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Guidelines aim to help alleviate lingering symptoms of post-concussion syndrome

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TORONTO - When Leah Braithwaite suffered a concussion after getting tripped up by another skier, she was told her symptoms — feeling fuzzy-headed, exhausted and unable to bear light or noise — should dissipate in a week or two. All she needed was to rest her body and brain.

But a month after her February 2011 mishap in the Gatineau Hills, she wasn't getting any better, despite the fact her fall had been so unremarkable it hadn't even put a mark on her helmet.

Braithwaite attempted to go back to her job as head of policy and planning for the Canadian Ice Service, but her fatigue, dizziness, headaches and vomiting only got worse.

"I was very sensitive to noise, particularly the dishwasher — unloading and loading the dishwasher was just excruciating for me," said the Ottawa mother of two. "And the kids learned eventually they had to kind of tiptoe around the house."

She was also having difficulty processing information and concentrating; she stumbled during conversation, unable at times to come up with the word she wanted.

Braithwaite tried to research her condition — and the reasons her symptoms were lingering —but using the computer had become difficult.

"If I could find appropriate sites, I couldn't figure out what information was relevant to me or how to connect it to my needs," she said.

Frustrated with her inability to recover, she asked her family doctor to refer her to a specialist, but "it was another four months before I saw someone familiar enough with concussions to actively address my symptoms and help me get back to work and my family."

That specialist, Dr. Shawn Marshall of the Ottawa Hospital Rehabilitation Centre, told Braithwaite most people who have a concussion get over their symptoms within a few months at most.

But about 10 to 15 per cent of patients who have taken a blow to the head develop what's known as post-concussion syndrome, in which symptoms persist far longer than expected.

"Those symptoms include very typical symptoms, like headache, sleep problems, irritability," Marshall said from Ottawa.

Initially after a concussion, patients are told to rest both physically and mentally — limiting or avoiding reading or time in front of the TV or computer screen — to give the brain an opportunity to recover from the injury.

"However, there comes a time where rest probably isn't that productive," he said of patients whose symptoms persist over time. "What we need to do is come up with a plan about resuming activities if possible."

To help primary-care physicians and other health providers, the Ontario Neurotrauma Foundation has published a set of guidelines for dealing with post-concussion syndrome.

"Concussion is commonly thought of as a sports injury," said Marshall, lead author of the guidelines. "But the reality is that many concussions, or mild traumatic brain injuries, come from mishaps of daily living, such as slipping on the ice while walking the dog, falling down the stairs at home or being in a car crash.

"There are currently good sports guidelines about how to return to play. Our guidelines take a broader view. We want to help people return to their lives."

The guidelines deal with a wide range of symptoms — from headaches and disturbed sleep to depression and vision problems — and how best to deal with them.

The key is to help patients find a balance, gradually increasing their ability to tolerate the demands of home, work and social life without causing symptoms to recur or worsen, stressed Marshall.

"For example, if you're having headaches and other symptoms just merely interacting with your spouse or your family members at home, you're probably not at the stage of looking at return to work or return to school," he said.

"And those are going to be indicators before trying something at a higher level, where it's truly cognitively demanding."

Braithwaite was able to return to her job in about 10 months, although she did it in graduated steps, including working from home for a period to avoid the cognitively taxing drive to the office. Her disturbed sleep pattern was treated with medication and good sleep habits that finally helped her get a solid night's rest.

"It wasn't do this, that and the other, it was let's try to find the balance that allows you to not completely remove yourself from life but allows you to heal in the least painful way possible," she said of Marshall's prescription for recovery.

"It wasn't really until I hit the two-year mark that I felt I was finally more myself," said Braithwaite, who was once again able to work all day, make dinner and resume her book club and other social activities, which she'd mostly had to give up.

"And I would come home after that and think: 'I still feel OK. I don't have a crushing headache and I'm not totally exhausted.'"

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Online:

Guidelines can be found at www.onf.org and www.concussionsontario.org.

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