Management of post-concussion balance difficulties

Why does it happen?

In short, a concussion causes brain cells to be temporarily damaged.  Thankfully, these brain cells will heal!  Until they heal, communication between brain cells is more difficult.  This difficulty results in concussion symptoms because the brain is having to work harder, with injured connections and less energy, trying to perform its usual numerous actions.   This very helpful blog post explains exactly what happens in the brain that causes balance symptoms: What happens to your brain?

How else could this symptom manifest?

• Tripping and falling more easily
• Appearing more “clumsy”
• Nausea or vomiting

Are there any helpful medications/supplements?

“Fortunately, your brain can repair and heal itself! It is valuable to remember that your brain can be retrained. Networks between neurons can be reshaped, rebuilt, and strengthened.”  With time, care, and occasionally with medications and natural health products, quality of life and symptoms will get better.  Though this list is not extensive, these are a few medications/supplements to discuss with your concussion provider that may be helpful for your child’s balance symptoms:

• Omega-3’s (while not targeted to a specific symptom, helpful in overall concussion recovery)
• Multivitamin (If lacking a well-balanced diet, a daily multivitamin is important since good nutrition is essential for healing. Also, it’s important to have adequate Vitamin D levels at baseline as Vitamin D deficiency can lead to prolonged recovery.)
• Ondansetron (Zofran)

The FDA does not regulate Natural Health Products (NHP’s) in the same way as prescription medications and therefore when choosing a NHP it is important to consider interactions with other NHP’s and medications, whether the product has undergone 3rd party testing (like that done by Consumer Lab), and the number of ingredients in each product.   The companies we typically trust, because they conduct 3rd party testing and have fewer added ingredients include:  Metagenics, Pure Encapsulations, Nordic Naturals, Barleans, Kirkland Signature, NatureMade, and Neurobiologix. 

What else can we do?

1. Encourage your child to listen to his/her body. If an activity he/she is doing is not making his/her balance feel worse or making him/her feel dizzier, it is likely okay to continue (assuming the activity has no risk for another brain injury).  If the balance/dizziness  are worsened by an activity, it is best to stop, take a break, and then try again.  Listening to his/her body, rather than “pushing through” an activity despite worsening symptoms, will greatly help recovery. An easy rule of thumb is not let their balance symptoms reach a number >5/10.  So, if for example they start their day with nausea rated 2/10 and being in the classroom causes it to go up to a 4/10, it’s okay to keep pushing; however, if that nausea reaches to a 5 or greater, stop and take a break. 
2. Avoid crowded places such as the grocery store, shopping areas, and hallways in school. Not only do crowded pose a greater risk for a fall, but also can also cause visual overstimulation, which often exacerbates impaired balance.
3. Avoid activities that could result in a fall. Though we do often recommend exercise throughout concussion recovery (assuming certain parameters have been met) we want to avoid another injury, which could worsen concussion symptoms. 
4. A referral to a concussion trained physical therapist for vestibular rehab is often the best course of action for persisting balance issues post-concussion; they have great techniques to help alleviate this condition and the symptoms it causes.
5. Though parents know our children so well, we can’t read their minds. To complicate things, their concussion symptoms are often not obvious us, unless they are specifically verbalized outload.  Because of this, it can be easy to doubt that they truly feel the symptoms they are reporting.  It is so important that we validate them, letting them know that that we believe them. Then, it is important to encourage them that these concussion symptoms will resolve and that they will return to normal.

Most children recover from a concussion in 3-4 weeks, and during that time, symptoms typically improve very gradually.  If this is not the observed trend, or symptoms are worsening, it is very important to talk to your concussion provider. 

References:

https://www.cdc.gov/traumaticbraininjury/pdf/pediatricmtbiguidelineeducationaltools/2018-mTBI_Recovery-508.pdf

https://www.concussionalliance.org/what-happens-to-your-brain