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Concussion Rehabilitation (4 Vital Areas to Address!)

Video Highlights

-- Post-concussion Syndrome
-- The 4 Domains of Dysfunction
-- Why Each Domain Needs Individual Assessment and Rehab

Enjoy this clip from our Post Concussion Rehabilitation Course and learn more here.

Now that we’ve talked about the, the mechanisms, let’s talk about the different domains. When people have post-concussion syndrome, it’s really important to recognize that there are four major categories of dysfunction. As a movement professional, you have to ask about all of them because your client has options here. They may only experience issues in one category, they may experience issues in all four.

So being very thorough in our history requires us to ask questions about each of these domains. So as you can see, we have physical, emotional, cognitive, and sleep. Let’s start off with cognitive. A lot of work in the PCS domain is going to involve doing some level of cognitive testing, eventually cognitive rehabilitation eventually. Particularly if they’re suffering from difficulties in school, difficulties at work. So whenever we look at the cognitive domain, we have attention deficits. Attention deficits are pretty easy to understand, easily distractible. Think about anyone that you know that has a DHD. A lot of those similar issues will appear. And someone with PCS, so easily, distractible is kind of the, the number one thing. Sometimes they have a lot of difficulty following instructions.

So let’s say you’re working with someone, they’ve had a head injury previously, you would train them. Now when you give them instructions about a particular exercise, they can’t follow you. That would be a very, very common attention deficit issue, concentration, deficits, these are a little bit different. Concentration deficits basically revolve around the idea that concentration is really hard.

These people often will complain of fatigue, lethargy, particularly, they can feel very foggy or spaced out. So you wanna make sure that you’re asking and observing attention issues versus concentration issues. Often people in the cognitive domain experience short-term memory issues. So obviously if you’re familiar with concussion protocols, there’s a lot of memory tests, particularly short-term memory testing. I’m gonna get, say you five words to you. Remember them five minutes later. I ask you those five words. Can you remember them? So short-term memory is often a big issue. Executive functions, executive functions are what we talk about as primary activities of the frontal lobe of the brain. Generally when we look at these functions, they involve learn long-term planning and our ability to basically set goals, complete those goals. So executive functions are often diminished in people with PCS. Neuro fatigue, I actually, it’s one of our terms that I just like to use. A lot of people in the cognitive domain will just complain about brain fog, meaning everything around them they can do, but it feels like they’re, you know, working a little bit in the dark.

Neuro fatigue is also our reference point for people. We ask ’em, Hey, prior to your head injury, were you able, did you like reading? I loved reading. What happens now when you read, after about 10 minutes, I fall asleep, or after 10 minutes I get really irritable. This is an example of fuel compromise. We’re asking the eyes to move a lot.

We’re asking you to process a lot of information and now you’re experiencing fatigue when you try to do that. And then finally, an inability to multitask. These are again, very, very common symptoms that you’ll see in the cognitive domain. So you have to ask about them. You may observe some of them, you may need to ask about them. And just remember this,

when you’re taking histories on people who have had a brain injury, as long as they have agreed to it and it fits into your legal standards, it’s also very, very helpful to get information from their family members or people who have spent time with them, because they may actually be much more aware of these changes than the person who’s actually experiencing the issues.

Alright, so that’s the cognitive, the physical domain. For those of you in that are in the movement professions, this is what you will hear the most about. This is what people will complain about. This is why I say, as professionals, we have to take a good history. The physical domain is very well known. Headache, migraine, both kind of go hand in hand.

Dizziness or vertigo, remember, those are different things, but some type of instability as they’re moving through the world. Nausea usually connected with the, the dizziness or vertigo. Photophobia, very, very light sensitive. This is a common, common issue that you’ll see in people with PCS, tinnitus or other hearing abnormalities. So that constant buzzing in the ear,

they may actually be hypersensitive to sound. So just like the photophobia, any kind of sound may be very irritating for them. Balance disturbances. They may not complain about being dizzy. They may not complain about feeling like they have vertigo. They may just simply notice that they don’t feel as confident with their balances are going up and down steps. One of the things I often will ask about is after your head injury, if you’ve been up and up and down an escalator, interestingly enough, because of the weird visual image that you get with escalators, very often they’ll say, no, it’s weird. I actually started to get really uncomfortable on them. I have to hold onto them, start to sweat and get anxious. So stairs and escalators I think are good questions to ask about.

And then finally, any kind of visual disturbance. My vision’s a little blurry, my eyes get tired, I get double vision periodically, et cetera. Emotional domain. This one is, as I was mentioning, very important to me. Just again, because of my experiences in working with people. A lot of different things can come up in PCS, massive mood swings.

People can go from, you know, I’m feeling really good to absolute rage in a split second. So mood swings and irritability I, I think, are very important to ask about. Feelings of isolation, loss of pleasure, hyperactivity, apathy or loss of motivation. So notice that the emotional domains can, can go two different directions. We can have people who are really hyperactive,

really irritable. We can also have the opposite, where they’re very lethargic. They’re, they feel isolated. They want to be alone, they’re apathetic. They don’t have any motivation to do anything. Depression and anxiety disorders. And remember whenever we were looking at the PCS risk factors, if they had anxiety or depressive disorders prior to the head injury, it’s likely that those will be exacerbated.

They’ll become more intense. Changes in personality, loss of libido, these are all really, really commonly reported symptoms or issues in the emotional domain. This is stuff that most of our clients, when they come to us, don’t wanna talk about. So once again, if you’re working with a head trauma person, you need to have a fairly standard history taking process so that you ask about changes in all of these.

And remember, you may have to ask this to people who are close to them. And then finally, we have the sleep component. Now the sleep component, insomnia, drowsiness, difficulty falling asleep or changes in sleep pattern. Pretty simple. Why this is really important is going back to our fuel compromise. Whenever we look at the lymphatic system, people who are not sleeping well,

we’ll have a more difficult time healing because sleep is a requirement, if you wanna call it that for what’s called the glymphatic system to work well. So if they’re having trouble falling asleep, they’re insomn insomniacs, meaning they’re just, they can’t sleep throughout through the night. They’re constantly drowsy, but they’re not sleeping well. Or they, you know, they were night owls, they always stayed up until 11 or 12 or one in the morning, and now they’re falling asleep at seven. All of these are things that we need to know about because they’re all pointing to this idea that, hey, we have changes in sleep patterns. These changes in sleep patterns may be impacting our fuel compromise.

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