Management of post-concussion cognitive difficulty

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 cognitive difficulty: What happens to your brain?

How else could this symptom manifest?

• Only able to focus for a short period of time
• Trouble remembering instructions
• Difficulty keeping pace with workload
• Trouble understanding new information
• Feeling like they are thinking in slow motion
• Irritability
• Headache
• Sleep problems

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 cognitive 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 - More info on Vitamin D. )
• Amantadine
• ADD/ADHD medication

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 focus/attention/concentration worse, it is likely okay to continue (assuming the activity has no risk for another brain injury).  If any of these symptoms 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 cognitive symptoms reach a number >5/10.  So, if for example they start their day with “fogginess” 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 “fogginess” reaches to a 5 or greater, stop and take a break. 
2. Talk to your concussion provider and ask for detailed academic accommodation notes for school. Provide these notes to your school’s academic advisor/counselor, teachers, nurse, athletic trainer, etc. The sooner that teachers are aware of the concussion, the sooner they can help accommodate your child.  Some school accommodations typically requested during concussion recovery include: 

• lengthening time for assignments
• ability to postpone tests/quizzes. (Then, when ready and with extra time, take the test.  If performance is significantly below normal standards, have the ability to repeat the test.)
• ability to take breaks more often, and when symptoms continue to worsen, despite breaks, to be able to leave school early
• allowing assignments to be completed on paper, rather than electronically
• teachers providing printouts of lectured notes to minimize student multitasking required when taking notes from a lecture

     Typically, Austin-area schools do an excellent job accommodating students  with concussions. The key is frequent communication between the student and the teacher.  It’s important to let the teacher know that the student wants to do their best but isn’t yet able due to concussion symptoms.  Teachers can’t read the mind of the student and because concussion symptoms are often not obvious to an outsider (like a child with a broken bone wearing a cast); the teacher needs to be informed of how the student is feeling.  Though not often, if a parent is struggling with a school allowing all needed academic accommodations, we recommend meeting with the school and asking for their child to have a temporary 504 plan.  More information on 504 plans can be found here: 504 plan in Texas

3. Set a timer and break tasks down into smaller chunks, with more frequent breaks.
4. Print school work or provide written notes so that it can be viewed off computer screens, when viewing computer screens worsens symptoms.
5. Help your child by providing information in various ways to facilitate memory. It may be helpful for parents to read material outload and to repeat the information often, and slowly.
6. In cases of prolonged symptom recovery, cognitive behavioral therapy, with a psychologist or neuropsychologist can be very helpful, though this is not often necessary.
7. 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