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Post-Concussion Syndrome (PCS)

What Is Post-Concussion Syndrome

Post-Concussion Syndrome (PCS) is when a person continues to experience concussion symptoms past normal recovery times. There is no consensus on when concussion stops and when post-concussion syndrome begins; Therefore, it is extremely difficult to officially diagnose. Generally, PCS “starts” and concussion “ends” about 2-3 weeks after initial injury when/if symptoms remain. 

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Common symptoms

  • Headache

  • Fatigue

  • Insomnia

  • Noise and/or light sensitivity

  • Exercise intolerance

  • Cognitive intolerance

  • Psychological symptoms (depressed mood/irritability/anxiety

  • Cognitive problems (memory loss/ poor concentration/ and difficulty problem solving

 

 

 

 

Risk factors and Prevalence

More likely to sustain a concussion

  • Longer recovery periods

  • Female sex

  • Younger age

  • History of concussion

  • History of migraine

  • Diagnosis of a learning disability or ADHD

More likely to have a longer recovery period

  • Posttraumatic migraine

  • Immediate dizziness

  • Sub-acute fogginess

  • Difficulty concentrating

  • Vomiting

  • General dizziness

  • Cervicogenic dizziness

  • Nausea

  • Headache

  • Slowness

  • Imbalance

  • Light or noise sensitivity

  • Numbness

It is estimated that up to 40% of concussions will become post concussive

 

Diagnosis

  • There is no test/image to 100% confirm, which is why baseline testing is important (lets us track symptoms and recovery)

  • Neurocognitive testing such as ImPACT is great for getting baseline data to compare when concussion/PCS is suspected

 

Post-Concussion Syndrome “Tracts”

PCS is subdivided into several “tracts.” These tracts are determined by the type of symptoms/deficits you are experiencing and have specific treatments associated with each tract. Many times people will fall into more than one PCS Tract, and treatment should reflect all tracts

Cognitive/Fatigue Tract

  • Risk Factors: learning disorders, ADHD, ADD

  • Common symptoms: difficulty with memory and concentration, difficulty following multi-step commands, fatigue, sleep disturbances

  • Treatment approaches: behavioral strategies/accommodations, monitored active rehabilitation, pharmacological, cognitive behavior therapy

 

Vestibular Tract

  • Risk factors: history of motion sickness

  • Common symptoms: loss of balance, feeling of imbalance, motion sickness, nausea, dizziness, fogginess

  • Treatment approaches: individually tailored vestibular therapy

 

Oculomotor Tract

  • Risk factors: amblyopia (lazy eye), strabismus (cross eye), family history of both

  • Common symptoms: eye pain/pressure behind the eyes, headache due to visual strain (reading/TV/computer or phone screen use), difficulty focusing (both physically and mentally), fatigue

  • Treatment approaches: vestibular therapy focusing on the impaired oculomotor deficits

    • *Neuro-opthalmologist treatment may be necessary in more severe cases

 

Anxiety/Mood Tract

  • Risk factors: history of mood disorders, family history of mood disorders

  • Common symptoms: increased anxiety, ruminative thoughts, hyper vigilance, sadness, helplessness, feeling of being overwhelmed, headache, sleep disturbances, dizziness, fatigue, fogginess

  • Treatment approaches: monitored active rehabilitation, regimented sleep schedule/diet/hydration/stress management, cognitive behavioral therapy, pharmacological

 

Post Traumatic Migraine Tract

  • Risk factors: history of migraine, family history of migraine

  • Common symptoms: chronic persistent headache, light sensitivity, noise sensitivity, nausea

  • Treatment approaches: strict behavioral management (sleep/diet/stress), pharmacological, monitored cardiovascular training

 

Cervical Tract

  • Risk factors: history of trauma to the neck (previous or at time of initial injury)

  • Common symptoms: headache that is occipital (back of head) in origin which may radiate to temples and eyes, neck pain/stiffness, fatigue, fogginess

  • Treatment approaches: cervical PT (manual therapy such as mobilization/manipulation/soft tissue release, AROM/PROM, stabilization training, and proprioceptive exercises

 

Physiological Tract

  • Risk factors: none

  • Common symptoms: headache, dizziness, fatigue, light sensitivity

    • These individuals will often have early symptom exacerbation with physical activity

  • Treatment approaches: monitored endurance training and strengthening as appropriate/tolerated

 

What Does the Research Say For Treatment?

Concussions

  • First 7-10 days it is important to rest and allow the brain to recover as much as possible, but to not completely eliminate all inputs into the brain

  • Patients/athletes should limit their physical, mental, and emotional activities to moderate intensities (i.e., not too much, but not too little)

Post Concussion Syndrome

  • Emerging evidence suggests that rest is only beneficial in the acute stages of injury, and may even be harmful if utilized for too long of a period

  • Moderate activity is beneficial after the acute stages of injury, but over and under activity are both detrimental

 

General Treatment – WHAT YOU CAN DO

  • Limiting physical, mental, and emotional stresses BUT not completely eliminating these entirely

  • You want a balance of exertion and rest

  • Your brain responds to the stresses applied to it à some stress is good; too much can cause delays in healing

 

WHY SEE A PHYSICAL THERAPIST?

  • Determining which tracts of PCS you fall into

    • Cervical, vestibular, oculomotor, anxiety/mood, cognitive/fatigue, post-traumatic migraine, and physiological/exertional

  • Creating and implementing individualized plans of care such based on your PCS Tracts and your specific symptoms

  • EDUCATION! Helping you to understand your brain and how it responds to different stimuli and how to best manage your symptoms when they do happen

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Let us help you with your recovery journey.

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