The Shift Model
At Shift, we utilize an evidence-informed approach to Concussion Management. That means that many of the rehabilitation strategies and recommendations we apply at the clinic are based on current evidence and expert opinion in the field of concussion management, and also take into account clinician experience and patient preference.
Experts agree that this injury often requires an interdisciplinary approach to treatment – particularly for those suffering from persistent symptoms. That is why you may find that our team recommends multiple treatment approaches and service providers both within and outside of the clinic in some cases. Each patient experiences concussion in a different way, which is why our rehabilitation recommendations may vary from patient to patient.
The types of rehabilitation methods employed at Shift depend largely on the characteristics and presentation of each individual patient. Some common interventions prescribed and carried out at our facility are included below:
Treatment for Headaches and Neck Injury
Headaches are one of the most common features of concussion and can present in a variety of different ways. Our clinicians use information gleaned from the initial assessment to help categorize the headache-type experienced by each patient and treat it accordingly. In some cases, lifestyle accommodations and energy management strategies are enough to significantly reduce head pain. In other cases, our clinicians may utilize other conservative treatment strategies such as manual therapy techniques, acupuncture, specific exercise and/or work or school accommodations to help get pain under control. Specialist interventions may be required in more severe cases.
What's more, many concussions occur simultaneously with neck injury, and the cervical spine has been a well-documented source of headaches, dizziness, and many other symptoms that overlap with concussion. It can be very challenging to determine the source of symptoms when there is both neck and head involvement. What’s more, it’s been shown that 30% of patients with co-existing neck involvement may not even complain of neck pain or stiffness.
Rehabilitation for the neck may include a variety of manual therapy techniques to reduce muscle tension, improve joint mobility/range of motion and reduce pain. You may also complete exercises in the clinic and at home to help improve strength and overall function
Dizziness and imbalance is another common complaint post-concussion, and are hallmark symptoms (but not the only symptoms) of vestibular-ocular dysfunction. These systems work in an interconnected fashion to give us a moment-to-moment sense of our position in space and an accurate perception of our surroundings. When these systems are not working optimally, it can be difficult to tolerate motion (ourselves or objects around us), busy spaces (like the grocery store) and can also make it difficult to carry out visual tasks such as reading and writing. It has been shown that those who exhibit difficulty with these systems after a concussion may be at risk of a longer recovery – which is why early intervention is imperative.
Vestibular-ocular rehabilitation involves a variety of exercises that may incorporate motion, balance, and/or visual tracking to “re-train” the brain so that it can function more effectively. These exercises may provoke some dizziness, but it is important to expose yourself to these sensations in order to overcome the “error-signal” your brain is experiencing.
For those with significant impairment of the visual system, it may be recommended that you see an Optometrist who specializes in head injury before carrying out the rehabilitation described above. It’s important to note that even though your clarity of vision might be unaffected by the injury, the overall effectiveness and efficiency of your visual system may still be suffering. An Optometrist may also recommend a specific form of Optometric Vision Therapy in some cases.
Exercise and Activity-Based Rehabilitation
Contrary to past guideline recommendations, new research suggests that complete physical rest post-concussion may actually be detrimental to recovery and produce further difficulties with rehabilitation down the road. A “strict rest” approach may lead to cardiovascular deconditioning, and when coupled with injury to the nervous system this can lead to more pronounced intolerance to activities requiring physical and/or cognitive exertion. We all know that for many health conditions (such as diabetes, high blood pressure) exercise provides a host of health benefits, and it appears the same may be true for concussion.
Gentle aerobic exercise initiated even in the acute (early) stage of concussion recovery may be beneficial. That said, it should be applied at an appropriate level of intensity (not too strenuous), and involve activity that is suitable to your preferences and fitness level. In some cases, exercise may be applied in the clinic under supervised conditions, and other times a program may be prescribed for you to carry out at home.
Lifestyle Strategies, Cognitive and Mental Health Supports
Our clinicians will provide advice and recommendations around schedule regulation, daily life activities, work obligations, school and sport participation where required to help support your recovery. These recommendations are based on your functional status, clinical findings, and will take into account any existing recommendations provided by the referring Medical Physician when applicable. In addition, it may be recommended that you see one of our Occupational Therapists for additional cognitive testing. Occupational Therapists are uniquely trained to provide cognitive therapy and supports for patients experiencing continued and significant difficulty with attention, concentration and memory post-concussion.
We also know that mental health challenges are extremely common in individuals who suffer from persistent concussion symptoms. It's been suggested that one in five individuals will go on to experience clinically significant mental health symptoms post-concussion including anxiety, depression and post traumatic stress. In some cases our Occupational Therapists can offer support through talk therapy and cognitive behavioural therapy methods, but may recommend additional outside mental health supports for some individuals. We are here to support you, and you are not alone.
The decision behind returning to daily activity after concussion, whether that be returning to school, work or sport, is one of the most difficult decisions a clinician has to make. Here at SHIFT we have one thing in mind: safety. For this reason, exertion testing has an important role in evaluating symptoms prior to returning to daily activity, particularly sport.
One of the most unique aspects of our concussion management program is our exertional testing. Exertion testing is the last phase of your treatment plan, and is designed to test your physical limits to ensure that you will be able to meet the demands of your sport (or other activities in your life). It also ensures that your symptoms won’t relapse when your body is put under added physical and cognitive stress.
Typically, as long as symptoms do not arise during testing, or for 24 hours following, and all other clinical assessment measures are normal, you will be discharged from the program. Athletes returning to sport must obtain clearance from their Physician first. Your Shift provider will communicate your testing results with your Physician.
How Long will my Treatment Take?
Unfortunately, there is no one answer to this question. As you might guess, length of rehabilitation is individual and depends on a variety of factors including injury severity, chronicity of injury, general health status, and compliance with rehabilitation among other things. Our clinicians will do everything they can to assist you in achieving a speedy and complete recovery from your injury.
For some, good progress is seen very quickly with rehabilitation and for others it progresses more slowly. That said, our clinicians are constantly evaluating your level of functioning and measuring progress to be sure things are moving in the right direction. If at any point progress appears to be slower than expected, our clinicians are quick to apply different strategies or refer out for alternate care options when necessary.