Photo-Manual%20Therapy_edited.jpg

CONCUSSION

Toronto Brain Health offers multidisciplinary concussion rehabilitation in Toronto (and across Ontario via secure video and digital platform). Our assessment and treatment services are informed by evidence-based guidelines 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 offer assessment to identify barriers to recovery and evidence-based treatment to address them. Our team includes neurology, neuropsychology/psychology and concussion physiotherapy. 

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). 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 our clients receive assessment by neurology, neuropsychology, psychology and physiotherapy, dependent on the nature of their symptoms. Most individuals experiencing persistent symptoms following concussion benefit from a multidisciplinary approach to evaluation and treatment. Our multidisciplinary evaluation can include assessment of the following:

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

  • Neurological examination.

  • Cervical spine screening.

  • Visual testing for oculomotor function.

  • Vestibular assessment.

  • Proprioceptive, balance and gait testing (integration of proprioceptive, visual, and vestibular inputs)

  • Submaximal treadmill test for autonomic function.

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

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

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

  • Return to work readiness (also monitored during treatment).

  • Referral to other professionals in the community as needed.

At this time concussion neurology services are not available to clients with an active WSIB or auto accident claim. For all other patients, referral by a family physician or other medical specialist is required. 

Concussion Treatment

Post-concussion management involves a multidisciplinary approach to address the range of symptoms and impairments that can occur with a concussion. 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.

 

Our overall treatment approach to concussion with persistent symptoms is to identify and address physical, psychological and neuropsychological barriers to recovery. We offer individually tailored intervention to each person.

Neuropsychological and psychological treatment

Many post-concussive symptoms are not unique to concussion. Although symptoms experienced immediately or shortly after injury are likely to be related to brain injury, over time the brain heals and persistent symptoms can be maintained by many other factors. 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 even misinformation by well meaning family and health professionals. These factors often form barriers to recovery and can make it feel like the post-concussion symptoms are getting worse. Fortunately, neuropsychologists knowledgeable in concussion management can treat many of the 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 as needed 

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

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

  • Return to work/school planning, hardening and guidance, in conjunction with physiotherapy as needed.

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

Physiotherapy treatment

Concussion physiotherapy covers the physical management of concussion rehabilitation. Services include:

  • Education.

  • Recommendations for academic or employment accommodations, in conjunction with neuropsychology as needed.  

  • Sub-threshold cardiovascular exercise (physical exertion training), informed by the treadmill test for autonomic function (adaptation to a stationary bicycle is available).  

  • Vestibular rehabilitation, which can include gaze stabilization, habituation exercises, and canalith repositioning maneuvers.

  • Proprioceptive and balance training

  • Cervical spine rehabilitation.

  • Individualized exercise prescription for progressive strength and mobility training.

  • Integration of systems to work on higher-level functioning.

Infrared Video Goggles are used for in-depth testing of the visual and vestibular systems. When the eyes are visualized via an infrared camera with visual fixation removed, specific eye movements can be observed for more efficient and accurate diagnosis and individualized treatments. Wearing the goggles allows the clinician to see eye movements that are often suppressed in room light, where the patient can use any object to fix their gaze. The infrared cameras inside the goggles (one in front of each eye) allow the clinician to view the patient's eyes via a computer or laptop screen and record the eye movements for further analysis.

Neurology management

  • Education pertaining to head injury diagnosis

  • Education about symptom management including headaches, neck pain, sleep, worry. 

  • Medication advice, if appropriate.

  • Work in conjunction with neuropsychologists and physiotherapists, as well as with the referring family physician. 

At this time concussion neurology services are not available to clients with an active WSIB or auto accident claim. For all other patients, referral by a family physician or other medical specialist is required. 

Stamp_web-email use_small.png
© 2020 Toronto Brain Health. All rights reserved.
Privacy policy           Terms of use

20 De Boers Drive, Suite 535

Toronto ON, M3J 0H1

Email: contact@torontobrainhealth.com

Phone: (416) 258-2367

Fax:  (416) 342-1968