CONCUSSION

Toronto Brain Health provides evidence-based assessment and treatment services for concussion management. Our services are open to individuals (18+ years) who need education / management for a recent injury, who are at risk of a protracted recovery, or who are experiencing concussion with persistent symptoms (also known as post-concussion syndrome). We provide assessment to diagnose the injury and identify barriers to recovery. Our treatment is evidence-based and targets barriers to recovery. Neuropsychologists play an important role in concussion management, particularly for the 15-20% of individuals who are stuck in their recovery process or individuals recently injured but at risk for a protracted recovery. 

Concussion Definition

Concussion (also referred to as a mild traumatic brain injury) can be defined as an immediate and temporary change in mental functioning following a direct blow to the head or body resulting in an “impulsive” force transmitted to the head. This can include injuries incurred due to falling, assault, sport or motor vehicle accident (e.g., whiplash). A diagnosis of concussion does NOT require a loss of consciousness. Further, structural changes to the brain are not usually visible on MRI or CT scans following a concussion.

 

Symptoms typically reported soon after a concussion can be physical (e.g., headache, dizziness, nausea, balance, sound/light sensitivity), cognitive (e.g., concentration and memory difficulties), and/or emotional (e.g., irritability, feeling down, anxiety, low stress tolerance). Experiencing these symptoms following injury however is not necessarily diagnostic of a concussion, as "post-concussive symptoms" can occur as a result of many different conditions and injuries. The good news is that most individuals can expect a full recovery, with symptoms resolving within a few days to a couple of weeks. In 15-20% of cases, individuals may experience persistent post-concussion symptoms and recovery can take longer. 

Concussion Assessment

At Toronto Brain Health the first step is to schedule an initial consultation with a neuropsychologist in order to determine your needs and likely barriers to recovery. While a neuropsychological evaluation may be the next step, many individuals do not require this in-depth assessment. If a neuropsychological evaluation is not indicated, a preliminary treatment plan is discussed, which may include referral to other disciplines / health professionals in your area. We only refer our clients to disciplines and related practitioners who provide evidence-based assessment and treatment for concussion and/or related issues. There are a growing number of expensive assessment and treatment services being offered to individuals with concussion, which are unfortunately not evidence-based (e.g., there is no evidence that the treatment works, the research findings are inconclusive, or the study methodologies are of poor quality). 

Initial consultation includes: 

  • Records review of injury, past medical, neurological, physical and psychological history, assessment of injury and related symptoms (physical, emotional and cognitive) and medication use.

  • Psychological screen (e.g., anxiety, mood, trauma, sleep disruption, stress tolerance).

  • Cognitive symptom screen and determination if a comprehensive neuropsychological assessment is indicated. 

  • Preliminary treatment plan to address neuropsychological, psychological and physical barriers to recovery. 

  • Referral to other professionals in the community as needed.

  • For acute injury (< 2 weeks ago), we provide diagnosis, education and guidance to reduce risk for a protracted recovery (1-2 sessions). 

Concussion management

Following a concussion, a brief period of rest is recommended for the first 24-48 hours and then the individual is encouraged to become gradually active while staying below their cognitive and physical symptom exacerbation thresholds. At Toronto Brain Health we provide education and guidance to individuals dealing with the acute effects of a recent concussion as well as to those who continue to experience symptoms beyond the natural recovery period, referred to as concussion with persistent symptoms or post-concussion syndrome. Treatment following an acute or recent concussion typically comprises one or two sessions which include initial consultation, education and guidance to optimize recovery. For individuals experiencing persistent symptoms, treatment duration and approach depends on the nature and extent of symptoms. We offer individually tailored intervention to each person. We also provide guidance and referral to other disciplines to assist you in building your gold standard treatment team. 

Neuropsychological and psychological treatment

Many post-concussive symptoms are not unique to concussion. Although symptoms experienced immediately or shortly after injury can be related to brain injury, over time the brain heals and persistent symptoms can be maintained by many other factors, known as barriers to recovery. Such factors can include depression, anxiety, avoidance of triggers (e.g., sound, lights, physical exertion), sleep problems, fatigue, pain (e.g., headaches), preoccupation with symptoms, and misinformation by well meaning family and health professionals. These factors can further interact to escalate each other (e.g., anxiety can drive pain circuits in the brain) and maintain or even worsen symptoms. Fortunately, neuropsychologists knowledgeable in concussion management can treat most barriers to recovery and get you on the right track to feeling like yourself again. For more information see our concussion blog. 

 

Neuropsychological treatment at Toronto Brain Health may include the following: 

  • Education and overall concussion management / guidance

  • Biopsychosocial approach to the treatment of chronic pain / physical symptoms (e.g., headaches, light/sound sensitivities), in conjunction with physiotherapy and neurology at other clinics or programs.

  • Treatment of anxiety, depression, irritability, trauma, sleep problems, symptom preoccupation, low stress tolerance.

  • Cognitive exertion training and cognitive rehabilitation (attention, memory etc.) if indicated.

  • Return to work/school planning, hardening and guidance.

  • Many of our psychologists provide services under the WSIB Community Mental Health Program, insurer benefit plans and auto insurance for motor vehicle accidents.