Much like the assessment of mTBI, the subsequent management and advice given to patients following diagnosis is variable. Most healthcare facilities have a minor head injury advice leaflet that they give to such patients, but it often fails to usefully answer their most pressing questions:
What can I do immediately?
When is it safe for me to drive?
When should I return to work or school and how should I go about doing this?
When can I play sport again and how should I go about doing this?
I am asked frequently 'what treatments are available for concussion (aside form rest!).' I have been present on many occasions when the phrase “CT is normal, they can go home” has been used. While this is probably true, it fails to fully understand the potential negative effects of not properly addressing and managing an underlying mTBI.
Treatments such as progressive cardiovascular exertion, vestibular and cervico-genic rehabilitation, visual processing and perhaps most importantly, education can all play a huge role depending on the cause of the concussion. It is perhaps most useful to think of concussion as an injury to the brain and much like an injury to a muscle there are treatment steps to progress through before it is safe to use fully again.
Currently concussion follow-up clinics employing some of these treatments are few and far between in the UK and while most mTBI’s recover without incident there is a small percentage that require specialist opinion. If symptoms are persisting longer than 14 days in an adult (28 in a child) or the patient has experienced more than 2 concussions in a 12-month period it is wise to seek this opinion.
Hopefully, as more time passes and the research into and awareness of mTBI amongst clinicians increases, we can start to standardise care and reduce the negative long-term complications of this injury.