Concussion is the focus of this collaborative service run by Rehabilitation Medicine
Author: | July 13, 2021
Concussion has been in the headlines for some time now, especially related to contact sports. According to the Centers for Disease Control, a concussion is a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. The sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.
This type of injury should be taken seriously.
The Concussion Clinic at M Health Fairview’s Clinics and Surgery Center in Minneapolis does just that. “We see patients from 18 to 90-plus years old,” said Michael Kasprzak (pictured at left), DO, Physical Medicine and Rehabilitation (PM&R) Division, Rehabilitation Medicine Department. “They have fallen, had car accidents, or were injured at work. Some are weekend athletes — we’ve even had a Quidditch player. Often, they are initially evaluated by ERs and get a diagnosis of concussion and then are referred to our concussion concierge service.”
Kasprzak, who is brain injury fellowship trained, runs the service within the Rehabilitation Medicine Department. “Our concussion patients have traumatic brain injuries that are typically categorized as mild or moderate,” he said. “Physiatrists like myself play an important role in getting them back to baseline.”
Continuum of care
Physical Medicine and Rehabilitation physicians — physiatrists — put their concussion patients through a symptomatic screener and comprehensive exam. “We see them all the way through the continuum of their care,” said Kasprzak. “With severe TBI patients, for example, they come to rehab following major neurosurgical procedures and we work with them on medication management and therapy sessions to optimize their return to independence. Those same principles apply to concussion.”
Every concussion is different
Recent research from Stanford University’s Neurosurgery Department indicated that every concussion is different and needs a tailored approach to help patients recover, according to Kasprzak. “Some patients have trouble with their vision, and we recommend ocular-motor therapy,” he said. “If they have dizziness, we send them through a vestibular therapy program. If they have whiplash, we concentrate on neck muscle soreness. It all depends on what they need.”
When some patients try to get back to their regular activities and run up their heart rate, Kasprzak noted, their concussion symptoms come back. “We call that a cardiogenic concussion,” he explained. “There are also psychologic or psychogenic concussions. These patients won’t get better unless we dive into their mental health.”
Most naturally get better
The majority of patients naturally get better within a week or two and just require monitoring by their primary care physician. “The current treatment guidelines indicate that if you get a diagnosis of concussion on Friday night and you feel better the next day, you are not cleared to get back to your regular pursuits for a week,” Kasprzak said. “Over the weekend, you should rest and do only light activities. On Monday, if you feel better, you should continue with the week-long return to activity protocol. If you’re not getting better after a week, we need to see you.”
It’s at that point that Concussion Clinic practitioners will determine the patient’s next steps, such as imaging, adjusting medication to optimize neurotransmitters, defining headache management, deciding if they need to see a neuro-optometrist, or recommending a more robust therapy program, according to Kasprzak.
Often have PTSD
“Many of these are trauma patients as well and have post-traumatic stress disorder [PTSD],” he added. “We work closely with psychiatry and psychology to see they get the appropriate care. Our neuropsychology team works with patients who have lingering memory issues. They might recommend tailored occupational or speech therapy.” If the patient is overly sensitive to sound, there is a new Safe and Sound program offered through Occupational Therapy Centers around the Twin Cities, Kasprzak noted.
“We work closely with physical, occupational, and speech therapists to see if the patient is improving,” said Kasprzak. “We determine if their vision, balance or headaches are better. If not, we recommend the appropriate therapy, and then we follow the patient’s recovery closely. It’s at that point that we might introduce medication to help with things like mood, sleep, and neck pain. If we find something else, we continue to see them until they’re optimized, knowing that everyone heals at their own pace.”
A common misperception
One of the misperceptions about concussion is that the condition is permanent. “Yes, you do suffer an injury, but you should get better in one to two months as long as you’re on the appropriate medication, stay properly hydrated, and don’t abuse cigarettes, alcohol, or other medications that can impair cognition,” said Kasprzak. “If patients aren’t better after that time, they have what’s known as post-concussion syndrome and could potentially have three to four lingering symptoms from the head trauma.”
Regardless of where the concussion patient is on their recovery journey, “We’re here for you,” said Kasprzak. “We know you’ve been through a traumatic event, whether it’s a car accident or a slip and fall. It’s not pleasant and can be challenging for other people to understand what you’re going through because they can’t see the injury. When you come to the Concussion Clinic, you’re going to get comprehensive care. We understand that everyone’s pace is different, and we will strive to get you the treatment that you need.”