What is PCS?
With the advent of new information and a somewhat better understanding of traumatic brain injuries (TBI), specifically concussions, it seems like the medical community is headed in the right direction. However, there is still a great deal to learn about the true effects of TBI in relation to long term physiological changes. Post-Concussion Syndrome (PCS) is a long-term condition caused by TBI that is still not widely understood, and is often undiagnosed in athletic and non-athletic populations (2015). Whereas most TBI that result in concussion tend to resolve within 1 to 2 weeks, some concussion symptoms can persist for much longer depending on the severity of the original injury, and on how many times the individual has actually suffered a TBI over their lifetime. PCS, specifically, is roughly defined as any TBI related symptoms that persist for more than 3 months beyond the original injury. While there are some discrepancies about how many symptoms must be present for more than 3 months in order for there to be a proper PCS diagnosis, the general opinion is that there must be at least 2 or more persistent symptoms (2015). As with many TBI’s, these symptoms can include headaches, light/sound sensitivity, difficulty concentrating, balance issues, difficulty sleeping, and host of other persistent symptoms. Complications that can come along with such long-term symptoms can include depression, anxiety, and even post-traumatic stress disorder (PTSD) (2015). PCS can last for several months (3 or more), or can even last for several years depending on the factors that caused the original TBI.
Who is most at risk of developing PCS?
· Athletes who play contact sports and have suffered multiple concussions over their sports career are at highest risk for suffering a TBI. As with many injuries, once an athlete suffers an initial TBI, they are much more likely to have a recurrence at some point in their future (2010). As such, these athletes are also most susceptible to prolonged concussion-type symptoms and potentially PCS as they receive additional concussions.
· People who have suffered a particularly severe TBI, such as from a motor vehicle accident or falling from an elevated position are also at risk of prolonged, PCS type symptoms (2014).
· People who are taking certain medications, such as those used to treat ADHD, are at risk of suffering from PCS (2010).
· Members of the military who have been exposed to concussive blasts as part of their training or deployment to hostile areas have a predisposition to PCS because of their repeated exposure to such conditions (2011).
What are some ways to possibly avoid prolonged concussion symptoms and PCS?
As with many injuries, the most immediate treatment option for reducing the amount of time that an athlete or patient suffers from concussion type symptoms is rest. While there is a bit of disagreement about how much and what type of rest is truly best for a person suffering from a TBI, it seems that rest immediately following the injury (i.e. 1-2 days) is the standard in most cases (2007). Such rest does not mean that the patient should lock themselves in a dark room and sleep the entire time, but does mean that the patient should reduce their use of electronics and physical activity during this period. Allowing the brain some time to start the healing process has been shown to reduce the period of time that the concussion symptoms will tend to persist. Recent research has shown that sub-symptom, individually controlled aerobic exercise does have some efficacy in reducing and/or eliminating concussion symptoms in both normal TBI populations and those suffering prolonged symptoms or PCS (2014). Such exercise has also been shown to reduce the incidence of depression and anxiety in patients during the recovery phase of a TBI, and in those suffering from PCS.
What are the treatment options for people suffering from PCS?
· Treating the symptoms of PCS, such as headaches, and sleep issues through drug therapy has been shown to reduce the stress caused by such symptoms. However, drug therapy should not take the place of physical and psychological treatments.
· Physical therapy that focuses on improving balance through exercise has been shown to be effective in reducing dizziness and balance issues.
· Physical therapy that slowly introduces sub-symptom aerobic exercise has shown efficacy in reducing and/or eliminating symptoms in PCS patients.
· Psychological therapy is effective in reducing and/or eliminating the incidence of depression, anxiety, and PTSD in patients suffering from PCS.
By: Hans Smelker, MS, LAT, ATC
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