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Post-Concussion Syndrome - Memory and Attention Impairments

Following a concussion – including from whiplash, there is a long list of symptoms which are identified as “Post-Concussion Syndrome” (PCS). Among those symptoms, changes in cognitive functioning is the longest lingering effect.

Most post-concussion patients complain of mental fog, poor recall, word-finding difficulty, and inability to focus on their work and other tasks. Some of my patients report missing their freeway exits, driving past their intended destination, and perseverating on a task (i.e. washing the same area repetitively without realizing it). This is not the typical “auto pilot” mode, it can be dangerous and can become a job retention issue.

The problem with undiagnosed PCS is that since it is not recognized, it goes untreated and may persist for years becoming Persistent PCS (PPCS). A student or worker with PCS is at risk for failing or losing their job, becoming anxious, and/or depressed because they know they used to be able to function more efficiently but now things are different but without medical acknowledgement. On top of this, there may be changes to personality and mood. The typical complaints reported by patient’s family are clinginess, being irritable, easily frustrated, and tearful.

Patients with PCS or PPCS will often report feeling less like they used to be and don’t understand why a mild head injury is having such debilitating effects despite their doctors telling them they are “ok.” Many have trouble sleeping and are mentally and physically fatigued before noon. It is important to understand that when a brain has been injured, it works even harder to rewire new pathways for processing information (depending on the areas that were injured).

The problem with undiagnosed PCS is that it goes untreated and may persist for years becoming Persistent PCS (PPCS). A student or worker with PCS is at risk for failing or losing their job, becoming anxious, and/or depressed because they know they used to be able to function more efficiently but now things are different but without medical acknowledgement. On top of this, there may be changes to personality and mood. The typical complaints reported by patient’s family are clinginess, being irritable, easily frustrated, and isolative.

Some post-trauma brain CT scans can show how many areas of the brain are over-stimulated as compared to an uninjured brain performing the same activity, which demonstrates why people often complain of mental and physical fatigue after a head injury, including the undiagnosed post-whiplash concussion. Rest is often recommended after a concussion, however, it can perpetuate the psychological symptoms of PCS. 1

Dr. Daniel Amen states, "The impact of head trauma is often overlooked in psychiatry. Even minor head injuries to vulnerable parts of the brain can cause problems for years to come. Dr. Amen is the pioneer of SPECT (single-photon emission computed tomography) Scan, which is the best imaging technology for detecting the functional damage from traumatic brain injury that is often not seen on CT and MRI studies."

Unfortunately, SPECT scan is not covered by most insurances and in the case of L&I (work) injuries, the injured worker is limited to short-term, traditional/basic therapies that result in early discharges due to lack of progress and then referred to "Independent Medical Evaluators" whose job it is to provide a report discrediting the injured person's complaints and closing the case. Too many PCS sufferers get written off by “Independent Medical Examiners” and are under-served by therapists too overburdened with productivity demands to really listen to their patients symptoms.

When an injured person is able to find a neuro-specialized clinic, a thorough PCS evaluation by a specialized occupational therapist provides practical and effective solutions (such as with Irlen Spectral Filter Lenses), not only for managing symptoms, but may also correct some of the dysfunctions associated with the head injury. Optimally, a multi-disciplinary approach will provide the best outcomes but only when each specialist is working as a team to prevent intervention gaps.

An in-depth PCS therapy evaluation by a neuro-specialized occupational therapist (OT) will include assessment of their patient while engaged in self-care and work tasks that have been impacted by their brain injury, in order to minimize overstimulation and distractions in their environments.

OT Interventions provide practical and effective solutions for managing symptoms and correcting some of the cognitive dysfunctions associated with the head injury, such as:

  • the patient’s energy and strength for task initiation and completion

  • the importance of good sleep habits

  • daily schedules to facilitate optimal functioning for home chores, work, and school

  • adaptive equipment and compensatory techniques for memory impairments

  • rule out scotopic sensitivity using the Irlen Method colored overlays and proceed with reading tasks and symptom management for a week

  • provide cognitive exercises among a host of other therapies

It cannot be overstated that the best outcomes are achieved by a multi-disciplinary team of specialists who collaborate to prevent intervention gaps. It is not necessary for all team members to be in the same clinic, a thoughtful and conscientious provider will refer to other specialists who have more expertise in addressing PCS and other complicated conditions.

As a patient, you have a choice in who you hire to be your healthcare partner. Choose relentless investigators who work hard at finding Integrative Therapeutic Solutions for your condition!

References:

  1. Medically reviewed by Jeanne Morrison PhD, MSN on December 1, 2016 — Written by Joe Bowman for Healthline online magazine

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