Have you been told you may have had a concussion or a mild traumatic brain injury (mTBI) that doesn't feel mild?  You are not alone.  By definition, traumatic brain injury (TBI) arises from external forces or actions that cause the brain to move against the skull or be penetrated.  This can occur in sports, automobile accidents, unintentional falls, gunshot wounds, assaults but the majority of TBI that result in hospitalization are from falls and motor vehicle accidents.

A TBI is classified as mild (mTBI), moderate or severe.  A concussion falls under the mildTBI category but does not mean the symptoms are mild.  A mTBI can result in physical, visual, auditory, cognitive and emotional problems that interfere with someone's ability to participate in their usual daily activities.

The people at highest risk of sustaining a TBI requires hospitalization are people over the age of 75 and males.  These injuries were mostly causes by unintentional falls and car accidents.  TBI is most common amongst people ages 15 to 24 years old.  For additional statistics on brain injury visit Brain Injury Canada (www.braininjurycanada.ca) or Center for Disease Control (CDC) (www.cdc.gov /traumaticbraininjury).

The Centre for Disease Control (CDC), also provides useful information on Brain Injury including monitoring, prevention and links to apps for training and concussion identification.

PROGNOSIS

Once a diagnosis of concussion or TBI is made it is important to follow the recommendations of your treating family doctor or specialist and maintain regular follow-up to monitor symptoms.  The majority of individuals diagnosed with a concussion or mTBI will have a full recovery within six weeks; however, a small percentage may continue to experience disruptive symptoms and require additional medical care and specialized rehabilitation services.  Spontaneous recovery or natural healing of the brain tends to occur within the 18  to 24 months after a moderate to severe TBI, but adaptations will continue to occur that may improve daily functioning.

Many personal factor can speed up or prolong recovery.   Recovery tends to be slower in adults over the age of 40.  Other factors that impact recovery including:  low blood pressure, loss of oxygen to the brain, severity of the injury, prior head injuries, mental illness and other health factors.  At Turning Point, we identify risk factors early in the recovery process and belief in early intervention to help the recovery process.

ASSESSMENT

Occupational therapists (OTs) are trained to identify the physical, cognitive and emotional impairments that are restricting participation in daily activities.  The assessment process typically begins with a referral from a family physician, insurance company, lawyer, other therapists or a self-referral.  Turning Point provides in-home assessments consisting of interview, testing, observations and consultation with other team members to provide a coordinated recovery progress.

TREATMENT

Occupational therapists develop physical activation and cognitive rehabilitation programs while recognizing the psychological impact of the injury.  Education is key and other functional activities are designed within a community-based rehabilitation program to optimize recovery.  OTs are responsible for the assessment and planning of rehabilitation programs, but rehabilitation assistance (RAs) or OT Assistants (OTAs) help reinforce the strategies taught by the OT.  For example, if memory is an issues, the OT will determine a targeted intervention and set up repeated sessions with the client and RA/OTA.  The RA/OTA may review use of memory strategies such as establishing a routine; use of assistive technology such as a smart phone or smart watch to set reminders; remediation activities such as challenging the memory through memory exercises; and functional activities such as creates to-do or other lists to participate in weekly grocery shopping or work tasks.

For those with moderate to severe TBI, treatment is likely to be prolonged and may also include wheelchair and seating assessments, recommendations for home modifications, assistive technology and home support services.

RESOURCES

There are many online and local resources to help support those who have experienced a TBI.  Our OTs often provide clients with support group information, apps available for smart phone, virtual exercises options, etc.  Some clients require OT assistance to apply for disability services such as government benefit programs or school accommodations.  Our OTs love what we do and are available to take your questions and try to help you get the services you need to improve recovery and daily functioning.  We take self-referrals and will attempt to secure funding for services if needed.

Practice Good Sleep Hygiene 

Learning how to practice good sleep hygiene may help you find a restorative sleep once again.  What is sleep hygiene?

Sleep hygiene is defined by Oxford as, "habits and practices that are conducive to sleeping well on a regular basis."  Sleep is the foundation that allows us to function in our daily lives.  If we don't sleep well, we can't think as well and any pain or mood symptoms can worsen.

A first step in rehabilitation is often to help restore sleep.  Your family doctor may have medical suggestions (medications, sleep study, sleep specialist or other therapies) and occupational therapists often provide tips to help you develop healthy sleep habits.

Here is a handout on sleep hygiene to get you on your way to finding that refreshed morning feeling.

Sleep Hygiene PDF

Tips for Pacing.PDF

Some people who have sustained a concussion may experience a change in their thinking (cognitive skills) and may have trouble with:

• Making Decisions
• Concentrating
• Remembering and Learning
• Multitasking
• Language and Learning
• Understanding
• Planning and Organizing
• Irritability

Sometimes these changes can make everyday tasks more difficult. So, what can you do?

Keep organized 

• Use a daytime calendar, or phone to help you remember appointments and things you need to do.
• Keep important things (like keys, phones, medications) in the same place so you don’t forget where you put them.

Use strategies to help you focus and remember

• Set alarms to help you remember to do things at a certain time.
• Write notes to yourself and place them in areas where they remind you to do important tasks.
• Avoid noisy and distracting environments that make it hard to concentrate instead.
• Try to work in a quiet area when you need to work, read, or study.

Try to reduce stress 

• Take a rest break before you feel tired or overloaded.
• Break up large or complicated activities into smaller more manageable tasks.
• Pace yourself and don’t try to do everything at once.
• Practice deep breathing and relaxation strategies. (See our resource page on diaphragmatic breathing).

If you feel that your thinking doesn’t go back to normal after a few weeks see your doctor or health care provider and discuss the possibility of getting support during your recovery. Our occupational therapists at Turning Point are trained in cognitive rehabilitation and can assist you learn additional strategies to manage your thinking difficulties. Talk to your OT and they can work with you to make a personalized plan.

More information about concussions and mTBI can be found at: www.brainstreams.ca

For the first time since 1979, International Association for the Study of Pain (IASP) introduced a revised definition of pain, the result of a two-year process that the association hopes will lead to improved ways of assessing and managing pain.

The definition is: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,” and is expanded upon by the addition of six key Notes and the etymology of the word pain for further valuable context.

• Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
• Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
• Through their life experiences, individuals learn the concept of pain.
• A person’s report of an experience as pain should be respected.
• Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
• Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.

A multi-national, multidisciplinary Task Force developed the revised definition with input from all potential stakeholders, including persons in pain and their caregivers.

The revised definition was introduced in this article in the journal PAIN and a via a press release. An infographic also illustrates the changes.

https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/?ItemNumber=10475

Standards of care to manage chronic pain includes the development of self management skills, but for many people, professional guidance is helpful to know what questions to ask, where to go for support and little things you can do to reduce your pain intensity and improve daily functioning.

Much of the educational information we provide and reinforce to our clients can be found on the Fraser Health website,  Manage Pain .  I highly recommend reviewing the relevant subheadings which include: medication usage, support groups, exercise, depression, sleep and even financial resources.  There are links to helpful videos and local resources.  I hope you find this website useful in your journey to develop your own self-management toolkit to manage your pain.

Ergonomics refers to good design intended to provide optimum comfort and to avoid stress or injury.  There are many great resources to determine if your work station is ergonomically sound including from the Cornell University http://ergo.human.cornell.edu/DEA6510/dea6512k/ergo12tips.html which provides a picture and 12 great tips to follow.

Another website from Stanford University http://web.stanford.edu/dept/EHS/prod/general/ergo/microbreaks.html, provides information on the importance of breaks, setting up your workstation to encourage micro breaks and stretches to reduce risk of ergonomic injury.  It can be difficult to assess yourself working at your desk or to remind yourself to take breaks but our expert OTs can assist you in making sound changes to your workstation and recommend equipment for optimal comfort and work tolerance.

Integrative medicine includes yoga which is compromised of breathing, meditation and physical postures.  Research has show Yoga results in many positive health effects including:  pain reduction, improved mood and anxiety, reduced functional disability and use of medications.  Don't know how or where to start?  Your OT is familiar with local resources and recommend an appropriate rehabilitative-type yoga class, so you can start achieving your own health and recovery goals!  Not ready or unable to access a class?  Well, your OT will be able to guide you to a vast array of online resources as well.