PCS Treatments

For the vast majority of concussions, simply resting and gradually returning to activity under the guidance of a medical professional clears up concussion symptoms in a matter of days or weeks. This is the current standard of care, and has helped countless concussion victims through a full recovery. Sometimes, however, rest on its own isn’t enough, and so doctors may suggest trying active treatments to target symptoms that are not resolving on their own.

When should I consider trying active treatments?

The decision to augment traditional concussion recovery with active treatments is an important conversation with your doctor. Unfortunately, there are currently no empirical guidelines on when is most appropriate to begin active treatments, underscoring the importance of working with an experienced doctor who has helped patients navigate the process before. As a rule of thumb, most medical professionals suggest waiting at least several weeks after injury before beginning additional treatments, fearing that beginning active treatments too soon may actually hamper recovery by over-exerting vulnerable brain cells.

Lily Winton PCS

What treatments are available for Post-Concussion Syndrome (PCS)?

There are many treatments available to help concussion patients recover.  Below, we provide a list of treatments that are supported by peer-reviewed scientific publications. Every concussion is different, however, so what works for others may not work for everyone. PCS Treatments are employed in conjunction with one another, like the pieces in the puzzle you see below, because most people with PCS will likely have more than one symptom. 

Often patients will try many different treatments unsuccessfully before finding the right one. Patience is key. It may be slow going, but remember that almost all concussions recover eventually!

Vision Therapy (also known as oculomotor training)
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Who could this work for?

Common vision problems and symptoms following a concussion can include sensitivity to motion, difficulty with eye movements, eye pain and headaches, dizziness and balance problems, sensitivity to light, blurry vision, double vision, and peripheral vision problems. Patients suffering from these symptoms may benefit from vision therapy.

What is it?

Vision therapy includes a large range of techniques designed to help train specific aspects of the visual system, helping it return to normal after a concussion. A variety of different tools and exercises that help improve the accuracy of our eyes can be utilized in vision therapy.

Why it might work

The vision system is the largest in the brain – more brain areas are involved in processing visual information than any other system in the brain. This makes it particularly vulnerable to concussion – there are a lot of parts that can break down during a concussion.

Vision therapies can help in two ways. In some cases, the exercises may help repair damaged connections, returning them to normal. In cases of more severe damage, the exercises can help the brain develop techniques to compensate for longer lasting deficits.

Neuro-Optometric Rehabilitation
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Who could this work for?

Neuro-Optometric Rehabilitation is a specialized, individualized treatment regimen for those who have visual deficits as a direct result of traumatic brain injuries, physical disabilities, and other neurological insults.

What is it?

Neuro-Optometric Rehabilitation therapy utilizes therapeutic prisms, lenses, filters and occlusion to help stimulate parts of the brain which are not functioning to their highest potential, due to interruptions caused by the brain injury. The rehabilitation plan and graded return can be tailored to the specific individual’s needs when it comes to returning to school, work, athletics, or other visually demanding tasks.

Neuro-Optometric Rehabilitation is not to be confused with vision therapy, which is a separate therapy (see above) needed by some brain injury survivors.

Why it might work

A neuro-optometric rehabilitation treatment plan can be designed on an individualized basis to improve specific acquired vision symptoms based on standardized diagnostic criteria.

Learn more: We collaborated with the Neuro-Optometric Rehabilitation Association (NORA) to create an educational resource on common vision problems and symptoms following a concussion. Click here to view or print.

 

Vestibular Therapy (also known as balance therapy)
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Who could this work for?

Vestibular therapy can be particularly helpful for patients who are suffering from persistent dizziness, vertigo, or balance problems after a concussion.

What is it?

Vestibular therapies encompass a wide range of techniques, including habituation exercises, gaze stability training, and balance training. Depending on what types of activities tend to make balance symptoms worse, doctors can develop training plans to alleviate symptoms.

Why it might work

Our sense of balance relies on input from many different systems in our brain, including the visual system, our sense of proprioception (which tells us where our body parts are in space), and our vestibular system (that tells us how our body is oriented and moving in space).

In some cases, doctors can isolate what systems are causing problems, opening the door for targeted treatments that can improve overall outcomes.

Physical Therapy
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Lily Winton PCS

Who could this work for?

Physical therapy can be helpful for patients with certain types of headaches, and for patients who may have suffered orthopedic injuries at the same time as their concussion.

What is it?

Physical therapy is a wide discipline of medicine that treats ailments through physical means, as opposed to surgical or pharmacological treatments. This includes techniques such as massage, exercise therapy, and heat treatments.

Why it might work

Often times, the violent collisions that cause concussions also cause other injuries, especially when whiplash is involved.

Sometimes, those other injuries can interact with the concussion, making the symptoms worse. Physical therapy can help concussions by relieving injuries that may be making the concussion symptoms worse.

Exertional Therapy
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Who could this work for?

Exertional therapy can be helpful for patients who are experiencing a slower recovery than may otherwise be expected.

What is it?

Exertional therapy involves a concussion patient performing light aerobic activity in a controlled and monitored environment. This could be on a treadmill, in a pool, or other setting with no risk of inadvertent head impact.

Doctors will design a custom plan for each patient that helps them raise their heart to a specified level. It is extremely important that this be done under the close supervision of a medical professional, as over-exertion can hamper recovery.

Why it might work

Exercise has a very well documented effect on health – simply put it is good for our bodies. By having patients lightly exert themselves in a controlled environment, doctors seek to take advantage of these benefits.

Cognitive Behavioral Therapy (CBT)
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Who could this work for?

Cognitive Behavioral Therapy (CBT) can be very effective for concussion patients who are suffering from mood changes after a concussion, most commonly depression or anxiety. This is especially helpful for patients with longer term symptoms, such as patients suffering from post-concussion Syndrome.

What is it?

CBT is a psychological therapy frequently used to treat problems with mood, including depression and anxiety. CBT helps patients develop the ability to identify negative thought patterns that contribute to a patient's individual difficulties, and teaches concrete skills that patients can use to help manage them.

Why it might work

CBT is a highly effective treatment for many mood and anxiety disorders, often providing clinically meaningful relief within weeks or months. In the setting of concussion, preliminary evidence suggests that CBT may be able to similarly help patients develop coping strategies to help manage their symptoms.

Cognitive Rehabilitation Therapy (CRT)
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Who could this work for?

Cognitive Rehabilitation Therapy (CRT) is a service provided by speech language pathologists to help individuals experiencing cognitive difficulties that impact daily functioning.  CRT can be helpful for patients experiencing changes or deficits with attention, memory, executive functioning (e.g. planning, organizing, time management), and word-finding skills.

What is it?

CRT is a goal-oriented approach to restoring and improving functional cognitive skills. A referral for CRT typically includes a comprehensive cognitive-linguistic evaluation assessing attention, memory, executive functioning, and expressive and receptive language skills. Treatment includes a functional approach that is both restorative and compensatory in nature to help support any areas of observed cognitive weaknesses.  Patients are typically actively involved in developing goals to improve their overall functioning.

Why it might work

CRT is an effective treatment for individuals who are struggling to manage daily tasks in the home, work, and community settings as a result of cognitive changes.  This may include difficulty managing bills, medication, time or emotions, difficulty sustaining attention in conversation with loved ones or at work, and difficulty studying or keeping up with job responsibilities.  CRT can help patients return to an academic or workplace environment with appropriate strategies and supports.  CRT is evidence-based and able to address the functional needs of the concussion population.

Neuroendocrine Assessment of Pituitary Function
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Brain injuries can be complex and create complications in locating the source of your symptoms. Unlike the active treatments listed above, this therapy is investagtional. Prior to homing in on active treatments, or if active treatments are not proving effective, it may be worth attempting to rule out certain underlying causes by undergoing investigational therapies like this one.

Who could this work for?

Neuroendocrine assessment of pituitary function may be helpful for those experiencing PCS symptoms, especially brain fog, fatigue, listlessness, and depression, that are not responding to active therapies.

What is it?

The specific tests run may vary from clinic to clinic. One comprehensive concussion clinic recommends a fasting blood test for prolactin, T-4, TSH, ACTH, cortisone, growth hormone, and testosterone along with vitamins B-12 and D. If abnormal levels are found, a referral to an endocrinologist is recommended.

Why it might work

The pituitary gland can be injured with traumatic brain injury, including concussion. Pituitary gland injury can negatively affect thyroid and adrenal gland activity or affect testosterone and growth hormone levels, and can result in symptoms that mimic PCS symptoms.

We'll review experimental therapies soon. Are there experimental therapies that have worked for you? Let us know at info@concussionfoundation.org.

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