Return to activity following concussion

I am a 66 year old woman who is in the process of doing her masters degree in counselling at UVic. On September 3, 2010 I was rear-ended by a large pickup doing approximately 80 km. I suffered a whiplash that caused severe pain in my neck, shoulders and back. Along with the whiplash I also suffered a concussion. I did not strike my head, but as you know, one doesn't have to inorder to have a concussion.

 

After the accident I was having a great deal of trouble concentrating, focussing, and recalling, as well as putting information to memory. I started to take a herbal remedy, which did help to take the brain fog away and did improve some of the above complaints, but I am still dealing with some memory lapses that are causing me great concern.

 

For example, I have lived in the same home for eight years and I forgot to pay my rent in January. That would be a first for me. On my way to my lawyers office I could not remember if I had reached the street to turn on or if I had passed it. This is a street I am very familiar with. My ability to visualize, a skill I was constantly good at seems to be very hit and miss. This is why I could not visualize whether I had past the street or not.

 

When reading a section in my class text book I find I cannot remember what I just read, nor can I comprehend what I just read. I am constantly rereading a page. If I do an assignment I can get the job done, but I cannot remember what I did so I have toconstantly review my work and I still cannot remember the information. The class I started right after the accident was grueling and I just barely passed the class.

 

Prior to the accident I did not suffer any of these maladies. At the end of the day my brain hurts and feels exhausted. I have gone to a chiropractor and massage therapist for my neck, shoulders and back, but who do I go to for my brain? Thank you in advance for helping me solve this problem. 

 

Sincerely,

Maureen A.

 

 

Dear Maureen,

The symptoms you describe following your motor vehicle crash are commonly experienced following a concussion and may also be influenced by any pain and discomfort from your whiplash injury, poor sleep, headaches, dizziness and/or fatigue.  As these symptoms resolve you will probably find that your thinking problems also settle down.

Although it is tempting to focus on the difficulties you have observed in specific situations I would recommend that you first reflect on your overall health.   

How well are you sleeping?  Falling asleep, staying asleep and feeling rested and refreshed when you wake up is very important to your healing and recovery.  You need to have a routine time for going to bed and especially for getting up in the morning.

Are you including some light aerobic activity in your daily routine?  Participating in regular exercise helps our cognitive performance and also helps with getting a good sleep.   I suggest that you either start or continue with regular light aerobic exercise (walking, treadmill, stationary bike, swimming or water based exercises) and gradually increase your participation (first the frequency, then the duration and lastly the intensity).

I am sure the demands of graduate studies are quite stressful.  Stress management is another important component of your recovery as stress can influence sleep, headaches and cognitive performance.  I encourage you to apply relaxation techniques, including meditation. 

It is expected that you will continue to recover and during that process you can improve your cognitive performance by taking care of your overall well being, as well as using written reminders, alarms, and/or personal assistive devices.  For example keep track of your appointments and when bills are due by writing the details on a calendar; use a daily planner and ‘to do’ lists to schedule and track daily or weekly activities.  When learning new material it may also help to rehearse or repeat information; for example it may be helpful to read the text out loud or to take time to summarize each chapter after reading it.

You mention that your brain sometimes feels exhausted at the end of the day.  People often struggle with physical and cognitive fatigue following a concussion so it is important to ‘budget’ your energy thoughtfully. 

Here are some suggestions for energy conservation that will also help your cognitive function:

Allow some time at the beginning of each day to plan and priorize the tasks and expectations for the day.  This time would be used to check your daily planner, e-mail, assignments, review written communications and pull information or materials needed for the day without interruptions or other demands. 

Avoid or limit your exposure to noisy, busy or overly stimulating places.  It may be helpful to use earplugs when in a noisy environment or organize your workspace to minimize clutter and visual distractions.  This will help you focus and it will reduce feelings of confusion.  For example, turn off the radio or television when you are trying to study; go to the grocery store when it is not busy; drive in light traffic. 

Work on one assignment or task at a time.  Write down your priorities and your plan.  This helps to keep your focus and helps you from feeling overwhelmed.

Give yourself more time than usual to complete assignments.  Work for short periods and take breaks.  This will help reduce the stress that can impact on your ability to concentrate

It is important to pace yourself throughout the day allowing for ‘micro-breaks’ of 5-10 minutes before you feel fatigued; it may take you more time to complete your tasks.  When concentration is critical for a task, pick a time when your energy level is at its best.  You can adjust your effort by pacing i.e. take regular brain breaks before you experience symptoms (poor concentration, fatigue)

Although the presence of symptoms does not mean you should not be participating in your academic studies it is important that you pace yourself and gradually return to activities both at home and at school.  Being a student is an extremely demanding job as you are being exposed to new information and learning every day.  If your symptoms increase it is a signal you have pushed too hard and need to adjust your effort.

You may find some other helpful suggestions on this website http://www.brainstreams.ca/learn/injured-brain/concussion/coping-symptom...

It may be helpful to contact the Resource Centre for Students with a Disability at University of Victoria.  They may be able to assist with short term accommodations or supports.  Please see their website for more information http://rcsd.uvic.ca/.  I understand that Victoria General Hospital provides some rehabilitation services for people who are recovering from an acquired brain injury.  Please talk to your Family Physician about the resources available in your community.   

Thank you for your excellent question and all the best with your graduate studies. 

Sincerely

Alice