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Management of Concussion and Persistent Post-concussion Symptoms

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Tackling the Concussion Epidemic

Abstract

While the majority of patients who sustain a concussion will recover completely, a significant number will experience persistent symptoms beyond the expected period of recovery of two weeks in adults and four weeks in children. Up to 10–30% of patients will continue to experience symptoms three-months post-concussion. Early management strategies to facilitate recovery include an initial assessment by a medical professional to confirm diagnosis and rule out more serious injury, and a recommendation of relative physical and cognitive rest for the initial 24–48 hours post-concussion, after which symptom-limited activity can be resumed as tolerated. While most individuals will recover spontaneously, early referral to an interdisciplinary team of clinicians with concussion expertise may be indicated for individuals who are at risk of persistent or escalating symptoms. Early clinical management should focus on symptoms that are readily managed and will have a significant impact, typically sleep disturbance, post-traumatic headache and mood. Ongoing management may be required for functionally-limiting symptoms that are multifactorial in origin, including fatigue, environmental sensitivity, dizziness/vestibular impairment, and vision impairment. Emerging research supports a multifaceted approach to symptoms management that includes education, cervical rehabilitation, vestibular therapy, cognitive behavioral therapy, and sub-symptom threshold exercise.

This chapter will address recommendations regarding the assessment and management of persistent post-concussion symptoms. First, the diagnosis of concussion and expectations for normal recovery will be discussed. Second, risk factors for prolonged recovery and recommendations for early referral to interdisciplinary care to prevent persistent symptoms will be presented. Finally, the assessment and management of common persistent post-concussion symptoms will be discussed.

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Authors and Affiliations

  1. Division of Physical Medicine and Rehabilitation, Department of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Shawn Marshall

  2. Bruyere Research Institute, Ottawa, ON, Canada

    Shawn Marshall

  3. University of Ottawa, Ottawa, ON, Canada

    Shawn Marshall

  4. Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, ON, USA

    Jacqueline van Ierssel

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  1. Keenan Research Centre, St. Michael’s Hospital, Unity Health Toronto and University of Toronto (Neurosurgery), Toronto, ON, Canada

    Tom A. Schweizer

  2. Departments of Critical Care and Anesthesia, St. Michael’s Hospital, Unity Health Toronto and University of Toronto, Toronto, ON, Canada

    Andrew J. Baker

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Marshall, S., van Ierssel, J. (2022). Management of Concussion and Persistent Post-concussion Symptoms. In: Schweizer, T.A., Baker, A.J. (eds) Tackling the Concussion Epidemic. Springer, Cham. https://doi.org/10.1007/978-3-030-93813-0_8

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