Post Concussion Syndrome: Ten reasons why symptoms persist
A concussion can happen to anyone. It can affect people who were perfectly healthy before their injury and those who were already managing a chronic illness. It can happen to people who always had a “bad memory” and those who never had to write anything down. It can affect people who found resilience a little easier and those who take awhile to adjust to something new. All of these factors impact someone’s concussion recovery.
In this blog post I’ll give you a brief overview of Post Concussion Syndrome and why some people have a harder time recovering from a concussion. Then I’ll talk about why cognitive symptoms in particular might linger based on my own personal experience and what I’ve seen in clinic.
Post Concussion Syndrome
Post concussion syndrome (PCS) is a complex disorder characterized by persistent physical, cognitive, visual, sleep, and/or emotional symptoms. Concussion symptoms typically resolve in a few days or weeks. PCS may be diagnosed when symptoms persist for weeks or more after the initial injury.
The medical community is still learning about post concussion syndrome. While the disorder is not fully understood, there are known risk factors that increase someone’s likelihood for persistent symptoms.
PCS Risk Factors
There are some known risk factors for Post Concussion Syndrome. If you have one of these risk factors injury might take a little longer.
History: People who have had a previous concussion, brain injury, or learning disability are more susceptible to PCS
Age: Older adults have an increased risk for developing PCS
Sex: Women are more likely to be diagnosed with PCS
Socio/emotional factors: People with a history of depression, anxiety, post-traumatic stress disorder, significant life stressors, a poor support system, and/or poor coping skills develop PCS more often
Ten reasons why cognitive symptoms persist
Persistent cognitive symptoms are really frustrating. Brain fog, trouble focusing, and disorganization all take their toll. Usually these skills improve after participating in a rehabilitation program. However, due to the complexities of health and life not everyone feels “back to normal” after their treatment program. Personally it took me a long time to see progress with cognitive symptoms.
If you or someone you know is frustrated by persistent changes in thinking skills after a concussion, consider these reasons why symptoms persist:
1. Medical conditions
Patients with persistent brain fog, difficulty concentrating, etc. may have other medical conditions contributing to the problem. Hormone imbalance, autoimmune disease, B-vitamin deficiency, mental health disorder, etc. all impact thinking skills. Ask your doctor if you should get tested for other medical conditions.
2. Physical symptoms
Thinking skills are complex processes involving different types of sensory input. Changes in brain functions such as balance and vision may be causing your difficulty with thinking skills. Migraines and other types of chronic pain also impact your concentration and energy levels. Some people do not see cognitive improvement until these problems are addressed. Ask your doctor if you should see a physical therapist, occupational therapist, or other healthcare provider.
3. Coping skills
Changes in cognition, work/school ability, physical symptoms, etc. after concussion are a type of loss. Any time something in life changes unexpectedly it takes time to adjust. It may take some time to understand the injury and adapt.
4. Stress levels
Some people experience stress from the injury itself. Stress is also common after sudden changes in health and daily activities. Some people already had high levels of stress in their life before the injury. High levels of stress may prolong recovery. Stress also has a negative impact on thinking skills, sleep, and physical symptoms like headaches. Talk to your doctor about stress management if this is impacting your recovery.
5. Executive functioning skills
Executive functioning skills are strategic thinking skills. They help you stay focused and organized. Executive functions are important for brain injury recovery. They allow you to learn about brain injury, understand your brain’s changes, and adapt. Executive functioning skills may be impaired following a brain injury. This makes everyday tasks harder. This also makes participating in rehab and managing your recovery harder. If life feels disorganized and unpredictable, you may need treatment to improve these skills.
6. Error sensitivity
Memory mistakes, feeling disorganized, etc. are all normal to some degree. After a head injury, you may be hyper-aware of cognitive difficulties. It can be hard to know what’s “normal” and what’s new from the brain injury. Each mistake may seem like a big deal. Focusing on mistakes can actually make them worse because they distract you from focusing on how to be successful. Try to reframe your thinking. Instead of saying, “I hate it when I’m late. This isn’t me.” you can say “Today I was late because I lost track of time. Next time I will set alarms to help me stay on track.”
7. Jumping back in too soon
The goal of therapy is to help you understand your condition, current strengths/challenges, and strategies to help bridge the gap between challenge and success. You may not be 100% when you discharge from therapy. It’s important to work towards a systematic return to activity instead of doing everything at once. Moving too fast can leave you feeling fatigued and scattered.
8. Waiting to feel 100%
Some people wait to challenge their thinking skills until they feel 100%. This actually hinders recovery. You may not be able to return to full-time work, school, volunteering, etc. right away, but you should “test the waters” as your symptoms allow. The brain grows through challenge, variety, and movement towards meaningful activities.
9. Treatment history
Not all healthcare providers have experience with the best approaches to treat mild head injuries. If you have not seen a therapist trained in mild head injury, ask your doctor for a recommendation to a multi-disciplinary concussion treatment team. Some people also benefit from seeing the same healthcare providers for multiple rounds of therapy.
10. Recovery speed
It does take time for the brain to heal. Underlying health conditions, how many skills/systems were impacted, how soon you started treatment, etc. all may impact recovery speed. Keep applying your strategies and challenging your brain. Progress over time is not only possible but expected.
Many people are surprised by how many factors impact thinking skills. This may seem overwhelming, but it should also give you hope. If you feel stuck moving forward with cognitive recovery, consider if one of these ten factors may be impacting your recovery.
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Disclaimer: This content is for informational purposes only and does not substitute personalized medical advice, diagnosis, or treatment. Always consult your doctor or other qualified healthcare provider with questions, and before starting any nutrition, diet, exercise, fitness, medical, or wellness program.