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CONCUSSION

We are a multidisciplinary team providing concussion treatment in Toronto (and across Ontario via videoconferencing) informed by evidence-based guidelines for concussion management. We have significant experience treating adults (18+) who have 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 psychologists, who have doctoral (Ph.D.) and post-doctoral training and specialization in neuropsychology, in addition to practice areas in clinical psychology and rehabilitation psychology and physiotherapists, who have advanced post-graduate training in vestibular rehabilitation and concussion management. 

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 an initial consultation is scheduled with one of our experienced neuropsychologists, physiotherapists or both, depending on the nature of the symptoms. Most individuals experiencing persistent symptoms following concussion benefit from a multidisciplinary approach to evaluation and treatment. A multidisciplinary evaluation, completed in tandem by a neuropsychologist and physiotherapist, includes assessment of all areas affected by concussion including the following:

Neuropsychological consultation

  • Interview/ records review of injury, symptoms, medical, neurological and psychological history

  • Psychological assessment of anxiety, mood, trauma, sleep disruption, stress tolerance

  • Nature of pain / symptoms and their onset triggers 

  • Cognitive symptom evaluation, determination if comprehensive neuropsychological assessment is indicated 

  • Return to work readiness (also monitored during treatment)

  • Preliminary treatment plan to address neuropsychological barriers to recovery and referral to other professionals as needed.

Physiotherapy assessment

  • Interview / assessment pertaining to injury, symptoms, medical, neurological and physical injury history

  • 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

  • Preliminary treatment plan to address physical barriers to recovery and consideration of referral to other professionals as needed.

 

Concussion Treatment

Post-Concussion Management involves a multi-modal approach to address the wide range of symptoms and impairments associated 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 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 (including the initial consultation) during which education and guidance is provided to optimize recovery. For individuals experiencing persistent symptoms, treatment duration depends on the nature and extent of symptoms.

 

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

Neuropsychological 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 even 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 physical medicine 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 physical medicine 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: 

  • Education and physical management of concussion, in conjunction with neuropsychology as needed.

  • 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 

  • 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.

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Phone: (416) 258-2367

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