Why Concussions Can’t Be Treated by a Chiropractor Alone

When someone sustains a concussion, a neck injury often occurs at the same time. These injuries share many overlapping symptoms, which can make recovery feel confusing. It’s common to hear suggestions like, “You should see a chiropractor.” While chiropractic care can be helpful for certain aspects of recovery, concussion management is much more complex than spinal alignment alone.

A concussion is a brain injury, and because the brain influences nearly every function in the body, effective recovery requires a team-based approach that goes beyond the musculoskeletal system.

Yes — the Neck Matters

After a concussion, the neck (or cervical spine) often plays a major role in symptoms. The sudden acceleration-deceleration forces that cause the concussion also strain the neck’s joints, muscles, and nerves. This can lead to:

• Headaches

• Dizziness

• Neck pain

• Visual disturbances

• Difficulty with balance

In these cases, manual therapy or gentle chiropractic work can help reduce neck-driven symptoms and restore proper movement patterns. But that’s only one piece of the puzzle.

But the Brain Does Much More

A concussion affects how the brain processes, coordinates, and integrates information. Even when the neck is functioning perfectly, the brain may still be struggling with:

• Visual processing: difficulty reading, eye strain, or double vision

• Vestibular control: dizziness, motion sensitivity, or imbalance

• Cognitive function: trouble concentrating, remembering, or multitasking

• Emotional regulation: anxiety, irritability, or mood swings

• Energy management: fatigue or feeling “foggy” despite rest

These are neurological and cognitive symptoms, not structural issues — meaning they cannot be corrected through spinal manipulation or adjustments alone.

The Importance of a Multidisciplinary Approach

Concussion care should be individualized and evidence-based. At Colorado Concussion Clinic, our interdisciplinary team includes:

• Speech-Language Pathologists for cognitive and communication recovery

• Physical Therapists for balance, vestibular, and exertion training

• Neuro-optometrist and Vision Therapists for visual rehabilitation

• Mental health therapist for counseling

• Neurofeedback to further support healing of the brain and body

• Neurologists 

• Collaboration with other medical specialists when needed
  

This integrated approach ensures that both the neck and the brain are treated — addressing the root causes of symptoms rather than just managing one component.

The Takeaway

A chiropractor may be part of a well-rounded recovery plan, but concussion treatment must go beyond neck adjustments. The brain drives vision, balance, attention, and emotion — all of which require specialized, neuroscience-informed rehabilitation.

If you or someone you know is still experiencing symptoms after a concussion, it’s important to get a comprehensive evaluation from a team trained in mild brain injury and neurorehabilitation. With the right care, recovery is possible — and you don’t have to navigate it alone.

Why Do I Still Have Symptoms Months After a Concussion?

CoTrauma After a Head Injury

The brain is brilliant at survival, which can make your recovery more difficult. 

A head injury can change everything. Your brain is smart - and adaptable. However, due to the nature of head injury or whiplash, your brain may stay locked into a protective response, long after the danger has passed, stalling your healing process. 

Imagine enduring a rock concert 24/7 under the loudest speaker - this is what it can feel like with a ricochet of symptoms after a concussion.

After a traumatic brain injury (TBI) or concussion, you may feel “fine” at first. But weeks,  months, or even years later, lingering symptoms often appear, such as:

• Brain fog and slowed thinking

• Headaches or migraines

• Word-finding difficulties

• Memory problems

• Dizziness, nausea, or balance issues

• Sensitivity to light and sound

• Mood Issues like Depression or Anxiety

These aren’t random side effects—they are likely the result of both physical injury and your intelligent nervous system creating negative adaptations (hello trauma). 

What Happens During a Head Injury?

The brain is like jello in a jar. It’s cushioned by cerebrospinal fluid, fascia, dura mater, and the skull. But during an impact, the brain can be impacted by the hard skull, or changes in fascial restriction and blood flow can occur. 

Even without loss of consciousness, this can set off a chain reaction:

1. Structural and Physical Stress

• Tissue constriction or shearing

• Reduced blood flow and oxygenation

• Strain in the neck, spine, and surrounding structures

2. Physiological Nervous System Response

• The brain prioritizes survival by slowing high-level processing.

• Chemical, emotional, and physical imprints are encoded in the nervous system.

• Even if you feel “okay,” your body may react as if the trauma is still happening. You are likely not even consciously aware of the impact chemically, physically and emotionally. This is where our body compensates with difficult symptoms that lock this history in our tissues.

This explains why many people develop ongoing sensory overload, fatigue, mood changes, or sleep problems long after the initial injury. Or why you aren’t responding to very helpful therapies.

Why Symptoms Persist

Trauma locks the nervous system into a contradictory state:

• One foot on the gas: hyperarousal, anxiety, irritability, poor sleep.

• One foot on the brake: brain fog, fatigue, poor recall, slowed processing.

You can’t drive with a parking brake! The Colorado Concussion Center can help. 

In addition to cognitive, physical and vision therapies, we provide a specific form of Neurofeedback technology called the LENS, which works to help the brain shift out of trauma patterning, and the results are often dramatic. 

LENS Therapy has shown rapid, even startling improvement (Larsen, 2006. The Healing Power of Neurofeedback)

How LENS Neurofeedback Helps

Your brain can repair itself. The Low Energy Neurofeedback System (LENS) offers a gentle way for your nervous system to downshift, so your brain can reset itself. 

“The LENS seems to increase cortical flexibility, decrease rigid and inflexible adaptations, and harmonize and balance the activity of the CNS” (Larsen, 2006).

• Tiny signal: Sensors measure brain activity and send back a signal offset from the brain’s own rhythm—1,000 x weaker than traditional neurofeedback.

• Breaks stuck patterns: This slight nudge bypasses protective filters and helps the brain reorganize, likely increasing blood flow, balancing brainwave function and boosting neuroplasticity.

• Encourages natural repair: Your brain isn’t forced to change in a specific way - with the LENS, your brain drives the feedback to change itself.
  

Research supports LENS as an effective therapy for symptoms of both TBI and trauma:

• Traumatic Brain Injury: LENS therapy has been shown to result in “reports of restored cognition, reduced headaches, and even recovery of smell after head trauma (Hammond, 2007, 2017).
  

• PTSD & Trauma: LENS reduces hyperarousal, improves sleep, and helps restore balance to emotional processing (Larsen, 2006). Most patients often describe feeling calmer, clearer, and less reactive.
  

Schedule a LENS Brain Mapping 

If you’re struggling with brain fog, dizziness, headaches, or mood changes after a head injury, it may not be the impact itself causing ongoing problems—but your nervous system’s protective response.

Even if you’ve tried everything - the LENS is different. Schedule your first LENS session at the Colorado Concussion Clinic. 

Your brain wants to heal. It’s time to let go of the brakes. 

CITATIONS

Larsen, S. (2006). The healing power of neurofeedback: The revolutionary LENS technique for restoring optimal brain function. Rochester, VT: Healing Arts Press.

Hammond, D. C. (2007, 2014). QEEG evaluation of LENS treatment of TBI. Journal of Neurotherapy, 14, 170-177.

How LENS Neurofeedback Works - A Novel Therapy for TBI and Head Injury Recovery

Living with Lingering Symptoms After a Head Injury

If you’ve experienced a concussion or head injury, you know recovery can feel frustratingly slow. Even months later, you might still struggle with:

• Poor cognitive function or brain fog

• Trouble thinking or concentrating

• Sensitivity to light, sound or movement

• Mood changes like anxiety, irritability or depression

• Anxiety, depression or irritability

• Chronic headaches, chronic pain or body tension

• Poor energy or sleep
  
  

For many patients, these symptoms can get worse over time after head injury and may not resolve even with rest, medication or therapy alone. 

That’s where LENS neurofeedback, a form of brainwave disentrainment can make a big difference.

What Is LENS Neurofeedback?

LENS (Low Energy Neurofeedback System) is a gentle, non-invasive brain training method. It works by sending a tiny, imperceptible radiowave signal through sensors placed on the scalp. The brain picks up on this signal, which is small enough to get underneath neuroprotective filters. This signal helps the brain outline and sense its own functioning, and the brain responds (the feedback) by releasing “stuck” and inefficient patterning created by injury or trauma. 

Think of Traumatic Brain Injury like a traffic jam in the brain: after an accident, your brain compensates by protecting and slowing down blood flow and neural pathways around the injury, causing symptoms such as reduced cognitive functioning, headaches and brain/body scrambling.

Slowing down in one part of the brain affects other areas, and eventually entire areas of ‘the city’ become less efficient. It takes more and more energy to function in your life and things that were once easy, become a chore. 

The LENS acts like traffic control, helping the brain sense these inefficiencies and access new resources (increased blood flow, neural signaling) to heal. 

Your own brain provides the feedback, as it traces the tiny signal from LENS and exercises out of stuck, inefficient pathways. 

How LENS Supports Concussion Recovery

1. Reduces Stress on the Body and the Brain – LENS is FDA cleared for Stress. The LENS calms overactive fight-or-flight responses, giving your brain and nervous system the support it needs to regulate and repair itself.
   

2. Restores Clarity – Patients often report clearer thinking, better focus, increased concentration and reduced brain fog.
   

3. Improves Sleep & Mood – By helping regulate the nervous system, LENS supports better sleep patterns and emotional balance.
   

4. Accelerates Progress in Therapy – When your brain is less stuck,it becomes receptive again to other treatments (cognitive, speech, vision, or physical therapy) often become more effective.

5. Releases NeuroMuscular Tension + Trauma Patterning - After an accident, the biggest challenge to the brain is the body. When the brain senses motor trauma, or neuromuscular patterns of gripping in response to an accident, functioning slows. The LENS can also be used on the body to release muscle tension, directly influencing the nervous system to repair neuromuscular or structural issues, recover from panic, anxiety or PTSD and reduce chronic pain signaling. 

What to Expect in a Session

• Small sensors are placed on the scalp and ears.

• The system measures brainwave activity and sends back a signal slightly offset from what it reads.

• Sessions are very brief — often just a few minutes of stimulation.

• Entirely Passive! Patients don’t need to “do” anything — your brain does the work.

Most people find the process relaxing, and depending on sensitivity, patients experience gradual or faster changes in mood, energy and cognition as the nervous system reorganizes. 

For 24-48 hours after a session, patients might experience responses based on nervous system changes such as: changes in energy, sleep, brief echoes of past symptoms, increased dreaming, or in the case of trauma - the release of memories without much emotional content. 

Is LENS Right for Post-Concussion Symptoms?

If you’re still experiencing headaches, brain fog, cognitive slowing, mood swings, or sensitivity after a concussion, LENS may help. 

Talk to your doctor and wait at least 2-4 weeks after a major concussion to give your brain time to rebalance, and then try a LENS session. It’s especially supportive when nothing else has worked, or for people who feel stuck in recovery. The LENS can even be helpful for people who are too sensitive to tolerate more stimulating therapies.

Citations: 

Hammond, 2007 (Anosmia). Case reversal of anosmia post-head injury with LENS.

Hammond, 2010 (QEEG TBI case). Quantitative EEG improvement post-LENS.

ISNR Journal 2006 issues. Multiple TBI-related LENS case series.

Larsen, 2009. Theoretical fit of LENS for TBI.

Nelson & Esty, 2012. Veterans with TBI/PTSD – symptom reduction.

Nelson & Esty, 2015. Chronic TBI-related headaches improved with FNS.

Schoenberger et al., 2001. Early randomized trial—FNS in mild to moderate TBI.

St. Clair, 2008. TBI from AVM – LENS application report.

Anxiety, Panic Attacks and Concussions

After a traumatic brain injury, some people experience anxiety or panic attacks. They don’t occur in everyone who’s had a concussion, however, they can happen. 

What’s the difference between anxiety and panic attacks? 

Are they the same thing? Well, yes and no. Panic attacks are a type of anxiety and anxiety is just a more general term. 

Anxiety is a general sense of worry that may be difficult to control. One may experience racing thoughts about a number of things including worrying about things that haven’t happened yet or worrying about situations that have already happened. Everyone feels stressed sometimes, but anxiety may feel like it’s impacting your functioning at work, at home, or in your relationships. It may feel difficult to relax, sleep or eat and you may experience tightness in your body. 

On the other hand, panic attacks can have a sudden onset, often lasting for 10-60 minutes. Common symptoms include shortness of breath, chest pain, trembling, hot or cold flashes, heart palpitations, sweating, nausea, and numbness. Sometimes people aren’t sure why they experience panic attacks as they can feel like they “come out of nowhere.” It’s my professional opinion that panic attacks occur when people are under a lot of stress or have had traumatic experiences. Getting a traumatic brain injury (TBI) or concussion is, by nature, a traumatic experience. 

What do I do if I am having anxiety or panic attacks after getting a concussion? 

If you haven’t already, you should see a doctor to get your concussion evaluated and treated. They may have a myriad of treatment recommendations to help you start feeling better including possible medications as well as different therapies.  

Make sure you are engaging in basic self-care like getting enough sleep, drinking plenty of water, eating nutritious foods, and moving your body in a way that feels good to you. This will help aid in your concussion recovery, support your overall health, as well as support your mental health. 

Then I would recommend seeking out a mental health therapist or counselor to help support you with your anxiety or panic attacks. Counseling can help you explore the cause(s) of your anxiety/panic and ways to cope with it. 

Reach out today!

At Colorado Concussion Clinic, we have a mental health therapist who can support you toward feeling better from anxiety and panic attacks after sustaining a concussion. Reach out today to schedule an initial appointment!

Why Choose Colorado Concussion Clinic for Physical Therapy?

At Colorado Concussion Clinic, we believe that your recovery should be as unique as you are. That’s why our physical therapy approach is built on expert care, personalized treatment, and an unwavering commitment to your long-term well-being.

One-on-One, Expert-Led Treatment

From the moment you step into our clinic, you'll work one-on-one with a Doctor of Physical Therapy who has advanced training in concussion, whiplash, and other neurological disorders. This means your care isn’t just hands-on—it’s highly specialized. We don’t rely on generic treatment plans. Instead, we develop a fully customized program designed around your symptoms and goals, helping you heal more effectively and efficiently.

Whether you’re recovering from a recent injury or have been struggling for months (or even years), we take the time to understand your story. If you’ve tried physical therapy at another clinic without success, we might still be able to help with our focused, evidence-based approach.

Coordinated and Comprehensive Care

Recovery often involves more than just one type of provider. That’s why we take a team-based approach, helping coordinate your care both within our clinic and with outside providers. Our physical therapists will coordinate with your care team to make sure everyone understands your specific path to recovery—so your treatment is consistent, thorough, and seamless.

Specialized Support for a Wide Range of Symptoms

Many of our patients come to us with symptoms that can be confusing and persistent. We specialize in conditions that don’t always have a clear path forward—and we’re here to guide you through them.

For example, if you’re dealing with visual disturbances like blurry or double vision, difficulty reading, or frequent headaches, these may stem from eye movement dysfunction. Our therapists are trained to treat these issues and can determine if a referral to a neuro-optometrist is appropriate.

Dizziness is another common—and often frustrating—symptom. It can be related to vestibular issues, positional vertigo, cervicogenic dizziness, or even autonomic dysfunction. Our team will evaluate the root cause and create a treatment strategy based on your unique presentation.

When it comes to headaches and chronic pain, we look beyond medication. Many of these symptoms are linked to problems in the cervical spine, like stiff joints or tight neck muscles. Through manual therapy, dry needling, and corrective exercise, we aim to address the primary cause of your pain and bring lasting relief.

And if you find that exercise makes your symptoms worse, especially if you’re an athlete trying to return to your sport, you’re not alone. This is often related to autonomic dysfunction, a condition we assess carefully. Once we understand your specific limits, we’ll build a safe, progressive exercise plan to help you regain your strength and confidence.

Why It Matters

Healing after a concussion or neurologic injury isn’t just about “getting better.” It’s about regaining control of your body, your mind, and your life. At Colorado Concussion Clinic, we go beyond symptom management—we focus on real recovery.

If you’re tired of being told “everything looks normal” or you’ve felt discouraged by previous treatment experiences, let us show you what a difference specialized care can make.

You don’t have to do this alone. Reach out today to schedule a consultation and take the next step toward feeling better, moving better, and living better.

Why You Need a Thorough Neuro-Optometry Evaluation if You’re Having Vision Problems After a Concussion

If you've experienced a concussion and are dealing with ongoing vision problems, a thorough neuro-optometry evaluation is essential. Unlike a standard eye exam, which primarily checks for eye health and visual acuity, a neuro-optometry evaluation goes much deeper, addressing the complex systems that control how we process visual information.

While a typical eye doctor will assess the health of your eyes and determine if you need glasses, a neuro-optometrist will look beyond these factors. Glasses are important, but they can only address part of the issue, as they may not resolve other visual symptoms caused by a concussion. A skilled neuro-optometrist will evaluate the following visual systems to determine the source of your symptoms:

1. The Focusing (Accommodating) System

The focusing system allows your eyes to adjust their power when looking at objects at different distances. For example, when you focus on something close up, your eyes need to increase their focusing power. If this system is impaired (which is common after a concussion), you may experience blurry vision, especially with near tasks like reading. Research shows that focusing issues are one of the most frequently affected systems following a concussion.

It's important to note that focusing difficulties can sometimes look similar to issues with the vergence system, so it’s critical that a neuro-optometrist differentiates between the two, as treatments for each system are different.

2. The Vergence System

The vergence system controls how your eyes work together to focus on objects at varying distances. This system helps your eyes converge (or cross) for near vision and diverge for distance vision. Proper vergence is crucial for depth perception, efficient reading, and preventing double vision.

If your vergence system is disrupted after a concussion, you may experience difficulty with eye coordination, which can affect your ability to judge distances or cause visual discomfort with visual tasks like driving, reading, and computer work.

3. The Tracking System

The tracking system enables your eyes to follow moving objects or smoothly shift from one point to another (like when you're reading across a line of text). This system is essential for activities such as reading, driving, or following a conversation. If your tracking system is compromised, you may find it hard to keep your place while reading, or experience blurry vision when moving your eyes across a page.

How These Systems Relate to Reading and Vision

When thinking about these systems in the context of reading, each plays a key role:

• The focusing system ensures the words are clear and crisp.

• The vergence system ensures the words appear as single, clear characters (rather than double vision).

• The tracking system allows for smooth movement from one word to the next without losing your place.

If any of these systems are not functioning properly after a concussion, you might experience a range of symptoms, including blurry or double vision, difficulty focusing, or trouble reading for extended periods. A neuro-optometrist can identify which system is malfunctioning and develop a tailored treatment plan to help you recover.

A comprehensive neuro-optometry evaluation is vital for anyone experiencing persistent vision problems after a concussion. It goes beyond just checking your vision—it examines how your brain processes and coordinates visual information, which can be significantly impacted by head injuries. If you’re struggling with visual symptoms after a concussion, it’s worth seeking out a skilled neuro-optometrist who can assess all the relevant visual systems and guide you through the recovery process.

Concussions and Grief | Thoughts from a Denver Concussion Therapist

You had a head injury and now everything has changed. You may not be able to think clearly, you’re having issues with your memory or concentration, and tasks that were easy for you before are now challenging. Some people may also experience ongoing headaches, problems sleeping, and other physical symptoms. There can be a lot of grief and loss associated with getting a concussion and the ramifications of it. 

Many patients we see at the Colorado Concussion Clinic either need to have accommodations at work or are unable to work all together for a period of time while they get treatment to heal their symptoms. There can be a sense of grief of not feeling like you’re the same person as you were before your head injury. 

What are symptoms of grief? 

Grief doesn’t only apply to mourning after a loved one has passed away. People can also experience grief after life events such as a breakup of a relationship, the loss of a job, or even due to a physical ailment or condition. 

Symptoms of grief mimic symptoms of depression. Grief may involve a depressed or low mood, feeling withdrawn, not wanting to do things you normally enjoy doing, changes in sleep patterns (sleeping too much or difficulty sleeping), and crying/tearfulness. Grief may also involve mood changes including feeling “normal, sad, irritable, and even anxious about the future. 

How can I cope with grief after a concussion?

1. Acceptance 

Know that it’s okay to be feeling what you’re feeling. What you’re feeling is completely understandable given the circumstance you’re experiencing. Allow yourself to feel your grief. When we ignore our emotions, sometimes they can come back even stronger later. 

2. Show yourself some compassion

Give yourself some grace. You have been through a lot and your brain and body are trying to heal. What might you say to a friend or family member going through something similar? My guess is that you wouldn’t be as hard on them as you are to yourself. 

3. Focus on what you CAN DO

When you feel out of control and you focus on everything you can’t do in the same way you could prior to your injury, this can make you feel more depressed. Focusing on the opposite – on what you can do and what you are in control of– can be helpful, even if it’s something small. 

4. Practice gratitude

Similarly to focusing on what is in your control and what you can do, practicing gratitude can also help break the cycle of negative thoughts. Maybe you feel grateful for certain people in your life. Or perhaps you are grateful for resources that you have, such as a place to live or access to food. 

What we focus on gets bigger. The more you focus on what’s wrong in your life, the more you will feel this. But if you can focus on what is positive in your life, this can have a positive impact on your mood.

5. Engage in hobbies or activities

If you’re still able to do the hobbies or activities that normally bring you joy, get back into doing those activities to help lift your mood. 

If you are currently unable to do the activities or hobbies that you normally enjoy since you got a concussion, I would encourage you to try to find a new hobby or activity that would be safe for you. Engaging in activities can help grief and depression. 

6. Attend your medical appointments and practice your exercises

There are many different kinds of treatment for concussion symptoms. Your medical provider may recommend supplements and/or medications for your symptoms. You may also see different types of therapists who recommend you practice exercises at home. Being proactive in taking care of your health will put you on the right path to get better, which will also help your grief. 

7. Get professional help

If you feel it would be helpful to talk about your grief with a professional, reach out to a mental health therapist. If you are in the Denver metro area or anywhere in Colorado, contact the Colorado Concussion Clinic to see if you are eligible to book an appointment with our mental health therapist. Visits are offered in person in Wheat Ridge or via video telehealth appointments if you are located anywhere in Colorado. 

conclusion

Healing from a concussion can take time and coping with grief after a concussion can be hard. But you don’t have to do it alone. Reach out today to the Colorado Concussion Clinic to book with our mental health specialist or to receive other treatments to help your concussion. 

Celebrating the Holidays with a Concussion: A Survival Guide

It’s the last 6 weeks of 2024, and we’ve officially entered the holiday season. Christmas music is playing, lights are going up on buildings, and people are getting into the festive spirit. Holidays are meant to be a fun time of the year, hopefully spent with loved ones. However, this year could be a little different if you’ve recently sustained a concussion. Holidays may now feel overwhelming and overstimulating. But with the following tips, you can prevent the worst of the symptoms. 

Traveling

1. Avoid travel on busy days and during peak times. Don’t travel on the day before Thanksgiving as this is one of the busiest travel days of the year. 

2. Wear a hat, sunglasses, and ear plugs/filters to reduce overstimulation. 

3. Stay hydrated. 

4. Stick to your daily structure as best as possible. Continue to eat and sleep around the same time as you would at home. 

5. Manage any time zone changes as best you can. If it’s 1-2 hours, consider staying in your time zone and just shifting activities to match. 

6. Pack light.  Use a packing list and follow it.

7. Use the airport wheelchair services when flying. This sounds unconventional, but it can really help to reduce the energy required to navigate through the airport. Typically this is a free service, but it’s always nice to tip.

Hosting

1. Make plans in advance. Share the plans with your family or friends. Try to avoid being spontaneous.

2. Let others know how they can help you manage your symptoms (e.g., keeping their voices down, respecting your rest time, etc.)

3. Delegate! Ask for help and know in advance that people will be able to help you.

Cooking

1. Use paper plates and plastic utensils. Fewer dishes!

2. Have a potluck so you don’t do all of the cooking.

3. Make simple recipes and don’t overcomplicate things. Also, there’s nothing wrong with storebought food.

4. Prepare food in advance as much as possible. 

Shopping

1. Avoid shopping in person. Utilize shipping, delivery, and pick up options for groceries and other items.

2. Go in with a plan! Create a list of what you plan to purchase, and try to only grab those items in order to avoid impulse buys (impulsivity can be a symptom of concussion!)

3. Don’t wait until the last minute.

4. Shop when the stores are not as busy. 

General

1. Listen to your body. If you are symptomatic, take a break. Don’t push through.

2. Create a script to discuss your injury and/or recovery. It can be difficult to put everything into words, so prepare this in advance. Be as detailed or minimalist as desired. 

3. It’s ok to say no. If you feel that you are not going to do well at an event, politely decline without feeling guilty. 

This is a small list of potential strategies to help you get through the holiday season after sustaining a concussion. There are many more and there is no right or wrong answer. Determine in advance what you can do to help you manage your specific situation. From there, just enjoy!

How Long Do Concussion Symptoms Last?

This is a question we are asked quite often here at the Colorado Concussion Clinic. It is a difficult one to answer, as there is no definitive timeframe for recovery from a brain injury, and no way to fully predict how long any given individual will take to feel fully recovered. Everyone recovers slightly differently, and every human brain is unique. 

About 1.6 to 3 million concussions are diagnosed every year in the United States (UPMC). The vast majority of these - about 80% - are considered to be mild and self-resolving. For some patients with concussion, the symptoms will generally resolve within 2-4 weeks post-injury. However, for 20% of concussion sufferers, the symptoms will persist for longer. We also know from the literature that early intervention is better than sitting and waiting at home. Since there is no way of knowing who is in the 2-4 week group, even if it means just coming into the office for an evaluation and education, beginning care will help to reduce the likelihood of persistent symptoms, and help you to understand what sorts of activities to do and what to avoid during the recovery process. 

Following a concussion, you may experience headaches, cognitive impairment, visual disturbances, balance problems, dizziness, nausea, fatigue, sleep problems (too much or too little sleep), autonomic disturbances such as heart rate or temperature regulation problems, and emotional disturbances. Sometimes all of these symptoms follow a nice linear pattern of improvement over time, sometimes one or more symptoms may be particularly stubborn and persist for longer than others. All of the symptoms can be helped and may resolve faster with proper treatment. Generally, concussion/mild traumatic brain injury (abbreviated as mTBI) is not considered to result in permanent changes in brain function. This is, however, an area of study in research, as some studies show evidence of lingering, quantifiable effects. Certainly the symptoms can last for quite some time.

In general, when patients present to us at the clinic post-concussion with symptoms that have persisted at the 4 week time frame post-injury, we start to look at recovery as taking months, not weeks. We will typically estimate around 4 months of active treatment, support, and follow up. Things will improve during that time frame, but absolutely may persist for that long. However, it is still “normal” for symptoms to persist at the 6 month mark, or even longer - although we certainly will try to help you feel better before then!

Some clues that things might get better faster: 

• Significant progress in symptoms within the first few weeks after the injury. If someone is already starting to feel better on their own, that is a good sign. Now it is our job to make sure they are 100% recovered over the next few weeks. 

• Being in excellent physical shape helps with recovery, no matter what injury you have. 

• Relatively mild symptoms in the beginning generally means a faster recovery. 

• No prior history of concussion. 

Some clues that things might take longer:

• Very severe symptoms in the beginning that do not significantly improve on their own within the first month. 

• Significant cognitive (mental processing) impairment.

• Oculomotor (visual) symptoms, such as difficulty focusing your eyes or keeping your eyes steady to read or to track. 

• Significant emotional disturbances, such as depression or anxiety, or significant post-traumatic stress disorder symptoms. 

• Underlying inflammatory conditions (for example, autoimmune conditions) will often delay recovery. 

• Prior head injury, but most especially if there were symptoms that did not fully resolve. 

• Prior neurological injuries, such as stroke, previous post-viral syndromes, etc. 

• A significant amount of other bodily injury occurring as a result of the injurious event, particularly neck injuries. 

A review study from the British Journal of Sports Medicine in June 2017 attempted a broad review of over 3,000 studies over several years regarding the risk factors associated with prolonged recovery from concussion. They found that multiple studies on concussion over the years failed to show a significant correlation between loss of consciousness or amnesia (memory loss of the event or of time around the event) as definitively associated with prolonged recovery (BJSM). There may be correlation between female sex and prolonged recovery over 4 weeks (BJSM). There is a strong correlation between acute symptom burden and worse clinical outcome (BJSM). Factors such as age, prior history of fully recovered concussions, neurodevelopmental disorders, or prior history of migraine were found to be very mixed and were not definitive (BJSM). 

In a nutshell, some patients have symptoms resolve within the first 4 weeks. For others, the symptoms can last longer, up to several months. Early access to treatment and management of symptoms will help, as will access to support in coping.

Sources: 

A systematic review of potential long-term effects of sport-related concussion. Manley, G, et al. British Journal of Sports Medicine, 51 (12), July 17, 2017. https://bjsm.bmj.com/content/51/12/969

University of Pittsburgh Medical Center, Sports Medicine Concussion Center, accessed on 9/24/24. https://www.upmc.com/services/orthopaedics/conditions/concussion

Are return to play protocols sufficient? Or are we sending athletes back too early, leaving them susceptible to additional injuries?

Most people reading a blog post about returning to play after a concussion have likely heard of the term chronic traumatic encephalopathy (CTE). CTE is a neuro-degenerative condition that is caused by repeated head impacts. Researchers found that even sub-concussive blows (i.e., the hits that an offensive/defensive lineman would incur on every play) can cause CTE even though the impacts don’t meet the criteria of a diagnosable concussion.[1] For those who did sustain a concussion, it has been shown that sustaining a second concussion before fully healing from a prior concussion significantly increases the risk of a protracted recovery time and more severe cognitive, physical, and emotional symptoms. Additionally, even if you have fully healed from a concussion, you are still more susceptible to sustaining a subsequent concussion, indicating a lower force threshold necessary for injury.[2]

With this knowledge, protecting the brain should be paramount. The only way to prevent this degenerative process is to reduce the number of head impacts. Clearly, there is no way to prevent all head injuries, and head injuries frequently occur outside of sports. In this blog, head injuries in athletes are discussed as there is the most robust research in that population. In most contact sports, helmets are required to be worn. While helmets can prevent more severe injuries (e.g., a cracked skull), they can’t stop the brain from hitting the skull internally. Think about shaking a jar (skull) with a tomato (brain)  inside. The jar does not have to make contact with anything for it to bruise the tomato. Given that an implantable helmet does not exist and that concussions will still occur in spite of preventative measures, how we treat athletes in the post-concussion period is extremely important. 

Most organized sports follow a return to play (RTP)regimen. According to the Centers for Disease Control and Prevention (CDC), RTP steps are as follows:

1. Regular activities (e.g., school)

2. Light aerobic activities (5-10 minutes)

3. Moderate activities (e.g., jogging, brief running, less time/intensity for regular activities)

4. Heavy, non-contact activities (e.g., sprinting, weight lifting) in 3 planes of movements

5. Practice and full-contact (if appropriate for the sport)

6. Competition

The CDC specifies that each step must take a minimum of 24 hours, but more importantly, that athletes should not move on to the next step unless they are asymptomatic at the current step. Additionally, if they become symptomatic at any point during their RTP plan, the athlete should rest/recover as needed and then start again at the previous step. [3] If athletes follow these steps, they should not be at risk of returning to play before the concussion has healed. 

However, there are significant limitations to this, most glaring that concussion symptoms are typically subjective (i.e., reported by the athlete), with limited ways to determine the presence of symptoms from an objective perspective (i.e., testing). Although it would be very difficult to prove this with research, athletes are likely not going to tell the whole truth and nothing but the truth if it would delay their return to play. (Call it personal prior experience, anecdotal evidence from treating concussions for the last 9 years, mom intuition…). For the sake of argument, let’s say that the athletes are truthful in their self-reported symptoms and follow the RTP steps diligently. They should be fully healed from their concussion and are cleared to return to play. But are they safe then? 

A study by Lavoie et al.[4] researched dual tasking (i.e., completing a cognitive task at the same time as a physical task) as well as performance on the same dual task after exercise in post-concussion asymptomatic athletes (n=19) and a non-concussed control group of athletes (n=20). All athletes in the concussion group had sustained at least one medically diagnosed concussion, had completed a RTP protocol, were asymptomatic (self-report) at the time, were within 3-11 months post-concussion, and did not have any concomitant medical diagnoses. The athletes in the control group had never sustained a concussion. The study compared gait speed and scores on a dual tasking test (completing a complex cognitive exercise at the same time as walking on a self-propelled treadmill) in two situations, once without exercise and once after they completed physical exercise (20 mins on treadmill at 80-90% of their calculated maximum heart rate). Researchers found that ”engaging in a moderate bout of aerobic exercise enhances the cognitive performance of all athletes.” This is consistent with multiple previous studies. However, they found that the concussion group athletes “experienced a significant reduction in gait speed when completing the dual task after exercise, while no change was observed for the control group.” One hypothesis to explain these findings is that after moderate physical exercise, the concussed group had to slow their gait in order to complete the cognitive task accurately, while the control group did not. 

In the guidelines set by the CDC, our current gold standard RTP test, neither incorporating cognitive abilities nor dual tasking are mentioned. Ideally, cognitive symptoms would be noticed during the first step, which would include returning to school/work, but there is no guarantee they would be connected to the concussion. The Lavoie et al. research showed that complex cognitive needs will require more energy for post-concussed asymptomatic athletes to the point of impacting their performance on a physical task. Some people might ask why that would matter if they’re playing a sport and not taking a history test. But sports are inherently very cognitively demanding. Take football for example. Yes, there is running and catching, but cognitive skills required to play football include reaction time, working memory, sustained attention, selective attention, processing speed, time management, decision making… (I could go on). The need to perform these cognitive skills may impact athletes’ ability to perform at their highest physical potential.

As discussed above, athletes’ ability to perform at the same level compared to their pre-concussion baseline is likely still impacted even when they are no longer symptomatic. But are there other potential consequences? A meta analysis completed by McPherson et al. [5] looked at eight studies that met their criteria for inclusion. They found that “athletes who had a concussion had 2 times greater odds of sustaining a [musculoskeletal] injury than athletes without a concussion.” Another study found that athletes during the 90-day period after returning to play post-concussion were 2.48 times more likely to sustain a lower extremity orthopedic injury compared to their non-concussed peers.[6] It is possible that the athletes became deconditioned during their concussion recovery, and therefore more susceptible to orthopedic injuries; however, the Lavoie et al. study noted that the researchers ruled out that the differences were due to deconditioning given that all athletes had completed the RTP protocol, and that they had no knowledge of other research that would support that hypothesis. 

As a cognitive therapist, I have previously utilized dual tasking as a therapeutic goal. When I worked in neuro-rehabilitation hospitals, I would frequently see patients post stroke or severe traumatic brain injury who struggled to walk and talk at the time. A typical pattern would be that they would start walking, listen to a question, stop walking so they could process and respond, then start walking again. For these patients, I would set a goal for the patient to be able to continuously walk down the hallway while holding a conversation. While this may not sound difficult to most people, those patients have to expend significant cognitive resources just to walk correctly and talk correctly, so it can be extremely difficult to dual-task.

I have been in private practice now for close to a decade. My current patients are very high level, typically still working and managing their households while trying to recover from a concussion. It was recently brought to my attention that I rarely complete dual-tasking activities, incorporating both physical and cognitive tasks. Don’t get me wrong, I require my patients to do a lot of multitasking, but the activities are typically both cognitive. Some of this has to do with the location- I no longer have extensive hallways and multiple floors for walking, nor am I able to co-treat with the support of a physical or occupational therapist to help with the patient’s needs. While researching and writing this blog, I have determined that I need to return back to my dual-tasking activities. So if you are coming to see me in the future, don’t be surprised if I ask you to do jumping jacks while saying the months of the year backwards!

In summary, the current RTP protocols do not incorporate any cognitive and physical dual-tasking. Current research identifies that this is likely a mistake. Athletes are not able to perform at their maximum output level, and even asymptomatic post-concussion patients a more than twice as likely to sustain a musculoskeletal injury within a year of the concussion. The likely reasoning is that even subtle deficits in neurocognitive abilities can impair neuromuscular functioning, including speed, control, and coordination. Sending athletes back to play without dual-tasking assessments may be setting them up for orthopedic injuries that will lead to more extended time away from play, or could even be career ending. Testing and RTP protocols need to be adjusted to reflect the most up to date research in order to protect athletes from sustaining potentially preventable injuries. 

1. https://www.bumc.bu.edu/camed/2018/01/18/study-hits-not-concussions-cause-cte/#:~:text=CTE%20causes%20brain%20cell%20death,both%20concussive%20and%20subconcussive%20episodes.l

2. https://www.cognitivefxusa.com/blog/multiple-concussions-effects-and-treatment#:~:text=It's%20worth%20noting%3A%20If%20you,lasting%20symptoms%20and%20brain%20damage.

3. https://www.cdc.gov/heads-up/guidelines/returning-to-sports.htm

4. Lavoie, G.; Bolduc, M.; Sicard, V.; Lepore, F.; Ellemberg, D. Maintaining Cognitive Performance at the Expense of Gait Speed for Asymptomatic Concussed Athletes: A Novel Dual-Task and Post-Exercise Assessment. Brain Sci. 2024, 14, 715. https://doi.org/10.3390/brainsci14070715

5. McPherson, A.L.; Nagai, T.; Webster, K.E.; Hewett, T.E. Musculoskeletal injury risk after sport-related concussion: A systematic review and meta-analysis. Am. J. Sports Med. 2019, 47, 1754–1762.

6. Brooks MA, Peterson K, Biese K, Sanfilippo J, Heiderscheit BC, Bell DR. Concussion Increases Odds of Sustaining a Lower Extremity Musculoskeletal Injury After Return to Play Among Collegiate Athletes. Am J Sports Med. 2016 Mar;44(3):742-7. doi: 10.1177/0363546515622387. Epub 2016 Jan 19. PMID: 26786903.

Signs of Developing PTSD After Sustaining a Concussion

There are a variety of ways one can sustain a concussion. While you don’t have to have hit your head in order to get a concussion, this is how concussions often occur. By definition, if a concussion or traumatic brain injury is due to a blow to the head, this is considered a physical trauma to the body, hence the term traumatic brain injury. 

Not only are concussions physical traumas to the body, but they can also be experienced as emotional traumas. An emotional trauma can occur when one either directly experiences or witnesses a scary event, often one that is life-threatening. 

If you think about the variety of ways that someone can sustain a concussion, these often are perceived to be life-threatening. For example, a serious car accident, a physical assault, or a skiing accident can all cause concussions and can be life-threatening. 

How to Know if You Have PTSD After a Concussion

Not everyone who has had a traumatic incident goes on to develop the mental health condition, Post-Traumatic Stress Disorder (PTSD). I will discuss some signs that you could have PTSD as a result of sustaining your concussion. 

Reexperiencing Symptoms

A classic symptom of PTSD is re-experiencing the traumatic incident in some way. This could be having nightmares about the event, having intrusive memories about it, or having flashbacks in which you feel like the traumatic event is happening again. You may also feel anxious or activated when you are reminded of the trauma. For example, someone who has had a motorcycle accident, may feel anxious any time they see a motorcycle. 

Avoidance

It’s normal, to some extent, to be nervous to get behind the wheel again after getting into a car accident. But if you are avoiding people, places, or situations that remind you of your accident for more than a few weeks, this could be a sign of PTSD, particularly if this avoidance is impacting your functioning. For example, if you find yourself taking the long driving route to work to avoid passing by the area where you had a car accident, even though it adds an hour to your commute every day, this could be a sign of PTSD, particularly if this change has occurred for more than a few weeks.

Changes in Mood and Beliefs

Individuals with PTSD will often have a change in their mood since the traumatic event. This could be a newfound fear or anxiety, irritability or anger, or even guilt or shame. They may also have a change in their beliefs about the world, such as now believing that “the world isn’t safe” whereas maybe they didn’t feel this way before. 

Nervous System Changes

Our brain’s purpose is to help us survive. After having a life-threatening trauma, your brain may go into overdrive to help you survive. For example, you may find yourself feeling constantly on edge or super alert (hypervigilant) of your surroundings, keeping an eye out for danger. You may have difficulty sleeping or concentrating, again because your brain is also more concerned with safety. 

Reach Out for Professional Help

If you’ve experienced any or most of these symptoms of PTSD for more than a few weeks since sustaining your concussion, it may be time to reach out for professional help. Contact the Colorado Concussion Clinic today to schedule an appointment for a medical evaluation, talk to a licensed mental health therapist, and to receive other important services for your healing journey. 

Headaches ... "They come out of nowhere"

One of the most prominent symptoms of concussion is headache. After a concussive injury headaches are often the main symptom that impacts one’s daily functioning. One moment you might be effectively managing your pain and then the next thing you know you have a significant headache that causes you to stop what you are doing. Patients often remark, “It just came out of nowhere!” . Usually, however, there is some kind of trigger that you are unaware of, causing the significant increase in head pain. 

While some triggers are more obvious, such as working for hours, others are less so.  Some triggers can be as simple as looking at a screen for too long, stepping outside without sunglasses, having the TV on in the background, overdoing it with physical exercise, etc.. The best way to understand your personal headache triggers is to monitor your symptoms, record your daily activities and any increase in symptoms you notice. Everyone is different, some symptoms may increase immediately at the onset or just after a trigger, but some symptoms may increase hours/days later. Keep an Activity & Symptom Log. 

For Example: 

• Gardening outside from 1:00 pm - 4:00 pm 

… difficulty sleeping and a massive headache the next morning 

• Went to the Costo 

… significant increase in headache beginning while at the store and continuing to increase on the way home

Once you have a log of your activities and symptoms, you can begin to find the patterns and identify your personal triggers. 

In the gardening example, the triggers may be sunlight, heat, and/or physical activity (e.g., bending down and standing up). Next time you garden, plan ahead and try to mitigate these triggers by wearing sunglasses and/or a hat, taking frequent breaks inside, and bringing a chair to sit down in instead of standing or kneeling. 

In the Costo example, the triggers may be background noise (e.g., people talking or music playing), fluorescent lighting, or trying to remember a long grocery list in your head. Next time you take a trip to Costo, plan ahead and try to mitigate these triggers by wearing a hat to shield your eyes from the fluorescent lights, wearing earplugs, and writing everything down in a grocery list organized by section in the store. 

The ultimate goal early in concussion recovery is to reduce significant symptoms such as headaches. When one is in a state of high pain and intense headache they are unable to complete daily activities (understandably so!). This is disruptive to one's life, and is also counterproductive to recovery. Once you understand your triggers, you will be able to hopefully reduce the frequency and intensity of your headaches, allowing the brain more time to heal your concussive injury.

Hannah Beach MS CCC-SLP

Getting Back to Work After a Medical Leave

Returning to work after a medical leave can feel intimidating.  Several questions may be running through your mind...Am I ready?  What if my headaches get worse again? What if I make mistakes?  How am I supposed to function at a high level all day?  How will I manage work and my home life?

There is really no way to know for sure how your brain and body will handle the transition.  Chances are, during a leave from work you haven’t been taxing your brain or body the way you did when you were working an 8-hour day.  Your physician may advise you to gradually increase your work hours, or have breaks scheduled throughout the day.  It’s only natural that when you first return to the work environment you will be tired.  The good news is that there are ways you can prepare your body and mind for this change.  

1. At least 2-3 weeks before you are due to return, start gradually adjusting your bedtime and wake up time earlier or later to suit your work schedule.  Try to make sure you are getting 8 hours of sleep.  If you have been napping, it’s time to phase it out.

2. Ask your therapists for strategies for managing headaches or pain during the day.  Will adjusting your computer monitor help your neck?  Will icing your neck periodically help your headaches?

3. Think about all the tasks or errands you will need to fit into your life after returning to work.  You will no longer have all day to complete these tasks.  It will be a good idea to build a weekly routine that creates space to complete chores, physical therapy exercises, etc. outside of work hours.  You may want to consider meal planning so that you only have to cook a few times a week.

4. Initially, save harder household tasks for the weekend.  You’ll need time to decompress in the evenings.

5. Remember that nutrition is very important to recovery.  If you don’t eat anything until lunchtime, it may be very hard for you to focus.  Think about having quick grab-and-go breakfasts at home.  If you are not hungry in the mornings, drinking a smoothie may feel easier.

6. Use lists, calendars, etc. to stay organized.  

7. Take your breaks.  A break is not surfing the web for 15 minutes or talking to your coworker.  A good break will involve quiet, and perhaps some movement or meditation.

Remember that your providers are there to support you.  If you face any struggles as you return to work, be sure to write them down and share.  

Do I need to see a neurologist?

You’ve just sustained a concussion, which is a mild traumatic brain injury. You might be wondering if you need a neurologist on your team, since neurologists diagnose and treat disorders of the brain.  This is a great question, and one we get all the time.  

In most cases, it is not necessary to see a neurologist following a concussion.  A lot of our patients go to the ER to get checked out in the first few days, which is a very appropriate course of action.  If there is no concern for brain bleed or need for surgery, they are typically told to follow-up with their primary care physician, or PCP.  Ideally the PCP will give the patient some guidance for how to manage the symptoms during the acute phase and refer them to a concussion specialist.  Getting care for your concussion early has been shown to decrease the risk of persistent post concussive syndrome.  

What’s most important to your recovery, is having a medical professional on the case who has extensive knowledge of the typical and atypical courses of concussive injury, as well as the treatments available.  Concussion management has dramatically evolved over the years, and it is important to understand that not all doctors, including neurologists, might be up to date.  BEWARE of physicians who tell you to sit in a dark room for a week, or that there is nothing you can do but wait for your symptoms to go away.  We now know that getting care within even as little as 36 hours post injury improves your chances of a shorter and faster recovery.

Our clinic was born out of the realization that high-quality comprehensive concussion care is hard to find.  The two medical professionals on our team who provide case management are Michelle Reed, Nurse Practitioner, and Kathryn Reitz, Doctor of Osteopathy.  These two providers have seen so many patients, spanning the acute concussion stage to several years post-concussion.  Unlike most neurologists, who often treat a variety of neurological issues, they are seeing concussion cases all day - it’s their wheelhouse.  They have a deep understanding of the symptomology of head injury, know that certain medications are more effective with this population of patients, and are well-versed in the most current evidence-based therapies and how these therapies interact to produce results.  A majority of the people that come through our clinic never need to see a neurologist.  They experience significant improvement from the care provided by our NP or DO, and the rehab therapists.  It’s a good thing, too, because it can take months to get an appointment with a neurologist!  

All that said, a good health professional understands when it’s time to refer to a neurologist or other specialist.  Is there concern for seizures?  Are the migraines not improving after several interventions have been tried?  Is the patient experiencing fainting spells?  Did a Brain MRI show something concerning?  Like investigators, they will always ask questions, but it is very important to share all of your symptoms with your providers so that they can be sure to point you in the right direction and get you the help you need.  

Helping Family Members with Concussion

When someone has a broken leg, it’s pretty obvious how we can be helpful.  We can drive them places, open doors for them, carry their groceries, etc.  Concussion is a different kind of injury.  It is known as “the invisible injury” because it is not externally obvious to others.  There’s no cast, no crutches, and it doesn’t even show up on a CT scan. The individual often struggles with thinking, overstimulation, and fatigue, among other things.  Sometimes people aren’t sure what they can do to help. The answers may vary, depending on the individual, but here are some general tips for how to help someone you know who has had a concussion.  

1. Ask if they would like you to go with them to an appointment. Sometimes people become very overwhelmed by the large amount of information they are presented with, and having another set of eyes and ears may be helpful.

2. Gain their attention and make sure they are looking at you before you speak to them. If possible, let them finish what they were doing.  Dividing their attention between two things will likely be unsuccessful.  Also understand that it may take the person a minute to switch gears from what they were doing before.

3. Text them instructions or important information so that they can process it when they are able to focus, rather than telling them in passing or when they cannot write it down.

4. Provide assistance, but try not to take all responsibility away from the person.  For instance, it is okay to remind the person of their appointments, but if they are able to schedule them and check their calendar, this is something they should continue to do. It will be good for their brain to have to pay attention to such things.

5. Try not to take it personally if they are wanting more alone time or need a break from a conversation. This is very common, as people with concussions often become quickly overloaded and symptomatic. After a while it may be difficult for them to process what you are saying.

6. Offer to bring them a meal or something else that might make their life a little easier.  Many people with concussions are very busy with medical appointments when they aren’t working, which can make it difficult to find the time to cook.

At the Colorado Concussion Clinic, we understand that mild traumatic brain injuries impact not only those who are injured, but those with whom they are closest.  There can be frustration on both sides, even if there is a lot of love.  You may feel just as overwhelmed as your partner if all of a sudden you are working full time and taking on a majority of the household responsibilities.  It can be helpful to see a therapist to address any feelings you may be having and learn effective coping and communication strategies.  If your loved one who is injured is open to it, it may also be helpful for you to ask their providers questions about their symptoms or treatment plan.  Having a deeper understanding of the injury may help you help not only your loved one, but you as well.

- Ramya Shyam, MS CCC-SLP

I’m not as young as I used to be...How do I know if my symptoms are due to concussion or early dementia?

As a speech-language pathologist who has focused on treating adults with neurological deficits, I hear this question ALL. THE. TIME. It’s understandable that people become very concerned whenever they have changes in their memory. And unfortunately, there is no easy answer. But hopefully the information in this blog post will provide you with the information you need to help answer this question.

Unfortunately, many of the signs of early stage dementia are also symptoms of concussion. These common signs include forgetfulness, trouble concentrating as long as you used to, difficulty finding the right words, changes in behavior/mood, and difficulty completing daily tasks. Therefore, it can be very difficult to determine if you have dementia based solely on those symptoms. One of the biggest ways to differentiate between the two is that you can typically make progress and recover after a concussion, but dementia typically gets progressively worse over time. If you did not notice any difficulties prior to sustaining your concussion, and then acute changes occurred, that would lead me to believe that the issues are concussion related. It is also possible that you are experiencing some normal cognitive decline (we call that getting older).

Once someone reaches us for treatment, we will typically perform a cognitive assessment.  After a period of time, we will re-assess the patient.  If the patient’s performance worsened, we would typically recommend a neuropsychological assessment, which can help determine the nature of the difficulties.  For most of the patients we see, the decline is related to factors other than dementia.  If there is some concern for a neurological process other than concussion, the neuropsychologist and/or neurologist will consider brain imaging, family history, and lab work to determine if a dementia (or other) diagnosis is applicable.  These tests will provide valuable information for treatment options, as well as comparison data for any future testing. 

If you are concerned, please schedule an appointment with your physician. Doctors are trained to differentiate between the two and to guide you on your path into aging. (Side note- you should consider seeing a physician who specializes in geriatric medicine.) Either way, early recognition is key. The sooner you know, the earlier you can do something about it! Cognitive therapy could be beneficial to learn some strategies to improve and/or maintain your functioning. 

If you think you’re having cognitive issues after sustaining a concussion and would like some help, call our office to schedule an appointment with one of our speech-language pathologists, who have spent countless hours specializing in cognitive rehabilitation.

Colorado Concussion Clinic 303.932.2030 

- Hilary Booco, MA CCC-SLP

“Jot That Down” - Thoughts about note-taking following a head injury

One of the things I hear frequently when I meet a new patient is, “All of a sudden I have to write everything down.  I used to just remember things and now I’m totally overwhelmed.  It’s SO frustrating!”

Let’s take a minute to analyze the situation and put things in perspective.  Normally, you have a routine which may involve work, typical household chores, family obligations, etc.  But now you’ve been hurt - maybe due to a fall, a sports injury, or a car crash.  You’re not feeling like yourself, you’re tired and scared, and all of a sudden tasks are piling up.  In addition to your usual responsibilities, you may be dealing with any or all of the following:

• Physical symptoms: headaches, dizziness, nausea, sleep disturbance, etc.

• Emotional symptoms: sadness, fear, anxiety, trauma, etc.

• Medical appointments happening at different times on different days

• Insurance companies

• Work issues

• Not having a car

• Being unable to perform household chores

When we think of it that way, it’s a lot!  You’ve had several things added to your plate, and it’s hard to juggle and remember everything that needs to be done.

It’s wonderful to be able to rely on your spontaneous memory - to not have to use a calendar, to not have to take notes every time you talk to someone, or to not have to check your notes 5 times a day to make sure you aren’t missing something.  Truthfully, though, this is what you have to do following a concussion.  My goal is to help you be at peace with this...to understand that writing things down is actually good.  It means that on some level you are recognizing that something isn’t working and you are problem solving that issue.  None of us need to be perfect.  What we need to be able to do is identify problems and solve them.  

Also, you need some free space in that precious brain to process the information that is coming at you throughout the day.  Putting appointments, reminders, and other information in your calendar is the perfect way to free up valuable brain space.  

Some of you may wonder, “Will I always have to do this?”  The answer is, probably not to the same degree.  Once you are feeling better, the appointments slow down, and you get back to your normal routine, your spontaneous memory will likely work much better.  Still, is it the worst thing in the world to use a calendar or to take notes during an appointment?  Life is busy, and as we get older we tend to have more on our minds.  For example, even though I pick my child up from school at the same time every day, I still set an alarm because I’m human and sometimes I can get caught up in what I’m doing...writing a blog post for instance.  Setting the alarm puts my mind at ease and allows me to focus on the task at hand without constantly checking the time.   

Writing information down allows us to focus, think better, and sometimes even process the information we are hearing.  At CCC, we encourage this sort of thing!

- Ramya Shyam, MS CCC-SLP

How Does Impaired Hearing Impact Cognition?

Did you know that hearing impairment is a common symptom after sustaining a concussion?  Many people are aware of post-concussive symptoms such as headaches, dizziness, or memory loss, but are less familiar with the possibility of hearing impairment.  Some people experience hearing loss while others may experience symptoms such as difficulty processing auditory information, ringing in the ears, or sensitivity to noise.  It varies significantly by person, but these symptoms can sometimes have a profound effect on your life. 

You might be surprised to learn that even mild hearing impairment can impact a person’s life and daily functioning.  In fact, research shows that even mild hearing impairment is associated with a faster rate of cognitive decline as well as an increased risk of dementia.  In this blog, we’re going to discuss several examples of different areas of cognition that are directly impacted by a hearing impairment in addition to some tips to help you alleviate these challenges.  

First, it is important to mention that if you are concerned that your hearing has changed in any way since your concussion, it will benefit you to:

1. Make an appointment with a certified audiologist for a hearing evaluation.  

2. Follow the audiologist’s recommendations.  There are many treatment options such as amplification technology (e.g., hearing aids, amplified telephones) or aural rehabilitation that may include auditory training, counseling, or learning strategies to help you hear better in situations you have more trouble.

Now, here’s where we dive into some of the specific areas of cognition that are often affected:

Hearing impairment can directly impact your ability to pay attention and concentrate on information you are listening to.  This is because your brain has to work extra hard to decode and understand the information.  This may cause you to experience cognitive overload and fatigue, both of which make it difficult to pay attention.  

So, what are a few ways you can improve your attention in these situations? 

• Modify your environment by reducing background noise or moving into a less distracting location

• Sit or stand near the speaker 

• Consider using amplification technology (e.g., conference microphones, amplified telephone)

Hearing impairment can impact your memory.  When our patients have trouble staying focused while listening, they often experience difficulty remembering the information they hear.  This is because attention is a foundational skill that is necessary for the formation of memories.  And, when concentrating and listening become so effortful, people often experience decreased memory. 

So, what are some things you can do to improve your memory?  

• Continue to practice and master the attention strategies mentioned above 

• Ask people to repeat what they said 

• Take a moment to stop and briefly summarize what you heard in your own words 

• Take notes that you can refer to later 

Hearing impairment can impact your ability to engage in effective communication with others.  As you can imagine, if you have trouble paying attention or remembering details you hear, it will be difficult to follow along during conversations, especially when there are multiple people speaking.  You might even feel like other people are mumbling because it is difficult to understand them.  If you miss important details, this can easily lead to a miscommunication.  And, after socializing, you may feel cognitively exhausted because of all the extra effort you used to listen and stay engaged. 

What types of strategies can help you improve your communication in these situations?

• Face the person you’re talking to so you can use both auditory and visual cues (reading lips) to help with understanding.

• Advocate for yourself ahead of time. Let people know about your hearing impairment.  Ask them to speak a little louder, slower, and only one person at a time.

• Ask questions to clarify that you understood. 

By addressing your hearing impairment with a full audiological evaluation and following through with the recommendations for treatment, you can improve your ability to concentrate, remember the details, communicate effectively with others, and your overall quality of life.  

And, if you are having any difficulty implementing the strategies outlined above or are looking for additional cognitive support, the licensed cognitive therapists at the Colorado Concussion Clinic are here to support you! 

- Mari Gottlieb, MA CCC-SLP

Concussion Recovery in the Time of Covid-19

When recovering from a concussion, routines are extremely important for brain health and healing. Given the current pandemic, many of us have had our daily routines completely upended. As we settle into the changes in our day to day lives, maintaining routines when possible, as well as creating new routines will be helpful to support ongoing recovery. With stay at home orders in most states, we have put together some tips to help get through these trying times while dealing with the effects of a concussion.

Designate a space for working from home. This is preferably outside of your bedroom when possible to create separation from your sleep environment. If you can work with a door closed to minimize distractions, that will also be helpful. 

Limit screen time. Many of us are now working online, which may make limiting screen time a challenge. If screen use increases your symptoms, it will be important to schedule frequent, short breaks from the computer. By taking breaks regularly, you can help prevent common symptoms such as eye strain and headache.

Keep moving! With gyms across the country closed, our exercise routines are disrupted. Getting out for daily walks is important, as exercise is one of the most important things we can do to facilitate the recovery process. The intensity is important and will vary for each person, but in general you want to aim for an intensity that does not make symptoms worse. 15-20 minutes of walking 1-2 times a day, as long as your symptoms are not worsening, is a great start. Just be sure you are maintaining 6 feet from others! In addition to daily walking, there are a lot of virtual workout options available through gyms, yoga studios, online trainers, and youtube. Make sure your exercise routine is approved by your physician/concussion management team.

Maintain good sleep hygiene. Sleep hygiene is extremely important, especially when we are spending so much time at home. Maintaining a regular schedule around when we go to sleep and when we wake up can be helpful. Develop a relaxing bedtime routine to facilitate falling asleep more easily. This can involve meditation, reading, and avoiding electronics for about an hour before bed. 

Stay consistent with meal times and meal planning. Being at home all the time can disrupt our structured eating habits. Try to maintain consistent times that you eat your meals to make sure you are getting the nutrition you need while recovering. Meal planning over the weekend or at the beginning of the week can help you stay on track throughout your work days. And be sure to stay well hydrated as this can help decrease your headaches.

Stay connected with friends and family. This is extremely important, as well as challenging, given the need for physical distancing to slow the spread of the virus. Finding alternative ways to connect is necessary to maintain social contact with your support network. Connecting via video chat is a great way to check in with people. If screens increase your symptoms, you may want to consider keeping video chats short, or schedule times for phone conversations instead.

Develop a mindfulness practice. With the increased stress of these times, mindfulness is a tool that can help manage the things that are being brought up. Meditation and breathing techniques are ways to stimulate the calming part of the nervous system to manage anxiety and stress. Youtube is also a great source for guided meditations, as is the app headspace.

Hopefully incorporating some of these tips as you settle into these changes in lifestyle will help with structure to support your healing. Stay safe and healthy!

Concussion and Vision Therapy

According to the Neuro-Optometric Rehabilitation Association, up to 90% of people following traumatic brain injury experience visual issues. 90%!! Given that the visual system is such a big driver of symptoms, we thought we would delve into the different symptoms that can occur due to visual dysfunction, as well as the most common visual dysfunctions seen following concussion.

Up to ⅓ of symptoms experienced following a concussion can be visual in nature. The most common visual symptoms are as follows:

• Blurred vision (constant or intermittent)

• Double vision

• Difficulty reading or sustaining reading

• Light sensitivity indoors, outdoors, or on screens

• Difficulty tracking or keeping place when reading

• Eye pain or strain

• Dryness or irritation of eyes

• Motion sensitivity (bothered by motion or crowded environments)

• Difficulty shifting focus from near to far/far to near

It’s important to mention while we are discussing symptoms that visual issues can also contribute to dizziness, balance impairment, and headache - but are often missed.

Visual dysfunctions are correlated with prolonged or incomplete recovery following a concussion, so it’s important that a comprehensive evaluation include an assessment of the visual system. The most common visual dysfunctions after concussion are:

• Dry eye - up to 90%

• Eye tracking issues - up to 70%

• Accommodative (focusing) issues - up to 66%

• Convergence insufficiency (eye teaming)  - up to 66%

• Light sensitivity - up to 59%

The good news is that there is a lot that can be done to treat visual dysfunction and symptoms! Optometrists specializing in neuro-optometric rehabilitation can be especially helpful. Neuro-optometrists can prescribe spectacles to correct any visual acuity issues. They can also prescribe the appropriate tints and filters for lenses to decrease light sensitivity for inside and outside. They provide treatment for dry eye. And one of the biggest areas where they can make an impact is in providing neuro-optometric rehabilitation therapy (often called vision therapy). The focus of vision therapy is improving the efficiency of visual processing and retraining the neurological control of eye movements and focusing to achieve optimal visual functioning. 

Given the high prevalence of visual dysfunction, evaluation of the visual system is an essential part of a thorough concussion assessment. Prompt treatment of visual issues can get you on the road to recovery faster!