Concussion exercises for a beach vacation: 5 experts share their tips (2/2)
Our medical director at York Region Concussion Clinic continues the discussion on vacationing after a concussion.
Tip #5 from our sports MD, Dr. Taher Chugh.
More to a beach vacation than what’s in the brochures
For many of our patients, the beach vacation is valued more for the things not listed on the resorts’ brochures; That is, not having to think about:
- Groceries and dinner plans;
- Answering cell phones and to social “obligations”;
- Handling finances – banking, accounting, planning;
- Potential guilt surrounding not getting through enough of that never-ending “to-do” list;
- Commuting and taking work home;
- Legal problems, relationship challenges;
- Doctor’s appointments;
- Distraction of emails and the like.
What is the effect of stress on the neurological system?
Many of us, even without a concussion, can easily find ourselves on this proverbial hamster wheel. How does it affect us? How do we get off?
1. Stresses Effect on the Sympathetic Nervous System: Stress, in basic physiological terms, will lead to overuse of the sympathetic nervous system – the system that mediates the fight-or-flight reaction – and with chronic overuse of this system, neurotransmitter levels and stress hormone levels can change which will affect performance and can change the way you feel psychologically and physically.
2. Effect of unbalanced mental effort on the brains electrical activity and neurotransmitters: With overuse (without effective rest) of the many regions of the brain to handle the tasks of the things mentioned in the list above, you can (inadvertently) get in the habit of encouraging unbalanced levels of electrical activity in the way the brain fires. It can’t always sprint, it does need a rest or it will run into challenges.
3. Stress can cause you to expand the perception of the stress and handle processes less efficiently (more mental effort required to get the same task done): Also, just as when you get in the habit of doing something over and over again, you get good at it, this works for maladaptive things too: you can get good at things that don’t work to your advantage, even thinking patterns. Emotional and (il)logical reactions to your situation may lead to resentment which has a neurological seat in regions of the brain – it is not something that is “made up” and that can’t be seen. So gradually, the tasks with which you concern yourself every day slowly involve more and more regions of the brain. Remember, what fires together, wires together.
Balanced lifestyle is part of the solution
Keep in mind that 30-50% of your body’s energy is used by the brain! The point is, if there is not balance in one’s lifestyle, the very brain you rely on to perform can be affected. And, the perception of your life that the brain relays to you can also be affected. You can see how who you are, as perceived by others, and who you are as perceived by yourself, can change. The ideal circumstance for learning and fostering neuroplasticity – the ability of the brain to create new connections – that is required in concussion rehabilitation is one centered on efficient mental processes; a balanced lifestyle helps a lot.
How does a vacation fit into all of this?
More than anything, especially in the context of concussion recovery, a vacation gives you a break from this vicious cycle so that you can start to rest you brain, your emotions, your thoughts, and slowly discover your sense of self again.
Who is Marnie? What truly is important to her? How would she like to live her life? What kind of behaviours and feelings does she want to experience on a day-to-day basis? Can she experience them now while on vacation? Let’s see. In setting up a more balanced lifestyle, for most of us, less is more, and the focus will be on behaviours not on accomplishments.
This is a good time for the time impoverished to look at Stephen Covey’s matrix. And many of us will realize we spend a lot of time doing things that aren’t important/necessary. Think on this:
Can you reduce Q4 items? Q4 items are things like screen time, gossiping, list (re-)reading, trivial Wikipedia research.
Can you increase Q2 activities? Q2 activities are things that take up some time up front – like concussion rehabilitation – but free up a lot of time later – through increased efficiency and less symptoms after succeeding in therapy. Examples: learning to improve sleep quality so you don’t need as much sleep; learning simpler nutritious meals so you save time in their preparation; learning an exercise regimen that can save you time while satisfying your workout desires, etc.; making a weekly time budget (just like a financial budget but for time) so you can get the help you need.
Bringing this spirit back will help you protect your time, live a balanced lifestyle and support your rehab efforts on your road to recovery.
One practical point on Optokinetic Stimulus (OKS)
Many of our patients have issues with OKS. OKS is a full-visual-field image (it has to occupy 90% of your field of view) that appears consistently indistinct enough that it makes it challenging to use it to orient yourself, e.g., starry night skies, busy crowds/stores, etc. Concussion patients often have issues with the way their brain weighs inputs coming in from their sensory system, i.e., vestibular, visual, somatosensory systems. See the article on Visual Vestibular Mismatch for more details on this. While we spend time helping patients recalibrate their sensory weighting, for some patients, they will need environments with OKS to train this. The beach vacation provides many opportunities to train grounding techniques in the face of OKS – that is, opportunities to learn how not to let OKS carry you away or throw you off your game. To achieve this, mindfulness is very useful. When doing this, try to imagine what it was like to experience all of this for the first time: having no preconceived notions of what was or was not possible; what or what you were not capable of. Tend to the exercises described by our physiotherapist with a calm, witness-state-like attitude, one with curiosity and observation.
Some examples of contexts that provide good OKS
1. Lying in the sand and looking up at the sky and feel that you are in fact not moving when you see the clouds moving, the clouds are what are moving. Incorporate simple half rolls while staring at the same scene and be aware of your motion and the clouds’ motion.
2. The same things can be done under a tree (without any falling fruit or coconuts!) and differentiate between the quivering of the leaves and your (lack of) motion.
3. Busy hotel lobbies with repetitive, patterned flooring can be more challenging because of the noise, conversations and so on, but if you feel confident in your grounding abilities and you can start off in small doses, this is a nice opportunity to test the waters, away from the stresses of home.
If you need advice on your individual situation or have concerns, reach out to your concussion team.
Read the tips from our therapists and optometrist here.
Last update: March 2019