Concussion for non-athletes: Resources for the everyday person living with concussion

Concussion for non-athletes: Resources for the everyday person living with concussion


A few years ago I attended a panel
discussion where a group of athletes discussed their experiences with
concussion. When they opened up to the audience for questions, there were a
number of people who addressed the microphone but there was one man in
particular who I’ll always remember. He first thanked the panel and congratulated
those who had returned to sport. He explained that he was not an athlete but,
he was struggling to return to work after his concussion. He wanted to know
what resources or research was being done to help the everyday person living
with concussion, because he felt that there seemed to be a lot more resources
to support athletes. I think that his question really stuck with me because he
represents the type of person that I want to help. I started my career as a
physiotherapist working in brain injury rehab at Parkwood Institute in London,
Ontario helping people injured in car accidents, workplace injuries, assaults or
falls at home, and now as a scientist at Western University and Lawson Health
Research Institute. I collaborate with clinicians and clients on clinical-based
research that’s driven by questions from our clients and clinicians. Our team is
called ‘Research to Practice.’ So, we know that the majority of brain injuries are
not sport-related, so what about that person injured in the car accident
the woman abused by her partner or the child who fell from the monkey bars? What
do we really know about how to help these individuals with concussion? And
the truth is that much of what we’ve learned in the sport concussion
literature can be applied to the everyday person living with concussion.
In 2017, a group of researchers from around the globe collated the best
available evidence in sport concussion. Their work is known as the Berlin
Statement and is published in the British Journal of Sports Medicine.
Clinicians and clients can access this document for free to
verify any questions they may have concerning diagnosis or acute management.
For example, the majority of sport related concussions do not involve a
loss of consciousness, and they may also not be related to a direct hit to the
head. The Berlin group concluded that a
concussion may be caused by either a direct blow to the head, face or neck, or
by a hit anywhere else on the body that causes an impulsive force up to the head.
It’s also well documented in the sport literature that symptom onset may be
delayed, and from the neuroimaging literature we’ve learned that a
concussion may not show up on standard x-ray or CT. This does not make diagnosis
any easier, but it’s imperative that this type of information is disseminated and
understood by not only our clients and clinicians, but also by our insurance
providers to ensure that people are not restricted from the services that they
need when it comes to acute management. We used to believe that you had to rest
until all of your symptoms went away. Now, the recommendation is to rest for the
first one to two days and then gradually resume normal activities using symptoms
as your guide. This strategy is outlined in both the Berlin Statement and the
Ontario Neurotrauma Foundation Guidelines for Concussion. But it’s still
really tricky for our clients and clinicians to operationalize. This is why
an occupational therapist at Parkwood who recognized this in her clients,
created a pacing points program, where she would assign a point value to
activities based on how difficult and symptom-provoking it was for that client.
Then each of her clients would be assigned a point-per-day maximum much
like diet programs assign points for food. And through the collaborative
efforts of our clients, clinicians, researchers, app developers and funding
through community partners and the hospital foundation, her idea has finally
become an app. And once launched, users will be able to track their own activity
and their own symptoms. And through the collection of user data,
the researchers will be able to evaluate this strategy and also be able to figure
out how to further tailor this gradual return to activity strategy for the
guidelines. Working alongside each other, clients, clinicians and researchers is
what our team calls a “collaborative practice based approach to research and
innovation.” Another example from our clinical site, is using a standardized
assessment battery for our group interventions. Our Parkwood occupational
and physical therapist created a customizable circuit-training group to
address the common complaints of our clients with concussion. And they also
did it to help support the wait list. But, the point is, every client that goes
through that intervention completes the same assessment before and after that 16-week intervention. This supports our quality improvement initiatives but it
also means that as researchers, we now have a large enough data set that we can
look at not only how effective this intervention is, but to be able to
identify client characteristics to figure out who this intervention might
work for the best. So, I encourage anyone listening to think about how a practice
based approach might be modeled at your site because those of us on our team at
Research to Practice, have tried to model this in each of our initiatives. And much
like the guy at the microphone a few years ago, we all believe that there
needs to be more resources to support the everyday person living with
concussion and believe that together we can make that happen.
Thank you.

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