After a concussion, one needs rest – physical and cognitive.
Brain slips are symptoms that reveal a mental deterioration in the ability to get stuff done; they can be common after a concussion, some examples are:
- Finding it hard to get started in a task
- Easily distracted and/or losing your train of thought frequently
- Difficulty with multitask ing
- Forgetful, decreased memory
Many of us take for granted that we were easily achieving numerous goals per day without a hitch, for example:
- Getting ready for school
- Making and bringing a lunch
- Keeping track of our school commitments
- Knowing how to get assignments done well and on time
- Learning new athletic skills
Some of us were having difficulties with these things before but weren’t aware; or we were just getting by. In fact, for some of us this may have stemmed from undetected or unrecalled past head trauma. Unfortunately, concussion will often exploit these deficiencies but, fortunately, a concussion can serve as a springboard to getting better by fostering awareness and triggering appropriate therapy.
Achieving even mundane goals requires intricate coordination between many cognitive processes – concentration, planning, multitasking, resilience to distraction, dealing with uncertainty and novelty, and using feedback mechanisms. This is what is referred to as Executive Functioning (EF). These skills are usually on ‘auto-pilot’. Just like for an athlete who finds it tough to hit a jump shot after an injury, these can become uncalibrated in the face of a concussion and require recalibration.
So the question becomes why is it important to recalibrate our EF’s ‘auto-pilot’?
Anyone who has enjoyed the mental and physical benefits of a good night’s sleep will appreciate that having a spritely body and mind is important to getting things done efficiently and also to recovering from injuries.
After a concussion, there is a complicated metabolic crisis that is occurring in your brain that ends up squandering much of your energy and also possibly rendering many basic neurological functions inefficient and/or inaccurate.
To sustain a concussion can be likened to the situation that occurs during a pay cut where your energy is like your cash flow. The degree of the pay cut (concussion) can vary depending on your injury, but needless to say, you will be able to afford less (performing activities/accomplishing goals) than you used to be able to afford (before your injury). So, one has to budget money (energy) to cover for all the basic necessities in life while putting off those that can wait until better times. In addition to saving money, one will also have to find some money to invest into recovery for the improvement of earning potential so one can get out of this tight cash flow situation (concussion). Many of the strategies in this handbook are budgeting suggestions (lifestyle adjustments) and investment opportunities (treatment plans).
It is important to act wisely so you don’t develop a situation that lingers. Fortunately, most get better but some will have problems for months or longer. Furthermore, many will have subtle symptoms that escape their attention, and some will neglect to report them due to a desire to get back to a ‘normal life’, leading to a premature return to activities. Without awareness of their deficiencies, patients may feel blindsided by a poor final grade or seeing less playing time or struggling with any goal-directed activity. Education is the foundation for awareness; medical assessment and response to treatment advice will further sensitize one to one’s deficiencies and their repair.
Withdrawal from activities, troubling symptoms and a generally less-than-desired level of success can lead to frustration. It is important to check this frustration. Frustration in this context can quickly lead to symptoms of anxiety, depression, headaches, muscle tension, poor sleep quality and worsening EF. All of these things are related to poorer mental and neurological functioning.
Relax, be patient, be kind to yourself, accept or seek help from teachers, family, guidance counsellors, peers/colleagues and your healthcare team. Concussion is an injury from which one can have a complete recovery with appropriate care.
How do we reprogram our EF?
We need to use techniques to save our energy…
1. Doing Less
a. Anything that exacerbates your symptoms should be minimized or avoided if possible.
b. Have people help you, whether it is with tasks, moral support, making decisions or giving you feedback.
c. Your healthcare team may outline permissible activities for you stage of recovery.
d. Temporary reduction in school and sport activities. This will be outlined in the last section “Return to Activities”.
e. Avoid unnecessary tasks
f. Keep in mind that studies show that patients’ perception of the effects of concussion are not in keeping with the actual level of impairment.
2. Simplifying how you do things
a. An ‘uncalibrated auto-pilot’ needs to be reprogrammed consciously. Just as you would consciously train athletic maneuvers until they become automatic habits, b. consciously training EF will make appropriate habits.
b. Here is an approach to consciously retraining your EF:
i. Stop: Take a moment to ‘hold your horses’ before you are about to do what you want to do, however mundane it may seem; e.g., making a meal.
ii. State: Think about your goal and what you need to do to get it done; e.g., making a specific meal for a certain number of people with certain components you desire.
iii. Split: Split up the task into easy-to-execute categories; e.g., prepare equipment/utensils, ingredients, cooking instructions, serving the meal, clean up.
iv. Do it: Do it without distraction
v. Check: Continually check what you’re doing as unexpected things may arise or you may lose focus and not end up doing what you intended to do.
3. Make a schedule
a. Make a daily & weekly plan for the things you plan to achieve.
b. Be realistic and strategic in the way you plan your affairs:
• give priority to the most important tasks
• put off things that can wait until you’re feeling better
• certain tasks are more congenial at certain times of the day
• at certain times, help may be available for challenging tasks
• Space out tasks and include rest breaks in between
• Allow more time as you may be less efficient
• You don’t have to get everything done today, focus on ‘biting off what you can easily chew’
• Plan to complete tasks in the ideal environments – free of distractions, with all the tools you need, in an ergonomic and relaxing environment
• Consider turning your phone to ‘airplane mode’ for certain assignments, meals, getting ready for work, etc.
• Plan to rest in relaxing areas and conditions
c. Consider setting an alarm on your phone to prompt you into changing gears towards the next item in your schedule
d. Track your goals and reschedule anything that doesn’t get done as planned. Remember, things will pop up and you should plan to be a little flexible.
e. Readjust your schedule if you realize that you are overloading yourself or are making ‘slips’.
4. Make rest and relaxation count
a. Pick rest breaks that are truly restful and not just entertaining
b. Maintaining a positive attitude (see the next section).
c. Improvement of your sleep, nutrition and physical symptoms will all help in improving EF as they are interrelated (see corresponding sections).
5. Most will need the assistance of an occupational therapist