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Persistent Symptoms after Concussion


Persisting Symptoms After Concussion (PSAC) (formerly referred to as Post-Concussion Syndrome) typically occurs when symptoms of concussion persist for more than a month. We are not exactly sure why some individuals recover quickly and others experience continued symptoms. Research is showing that factors such as genetic predisposition, gender, age, number of previous concussions, pre-injury history of headache, migraine, learning disorder, attention disorder, emotional disorder, presence of amnesia at the time of injury, or lack of rest immediately after the concussion may affect recovery time.


The treatment of PSAC requires a comprehensive team approach. The team may include the neuropsychologist, primary care physician/pediatrician/sports medicine doctor, athletic trainer, physical therapist, neurologist, patient, and patient family members. For students, school personnel and the child study team may assist with educational planning. If an individual has never engaged in a period of comprehensive cognitive and physical rest, then it may be appropriate to try such rest to give the brain a break and allow it some healing time. Currently, for concussion, immediate removal from play and physical activity, with physical and cognitive rest during the acute phase, followed later by supervised, paced physical activity, and a gradual return to school/work and cognitive activity is the treatment plan of choice.


For persistent symptoms, treatment may include a neurological referral for possible headache medication management, biofeedback to help control the headaches, psychotherapy to address life stressors and the effects of persistent symptoms on quality of life, vestibular therapy to address balance issues, acupuncture and/or massage to help manage pain and stress, and vision/ocular motor therapy to correct visual difficulties. In addition, good nutrition and hydration are always important when healing. Basic vitamins, Omega 3 Fatty Acids, Fish Oil, and Magnesium Supplements have been suggested as possibly helpful, although strong research support is still not available. A very important factor for healing is sleep. Sleep helps the brain and body heal and re-energize. Sleep deprivation can result in symptoms that can be mistaken for concussion symptoms.


For individuals with persistent concussion symptoms, a light exercise program that is carefully tailored so as not to increase symptoms, but to provide an avenue for re-conditioning and elevating self-esteem, is recommended. A certified athletic trainer or physical therapist specifically trained in the specialty of concussion can help create the appropriate re-conditioning program.


An individual experiencing PSAC may require temporary academic or work accommodations or a medical leave due to symptoms such as fatigue, slowed mental processing, memory difficulties, periods of confusion, problems with multi-tasking, headaches, and emotional distress.


At RSM Psychology Center and the Sports Concussion Center of New Jersey, the neuropsychologist serves as the point person on the concussion team. The neuropsychologist 1) coordinates the concussion services and appropriate referrals for adjunct therapies, 2) creates a treatment plan that can include concussion education and counseling, stress management, and post-concussion cognitive test monitoring, 3) develops the personalized plan for return to learn and return to work accommodations, and, if needed, 4) arranges for cognitive rehabilitation services. The goal is to help the patient return to normal function and improve their quality of life as quickly as possible.

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