensitivity
- Fatigue– having to work harder to be successful in activities that were easy before
- Difficulty learning and retaining new information
- Additional individual needs
How can Occupational Therapy help?
Occupational therapy is a natural fit for rehabilitation of concussions and mild traumatic brain injuries because Occupational Therapist’s (OT’s) are trained to analyze activities and identify environmental barriers and client-factors that may be interfering with participation in everyday occupations. With a focus on client-centered care OT’s can specifically help with:
Initial transition back to school including assessment and treatment regarding:
- Vision and visual-perceptual skill rehabilitation and compensatory strategies
- Sensory processing skills
- Cognitive skills and strategies
- Identification of sensory triggers
Monitoring school-based support:
- Tools to recognize when breaks are needed
- Reduction of cognitively demanding school tasks
- Frequent modification of program to facilitate progress
Classroom-based support:
- Increased test time
- Recording devices for taking notes
- Access to lesson notes ahead of time
- Flexibility for assignment due dates
- Preferred seating
- Strategies to manage extraneous sensory stimulation
Home-based support:
- Regulation of sleep patterns
- Skills and strategies for homework/studying
- Symptom management: headaches, nausea, etc.
References:
AOTA (2015). About occupational therapy. The American Occupational Therapy Association, Inc. Retrieved from: http://www.aota.org/about-occupational-therapy.aspx
Araujo, G., Antonini, T., Monahan, K., Gelfius, C., Klamar, K., Potts, M., Yeates, K., Bodin, D. (2014). The relationship between suboptimal effort and Post-Concussion Symptoms in children and adolescents with mild traumatic brain injury. The Clinical Neuropsychologist. 28 (5), 786-801.
CDC (2013). Concussion fact sheet for school professionals. Center for Disease Control and Prevention: Heads Up Concussion. Retrieved from http://www.cdc.gov/headsup/pdfs/custom/headsupconcussion_fact_sheet_for_schools.pdf
Duff, M. (2009). Management of sports-related concussion in children and adolescents. The ASHA Leader. 14, 10-13.
Foy, K., Murphy, K. (2009). Post-Concussion Syndrome. British Journal of Hospital Medicine. 70 (8), 440-443.
Gutierrez, G., Conte, C., Lightbourne, K. (2014). The relationship between impact force, neck strength, and neurocognitive performance in soccer heading in adolescent females. Pediatric Exercise Science. 26, 33-40.
Kirkwood, M., Yeates, K., Wilson, P. (2006). Pediatric sport-related concussion: A review of the clinical management of an oft-neglected population. Pediatrics. 117 (4), 1359-1371.
Kostyun, R., Milewski, M., Hafeez, I. (2014). Sleep disturbance and neurocognitive function during the recovery from a sport-related concussion in adolescents. The American Journal of Sports Medicine. 43(3). 630-640.
Reed, N. (2011). Sport-related concussion and occupational therapy: Expanding the scope of practice. Physical & Occupational Therapy in Pediatrics. 31(3), 222-224.
Head Case (2013). Sports Concussion Statistics. Head Case. Retrieved from: http://www.headcasecompany.com/concussion_info/stats_on_concussions_sports
Waskiewicz, M. (2015). The role of occupational therapy in managing Post-Concussion Syndrome. Special Interest Section Quarterly: Physical Disabilities. 38(1), 1-3