Pre-Existing Conditions And Concussion Treatment (Part Two)

Most individuals who have sustained a concussion will recover within four weeks. Medical professionals are studying the “outlier population” of people who, for one reason or another, take longer to recover.

For some, it is a matter of age. The elderly population recovers more slowly from traumatic brain injuries. For others, concussion recovery can be complicated by a pre-existing medical condition related to the brain.

Dr. Nathan Cook, Pediatric Neuropsychologist, Sports Concussion Program, Massachusetts General Hospital for Children, is part of the Virginia Concussion Initiative and works primarily with “outlier” cases, which he describes as children and young people who take longer than the usual four weeks to recover from a concussion.

The challenge in treating this population is in being able to distinguish between symptoms caused by the concussion, and symptoms related to a pre-existing condition. Balance issues and headache are two of the more typical examples.

Dr. Cook explains that when a young person who suffers from anxiety and headaches, for instance, sustains a concussion, the injury will by its nature bring along symptoms such as chronic headache and perhaps sleep difficulty. “A concussion might turn up the volume on mood irritability, nervousness or tension. This can make things more difficult for a student who is already vulnerable because of one or more pre-existing mental health conditions.”

“So you can imagine you’re kind of getting by at school really quite stressed, struggling with these other concerns, and then you have an injury and that’s just one extra barrier. And so now you start to fall behind on schoolwork or fall further behind on schoolwork. Things can begin to compound more quickly.  In that case, we might also think about helping negotiate a school plan, helping to advocate for that student in school, help determine what sort of accommodation supports might be beneficial for that particular youth,” says Dr. Cook.

He explains that a major complexity with patients who present with pre-existing conditions is determining the point at which it is safe for them to return to sports play, including whether to return specifically to contact sports.

“That’s really a key difference clinically in terms of determining recovery from a treatment and rehab standpoint. The menu of options that we’re choosing from wouldn’t differ necessarily, but maybe the variety, and number of activities that we’re going to try to integrate into a rehab plan and, or the intensity of the treatment rehab might differ. For example, generally the majority of pediatric concussions can recover quite swiftly in days or weeks, and we wouldn’t be thinking about the need to get that patient involved with mental health support, for example. But with someone who already has preexisting anxiety, maybe even sub-threshold mild anxiety, psychological health treatment may be indicated over a period of time.”

It is a relatively new field of study with much still to be learned, he concludes.