The Do’s and Don’ts of Concussion Rehabilitation in Children
- Posted by Rim Boulos
- On July 28, 2021
- 0 Comments
- Children, Concussion, Concussion Rehabilitation, Paediatric Physiotherapy, physiotherapy, Rehabilitation
Concussions are something pretty much everyone has heard about. Maybe you or someone in your family have had one. Or perhaps a friend or colleague? Did you know that concussions are found to be more common in children than adults?
Let’s take a look as to what concussions are, why children are more susceptible, and the do’s & don’ts on how best to recover.
What is a Concussion?
A concussion is a mild traumatic brain injury (mTBI) resulting from an impact to the head, face, or neck. They can also occur as a result of an impact to other areas on the body which transmit the forces of the blow towards the head. Sometimes, doctors will ask for an MRI or CT scan to be done to rule out any internal damage, depending on how the injury occurred, but these scans aren’t always necessary to diagnose a concussion.
When concussions were first introduced, it was believed that they were the result of a “coup-contracoup” injury. In other words, the brain would move against the front & back of the skull. That movement would injure the grey matter of the brain, causing your typical concussion symptoms.
However, new research has shown that it is a stretch & shear mechanism, where the acceleration and deceleration of the brain water impact causes the grey and white matter to move at different rates of speed. This difference in movement pulls & stretches the nerve cells creating an electrical storm. That electrical storm is what is thought to lead to the symptoms of the concussion.
Check out this video to know more about concussions and learn about some old treatment myths.
A concussion doesn’t change how your brain looks, but it changes how it functions. That’s why, typically an individual will experience rapid onset, short-term neurologic symptoms. Let’s see what those symptoms can be.
Symptoms of Concussion
A concussion can be diagnosed if there was a direct bodily impact and only ONE symptom. Some common symptoms of concussions include:
- Pressure in the head
- Nausea or vomiting
- Blurred Vision
- Balance Issues
- Drowsiness, confusion & fatigue
- Neck Pain
- Sensitivity to light or noise
- Feeling slowed down or “in a fog”
- Difficulty with memory or concentration
- More emotional, irritable, moody, nervous, or anxious
Take a second and look over that list again – how often do you experience one or more of those symptoms? It happens! The important part of diagnosing a mTBI comes from the impact transmitting forces on the head. That, in combination with one or more of the above symptoms, can indicate a concussion.
The hardest part of diagnosing a concussion in children is having them recognize those symptoms & know how to express them. Especially for young children. While some are easier, such as a headache or nausea, “my head hurts, my tummy feels funny “; others are much more complicated. For instance, irritability could be mistaken for a temper tantrum, and difficulty concentrating can be easily confused with a typical 3 year-old’s short attention span.
So how do you know? Well for starters, if there is an impact to the head it’s better to be safe than sorry & consult your primary healthcare provider. If you aren’t sure, and your child isn’t acting like themselves, contact your primary healthcare provider. Think back on the last few days – did your child suffer any falls or injuries? It may seem overly cautious, but it’s always better to be proactive when it comes to concussions!
But why are children more at risk?
Children are uniquely susceptible to concussions for a variety of reasons. Some are biological and developmental, while others are a result of the typical child’s lifestyle.
Think about your child’s average day – does it usually include school, camp, or maybe some sort of activity or sport? Most children spend their day running around, doing a variety of activities. With those activities come risks!
Sports are a pretty well-known and well documented source of concussions in children. From contact sports such as hockey or football, to sports that often times have incidental contact or falls such as soccer or gymnastics, these are fairly obvious causes of head injuries. But did you know that concussions can, and do, happen in school settings or at home? In fact, almost 70 % of concussions in children occur in a sport or school setting.
Not all concussions happen as a result of sports – many happen simply as a slip and fall, or a random accident. Some happen at home, some at school, some even on family walks. I don’t know about you, but my children were pretty clumsy growing up and fell around the house a lot. Slipping on the hardwoods trying to be a rockstar, losing their balance on a curb practicing their balance beam routine, running into a pole while playing tag, you name it, they’ve done it. Any of those minor falls could cause enough force to impact the brain.
Maybe you’re thinking “But I’ve had worse falls than that and haven’t ever had a concussion. Why is it different for children? “. This is where the science comes in.
Brain Development & Concussions
Did you know that our brains are still developing and changing up until the age of 25? While our heads are 90% the size of an adult skull by the age of 5, our brain doesn’t fill that whole skull the same way an adult brain does since it still has lots of growing to do. This then leaves more room within the skull for the brain to move around in.
So, if a child suffers a bump to the head, the brain can move around more. As a result, it injures the nerves and tissues more than it would an adult brain. Children also tend to have weaker neck muscles. Stronger neck muscles can help lessen the impact to the actual skull in a fall or collision. So, with a weaker neck, a large head with a comparatively smaller brain, when a child suffers an impact to the head it can cause more damage than if an adult suffered the exact same impact.
Children have one very special advantage over adults when it comes to concussion recovery – Neuroplasticity. Neuroplasticity is the ability of the brain to change and heal itself. This ability tends to be stronger in childhood when the brain is making more and more connections daily as children develop. Into adulthood, the brain still has this function but it is not as quick or as efficient. When children’s brains are injured, they tend to recover with minimal medical intervention, if the right steps are taken to protect the brain.
The Do’s and Don’ts of Concussion Rehabilitation
Here’s a quick list of the best do’s and don’t when it comes to concussions in children. Remember, it is always best to follow the advice of your primary healthcare practitioner first!
- DO approach your primary health care provider if you think your child has suffered a head injury or hard fall
- DO seek out a certified paediatric concussion practitioner
- DO set a baseline for your children – this makes it easier to see the effect of a concussion if it happens
- DO rest for the first 24 – 48 hours to get a full understanding of symptoms
- DO follow your unique, specified guidelines for return to activities
- DO conserve your energy and focus on completing basic, daily tasks – when suffering from a concussion, you can wear out more quickly than normal.
- DON’T wake up every hour unless advised by your medical practitioner – more sleep is better and necessary for healing
- DON’T reduce the use of electronics entirely – prioritize your usage and take frequent breaks
- DON’T be put into dark room to avoid all activity – you can do light & cautious activity with rest as needed
- DON’T participate in activities that put you at a risk of re-injury – while light cardio in a safe setting can help you to recover better, intense contact sports put you at a greater risk for another concussion and more problems down the road
- DON’T continue your activities at the same pace as before – take things slow, as you may need to reduce your workload in order to avoid worsening symptoms
- DON’T assume you are fine because your symptoms improve – it can take double the time for the brain to recover fully!
With all that in mind, it makes sense why receiving the appropriate treatment as soon after a concussion as you can is vital for long term recovery.
What are the treatment options? What does recovery look like?
With proper care & treatment, concussions typically have good recovery outcomes! On average, it takes 22 – 30 days to fully recover, but many patients see symptoms fade within the first 10 – 14 days. However, this can be misleading.
Patients will often be told to return to school, sports or work once their symptoms have subsided – only to have persistent symptoms down the road. This is because, while symptoms can disappear, the brain isn’t actually fully healed yet. In order to allow the brain to heal completely, it often means waiting just a little bit longer before returning to your typical routine. It’s also important to help prevent another, more serious concussion from occurring.
Secondary Concussions & PCS
Secondary concussions, and persistent concussion symptoms (PCS), happen as a result of returning to too much, too soon.
Concussions that occur too soon after the initial injury are called secondary concussions. As a result of returning too soon, secondary concussions can be more damaging and longer lasting. A secondary concussion that occurs within 5 days of the first can increase the damage to nerve cells and even cause cell death if severe enough. This adds on to the importance of waiting until the brain is fully healed to prevent symptoms from reappearing and to enable the brain to heal itself enough so that another injury will not leave lasting damage.
Persistent concussion symptoms, also known as post-concussion syndrome, present in a similar manner to the initial concussion, but the symptoms are just not getting better on their own. Improvements usually happen more slowly in cases of PCS than for the initial injury. So, to help avoid issues in the future with concussion symptoms, it’s important to have an accurate, personalized plan to follow to return to activity.
Take a look at our Treatment Approach
Our physiotherapists perform a comprehensive assessment to get a better idea of exactly what your child needs to recover quickly and get back to what they love! All children are unique, and we treat every patient with the combination of treatments that will best suit their needs. Using an evidence-based concussion protocol, we will provide your child with an outline of exactly what your child can and can’t do at every stage of their concussion recovery.
Our trained concussion practitioners will administer the Buffalo Concussion Treadmill Test; a specialized test to assess exactly how your child’s concussion has impacted their body systems. It allows our physiotherapists to better understand the underlying cause of their symptoms & the best way to get them back to their normal routine quickly but safely.
But there is more to our treatment approach than just that!
In addition to our specialized concussion rehab program, our paediatric physiotherapists will utilize their other tools to help combat your child’s concussion symptoms. Neck pain is a common symptom of mTBI’s. A combination of soft tissue release, joint mobilizations & motor control exercises will be used to help ease your child’s pain.
Vestibular rehab is another great tool that can be used in conjunction to our specialized concussion rehab protocol. Our vestibular system provides information for our sense of balance and spatial orientation and allows for coordinated movement. It also contributes to appropriate head and eye movement, which can become compromised following a concussion, which causes headaches, dizziness, and balance issues.
At All About Kids Rehab, our physiotherapists have the tools to assess, diagnose and treat vestibular dysfunction as a result of a concussion. One of the measures we use is the Vestibular Ocular Motor Screen, which is a series of tests to assess different types of eye movements & reflexes. This will give us a better idea of where to focus our treatment and give us a way to monitor your child’s progress over time!
Our concussion rehabilitation program at All About Kids Rehab uses an integrated, multidisciplinary approach to help get your child back to normal as safely as possible. Our 1 on 1 treatment sessions utilize a wide variety of treatment methods, including soft tissue work, strengthening, electrical muscle stimulation, endurance training and vestibular rehab. Most importantly, we can help your child not only overcome their concussion but also reach their goals!