Things that support recovery
• Allowing plenty of opportunities for rest .
• Protecting them from another concussion – ensuring they avoid contact sports and other risky activities .
• Providing a supportive environment for them to share their concerns .
• Returning to medical staff as soon as they feel worse or experience any warning signs *.
Figure 1 : What supports and hinders recovery from mTBI
Things that hinder recover
• Sustaining another concussion before the first one has had adequate chance to heal .
• Alcohol consumption .
• Poor sleep ( made worse by caffeine or ‘ energy-enhancing ’ products ).
• Sleeping aids and sedatives ( unless prescribed by medical staff .)
• Returning to full duties too quickly .
• Undertaking strenuous exercise too soon .
* Warning Signs : If the person experiences any of the following , they should seek urgent medical attention :
• Worsening headache .
• Worsening balance .
• Double vision or other visual problems .
• Seizures or fits .
• Decreasing levels of alertness .
• Increased confusion .
• Repeated vomiting .
• Unusual behaviour .
Figure 2 : Warning signs following a mTBI
Figure 1 outlines what can help and what can hinder recovery following an mTBI and figure 2 lists warning signs to be aware of .
Combined working with vestibular rehabilitation
Research has shown that there is a strong crossover between vestibular cognitive symptoms and mTBI cognitive symptoms ( Carrick et al 2015 ). In 2018 , the mTBI and vestibular services were combined , in response to research and due to the large overlap of symptoms observed within the services .
The aim was to improve efficiency and patient outcomes . A service evaluation in 2020 , looked at data from 283 patients who had passed through the mTBI service at DMRC Stanford Hall .
It demonstrated that treatment had become more effective ( and efficient ) since the mTBI and vestibular services combined . Post-treatment outcome measures scored lower among patients who received vestibular rehabilitation and the return to work rate rose from 53.32 % to 69.70 %. This supported the combined approach and identified the benefits of joint working .
The occupational therapy role
Within the specialism of mTBI , the occupational therapy role covers many areas and draws on a range of our professional skills . The overall aim of intervention is to maximise function and return to occupations meaningful to the person , while supporting symptom reduction .
The occupational therapy skills in activity analysis , grading and adapting the task / environment to facilitate participation , are frequently used to support symptom management and a return to pre-morbid activities .
Frequently , following an mTBI , individuals experience a change to their routines and roles that can lead to social and occupational isolation . The service supports them to identify appropriate activities and maintain a balance of activity and rest within their symptom tolerance .
Maintaining a balanced routine and engagement in activities can be helpful in maintaining a good sleep / wake cycle and make the transition back into full-time work smoother . Education is a key component for this , helping the individual understand the link between their activities , demands and the symptoms experienced .
Within the military population , individuals are often highly motivated to return to work and guidance helps ensure that this is done in a graded , appropriate way that is not detrimental to their recovery .
Intervention is person centred and targets the symptoms reported by the individual . Information gained through the assessment process is used to help set goals and create management strategies that support function while the individual is recovering .
If symptoms persist long term , then management strategies are reviewed and tailored to fit daily demands to help support function over the long-term .
Examples of the areas the occupational therapist supports people with include :
• cognitive assessments
• grading participation and return to activities
• maintaining occupational balance
• maintaining and returning to roles
• maintaining balanced routines
• sleep
• relaxation
• management strategies
• goal setting
• supporting return to work .
40 OTnews June 2023