Selected Podcast
Rehabilitation After a Concussion
Dr. Sachin Mehta discusses post-concussion health complications, as well as post-concussion syndrome itself, and ways to rehabilitate someone recovering from a traumatic brain injury.
Featuring:
Sachin Mehta, MD
Sachin Mehta, MD, is board-certified in physical medicine and rehabilitation. He earned his medical degree from Indiana University School of Medicine and also completed his residency in physical medicine and rehabilitation there. Dr. Mehta is one of four physicians in the state of Indiana to obtain a subspecialty certification in brain injury medicine by the American Board of Physical Medicine and Rehabilitation. He also specializes in spasticity management (Botox, baclofen pumps, etc.), interventional pain management, outpatient day rehabilitation, seating and positioning, and stroke, neuromuscular and musculoskeletal rehabilitation. Dr. Mehta is the medical director for the Inpatient and Outpatient Rehabilitation Center at Franciscan Health Indianapolis. Transcription:
Scott Webb: While many individuals with a concussion or mild traumatic brain injury do fully recover, others may experience persistent neurocognitive symptoms, including memory issues, slower processing speed, and difficulty concentrating or physical symptoms such as increased fatigue, irritability, headaches, dizziness or vision problems. These residual effects can interfere with a person's ability to fully function at home, work or school.
And joining me today to talk about all of this is Dr. Sachin Mehta. He's the Medical Director of the Franciscan Health Post-concussion Rehabilitation program in Central Indiana. This is the Franciscan Health Doc Pod. I'm Scott Webb.
Doctor, thanks so much for your time today. We're going to talk about concussions. And before we get rolling here and talk about acute versus complex and some other things, let's just start with a baseline question here, what is a concussion? What happens to our brains when we suffer these injuries?
Dr. Sachin Mehta: A concussion is by definition a mild traumatic brain injury. So if you break that down, there has to be some type of trauma involved. So either the head has to hit something or the brain inside the skull has to hit something, so if our head moves really quickly in one direction, and then all of a sudden changes directions. For example, like in a car accident, even without hitting something or falling, even if your head didn't hit something, that can also cause some trauma to the brain.
And it's a transient injury. Typically, it's a short-term or nonpermanent injury to our brain functioning. So what happens is that we have an impact. We get possibly a bit of a bruising, kind of where the impact occurred. But then some of our neurons, which are kind of the wires in our brain, those nerves, they get stretched out and that causes some more damage. And there's this cascade of chemicals, this whole physiologic process of ions and free radicals that get released and cause some more damage for the next few days afterwards.
So we get this injury to the brain and it affects the way the brain functions. And that causes a lot of the symptoms that we often see after a concussion based on possibly what part of the brain was impacted. And we can get headaches and dizziness, visual disturbances, cognitive issues like memory and concentration issues. Sometimes we get a little bit of a mood disturbance, a little bit more depressed or anxious. And oftentimes, we have trouble sleeping after concussions as well, either sleeping too much or sleeping too little, having trouble falling asleep or staying asleep based again on what part of the brain was injured.
Scott Webb: Yeah. And good for you to clarify that you don't actually have to have your head hit something or something hit your head, that it can just, as you say, be caused by a car accident where there's that sort of whiplash effect. And I think for any of us who've ever had a concussion, we sort of know exactly what you're describing there. I can recall one particularly bad one that I had where the way I would describe it is I felt like a truck ran over me. And I just felt like I was in this fog. Are those pretty common symptoms?
Dr. Sachin Mehta: Those are classic symptoms. We see a lot of that. The most common symptom after a concussion is the headache and that pressure in the brain. But we also know, you mentioned whiplash, is that we can also have injury to our neck. And when our neck is injured, it can also cause some different types of headaches and neck pain. And those are things that we can address as well.
And that fogginess is usually a sign of some brain fatigue. Our brain gets tired as we try to do our physical and normal activities. As once we had an injury to the brain, it can impact our ability to do those physical activities, mental activities, like going to school or working, and that can cause some of that fogginess feel. So those are classic symptoms of a concussion.
Scott Webb: Yeah. And you mentioned that usually concussions just kind of heal themselves and you go on about your lives and your business and all of that, but sometimes they don't. So I want to have you talk about the difference between acute concussions and the more serious complex ones.
Dr. Sachin Mehta: Absolutely. And I'm glad you asked that question. No, you're exactly right. Fortunately, which is great news, is that most concussions are transient and that we would expect people to get better within 10 to 14, 21 days. And one interesting fact is actually that the younger you are, the longer it takes to get better. So it's very atypical of other injuries that we see in healthcare, is that the younger you are, so children will take a little bit longer to get better and high schoolers will take a little bit longer to get better than those that are in college and in adulthood, which makes it really interesting.
And we know athletes about 10% of them, however, despite that, do lingering symptoms and most concussions are not caused by sports. Most concussions are caused by falls or motor vehicle accidents or other types of trauma. And about one out of three of those people and patients will have lingering symptoms that kind of go past that typical three or four-week mark. And they kind of then changed that name from concussion to post-concussion syndrome. So, fortunately, it's not a common thing after a concussion, but it's not a small number either. And it's something that needs to be taken seriously.
Scott Webb: Yeah. You and I were talking before we got started here today about athletes. As you say, most concussions are not caused by athletic injuries, but the ones that are, you know, about certain athletes, especially hockey players, where these things tend to linger for months or years and sometimes are career-enders. So you mentioned their post-concussion syndrome. Is that what we're talking about, where these concussions just never really go away?
Dr. Sachin Mehta: Exactly. And I wouldn't use the word never because, you know, part of being someone who treats post-concussion syndrome is that we do have our approach to help them. But we know there are some trends. We still don't know exactly why some people make a full recovery from a concussion within a few weeks while others do have these lingering long-term symptoms.
And there's a lot of things we're still trying to figure out, but we know some trends. And like you mentioned, so for some reason, people who've had multiple concussions or multiple sub-concussive hits where they maybe hit their head several times but didn't actually have symptoms or maybe underreported their symptoms. We think maybe people with a history of some depression or anxiety, history of chronic headaches or migraine headaches, also people with history of some learning issues such as ADHD or dyslexia, for some reason, we don't know if it's a hormonal thing or a chemical thing in the brain, but having one of those conditions may actually predispose us to having some prolonged recovery.
Scott Webb: You mentioned there, one of the words that jumped out was the sort of underreporting of symptoms. Is that fairly common, especially in athletics?
Dr. Sachin Mehta: We've been changing the rules recently to protect the athletes. And, you know, we've changed the way we do kickoffs and we've protected wide receivers from helmet-to-helmet hits and there's different rules, similar rules that have been made across different sports and less contact in practice.
And what we're noticing is that actually the incidence of concussions have gone up in the high school athletes. And the thought is, is that because of education and awareness, we're actually reporting more of these concussions when previously it was underreported. So I do think it's still an issue, but I do think that's getting better.
But what we've also noticed is that the number of concussions in practices has gone down because of some of the rule changes and preventing some of the full contact practices that were typically had before some of these rule changes were made. So even though it seems like the numbers of concussions are going up in the high school and college and professional athletes, we think that because of better awareness, better education, people trying to protect long-term sequella and long-term problems, that were actually recognizing this a little bit earlier.
Scott Webb: That's good to know. And I think you're probably right. That it's just simply not that there are more concussions, but that we understand the signs and symptoms and we're reporting them better because we understand the long-term ramifications of not treating concussions properly. So that's really good to know.
And along the lines of treatment, and you mentioned post-concussion syndrome, what are the treatment options? And maybe tell us about the day rehab program.
Dr. Sachin Mehta: Absolutely. What we do know again is that most concussions get better. The old mantra used to be that when you had a concussion, you were supposed to rest or go be in a dark room or a cocoon until you felt better. And that's actually no longer the case. We do want more of an active approach now to both concussion and post-concussion syndrome.
So on your acute concussion side, the brand new concussion, we rest for about 24 to 48 hours. And then, we slowly increase our physical and mental activities as tolerated to not exacerbate our symptoms. And that we've also noticed is with post-concussion syndrome, so those that are taking longer to get better, that a more active approach has been shown to really be beneficial.
We notice a lot of our patients who have post-concussion syndrome have issues with their balance and they have neck pain and neck spasms. So we get them into some physical therapy to work on their balance and work on their neck and upper back. We also note that a lot of these patients have issues with their vision and they have trouble focusing on their computer screen and their cell phones and that near work activity, and we can give them vision exercises on the direction of an occupational therapist.
And then they also, like we mentioned before, have issues with memory and concentration and multitasking. You can exercise those mental skills, just like you exercise those physical issues. And those are done under the care of a speech and language pathologist or a speech therapist.
So what a day rehab program is, it's a team approach to treating post-concussion syndrome where the rehab physicians such as myself, the physical therapists and occupational therapists and speech therapists all work together. And then as we know that when people aren't getting better as fast, often it starts to affect their mood. So they get some depression or anxiety. And we also have a neuropsychologist to help with kind of the behavioral and mood issues that are associated with prolonged recovery.
And the best success stories for helping people who are suffering these prolonged sentences is that team approach. And we call that a day rehab model. And that's why we've been very successful in taking that 10 to 30% of patients who have lingering symptoms and helping them get over the hump and get back to their sport and back to their job, back to school, get their grades back up with this day rehab program to treat post-concussion syndrome.
Scott Webb: That's great. I love that team approach. And you're so right. Boy, things have come a long way. It does seem that the recommendation back in the day was sit in a dark room, close your eyes, you know, and lay there until you feel better. But that's not the approach today, right?
Dr. Sachin Mehta: That's exactly right. And that's how it used to be. It's very recently when those recommendations changed. And what we were finding out is that the longer we laid in bed, if you were an athlete, you became very deconditioned and maybe you set yourself up for further injuries. And then if you were in school and it was not a sports-related injury, you weren't around your friends and you're getting behind in school. And then when you're getting stressed out about trying to get caught up on school, you get more depression or anxiety. And so now we're setting our patients up for further problems down the road because we're getting behind physically and mentally and getting deconditioned. We're getting very weak, almost debilitated and we were actually causing more problems.
So what research has shown is that a more active approach, let's start moving. Let's start walking. Let's get back to school with some accommodations. Let's give you extra time to take your tests and quizzes and have you sit at the front of the room so we don't get too distracted by my other noises and lights. And let's start exercising and getting your heart rate up a little bit every day and build up your endurance. So we're not actually going back to full activity, but we can start low and then go slow. We're actually speeding up recovery in the long run.
Scott Webb: That's great. And as we wrap up here today, doctor, you know, we're talking about all the pros and cons and things we should do or not do and all of that, but maybe just like to have you give us a takeaway here, what are the downsides? What can really happen if concussions aren't treated properly?
Dr. Sachin Mehta: The number one priority is if we've had a concussion, we need to diagnose it and get it treated so you can get better. And with the right rehabilitation and active recovery program, almost everybody should make a full recovery. What we do worry about is without the right treatment is it just prolong symptoms.
If we get to a point where now it really starts to affect our mood and now it's going to impact our ability to work, it's going to impact our ability to drive. It's going to impact our social interactions, our hobbies. We're not able to perform in athletics or other activities as we would like. So the key is to really get treatment, get diagnosed if we think we have a concussion. You get the right treatment and get better so we can prevent some of those long-term issues down the road of headaches and sleep dysfunction and mood disturbance and balance issues and vision issues.
Scott Webb: Yeah, that's a great way to wrap up. And great conversation today. And we know that concussions are common and they're also highly treatable. And I guess that's really the message here is people need to be diagnosed and treated. And the sooner we do that, the better off we'll be longterm. So doctor, thanks so much for your time today and you stay well.
Dr. Sachin Mehta: Thank you very much.
Scott Webb: For more information, go to FranciscanHealth.org/blogs and search concussion. And we hope you found this podcast to be helpful and informative. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well. And we'll talk again next time.
Scott Webb: While many individuals with a concussion or mild traumatic brain injury do fully recover, others may experience persistent neurocognitive symptoms, including memory issues, slower processing speed, and difficulty concentrating or physical symptoms such as increased fatigue, irritability, headaches, dizziness or vision problems. These residual effects can interfere with a person's ability to fully function at home, work or school.
And joining me today to talk about all of this is Dr. Sachin Mehta. He's the Medical Director of the Franciscan Health Post-concussion Rehabilitation program in Central Indiana. This is the Franciscan Health Doc Pod. I'm Scott Webb.
Doctor, thanks so much for your time today. We're going to talk about concussions. And before we get rolling here and talk about acute versus complex and some other things, let's just start with a baseline question here, what is a concussion? What happens to our brains when we suffer these injuries?
Dr. Sachin Mehta: A concussion is by definition a mild traumatic brain injury. So if you break that down, there has to be some type of trauma involved. So either the head has to hit something or the brain inside the skull has to hit something, so if our head moves really quickly in one direction, and then all of a sudden changes directions. For example, like in a car accident, even without hitting something or falling, even if your head didn't hit something, that can also cause some trauma to the brain.
And it's a transient injury. Typically, it's a short-term or nonpermanent injury to our brain functioning. So what happens is that we have an impact. We get possibly a bit of a bruising, kind of where the impact occurred. But then some of our neurons, which are kind of the wires in our brain, those nerves, they get stretched out and that causes some more damage. And there's this cascade of chemicals, this whole physiologic process of ions and free radicals that get released and cause some more damage for the next few days afterwards.
So we get this injury to the brain and it affects the way the brain functions. And that causes a lot of the symptoms that we often see after a concussion based on possibly what part of the brain was impacted. And we can get headaches and dizziness, visual disturbances, cognitive issues like memory and concentration issues. Sometimes we get a little bit of a mood disturbance, a little bit more depressed or anxious. And oftentimes, we have trouble sleeping after concussions as well, either sleeping too much or sleeping too little, having trouble falling asleep or staying asleep based again on what part of the brain was injured.
Scott Webb: Yeah. And good for you to clarify that you don't actually have to have your head hit something or something hit your head, that it can just, as you say, be caused by a car accident where there's that sort of whiplash effect. And I think for any of us who've ever had a concussion, we sort of know exactly what you're describing there. I can recall one particularly bad one that I had where the way I would describe it is I felt like a truck ran over me. And I just felt like I was in this fog. Are those pretty common symptoms?
Dr. Sachin Mehta: Those are classic symptoms. We see a lot of that. The most common symptom after a concussion is the headache and that pressure in the brain. But we also know, you mentioned whiplash, is that we can also have injury to our neck. And when our neck is injured, it can also cause some different types of headaches and neck pain. And those are things that we can address as well.
And that fogginess is usually a sign of some brain fatigue. Our brain gets tired as we try to do our physical and normal activities. As once we had an injury to the brain, it can impact our ability to do those physical activities, mental activities, like going to school or working, and that can cause some of that fogginess feel. So those are classic symptoms of a concussion.
Scott Webb: Yeah. And you mentioned that usually concussions just kind of heal themselves and you go on about your lives and your business and all of that, but sometimes they don't. So I want to have you talk about the difference between acute concussions and the more serious complex ones.
Dr. Sachin Mehta: Absolutely. And I'm glad you asked that question. No, you're exactly right. Fortunately, which is great news, is that most concussions are transient and that we would expect people to get better within 10 to 14, 21 days. And one interesting fact is actually that the younger you are, the longer it takes to get better. So it's very atypical of other injuries that we see in healthcare, is that the younger you are, so children will take a little bit longer to get better and high schoolers will take a little bit longer to get better than those that are in college and in adulthood, which makes it really interesting.
And we know athletes about 10% of them, however, despite that, do lingering symptoms and most concussions are not caused by sports. Most concussions are caused by falls or motor vehicle accidents or other types of trauma. And about one out of three of those people and patients will have lingering symptoms that kind of go past that typical three or four-week mark. And they kind of then changed that name from concussion to post-concussion syndrome. So, fortunately, it's not a common thing after a concussion, but it's not a small number either. And it's something that needs to be taken seriously.
Scott Webb: Yeah. You and I were talking before we got started here today about athletes. As you say, most concussions are not caused by athletic injuries, but the ones that are, you know, about certain athletes, especially hockey players, where these things tend to linger for months or years and sometimes are career-enders. So you mentioned their post-concussion syndrome. Is that what we're talking about, where these concussions just never really go away?
Dr. Sachin Mehta: Exactly. And I wouldn't use the word never because, you know, part of being someone who treats post-concussion syndrome is that we do have our approach to help them. But we know there are some trends. We still don't know exactly why some people make a full recovery from a concussion within a few weeks while others do have these lingering long-term symptoms.
And there's a lot of things we're still trying to figure out, but we know some trends. And like you mentioned, so for some reason, people who've had multiple concussions or multiple sub-concussive hits where they maybe hit their head several times but didn't actually have symptoms or maybe underreported their symptoms. We think maybe people with a history of some depression or anxiety, history of chronic headaches or migraine headaches, also people with history of some learning issues such as ADHD or dyslexia, for some reason, we don't know if it's a hormonal thing or a chemical thing in the brain, but having one of those conditions may actually predispose us to having some prolonged recovery.
Scott Webb: You mentioned there, one of the words that jumped out was the sort of underreporting of symptoms. Is that fairly common, especially in athletics?
Dr. Sachin Mehta: We've been changing the rules recently to protect the athletes. And, you know, we've changed the way we do kickoffs and we've protected wide receivers from helmet-to-helmet hits and there's different rules, similar rules that have been made across different sports and less contact in practice.
And what we're noticing is that actually the incidence of concussions have gone up in the high school athletes. And the thought is, is that because of education and awareness, we're actually reporting more of these concussions when previously it was underreported. So I do think it's still an issue, but I do think that's getting better.
But what we've also noticed is that the number of concussions in practices has gone down because of some of the rule changes and preventing some of the full contact practices that were typically had before some of these rule changes were made. So even though it seems like the numbers of concussions are going up in the high school and college and professional athletes, we think that because of better awareness, better education, people trying to protect long-term sequella and long-term problems, that were actually recognizing this a little bit earlier.
Scott Webb: That's good to know. And I think you're probably right. That it's just simply not that there are more concussions, but that we understand the signs and symptoms and we're reporting them better because we understand the long-term ramifications of not treating concussions properly. So that's really good to know.
And along the lines of treatment, and you mentioned post-concussion syndrome, what are the treatment options? And maybe tell us about the day rehab program.
Dr. Sachin Mehta: Absolutely. What we do know again is that most concussions get better. The old mantra used to be that when you had a concussion, you were supposed to rest or go be in a dark room or a cocoon until you felt better. And that's actually no longer the case. We do want more of an active approach now to both concussion and post-concussion syndrome.
So on your acute concussion side, the brand new concussion, we rest for about 24 to 48 hours. And then, we slowly increase our physical and mental activities as tolerated to not exacerbate our symptoms. And that we've also noticed is with post-concussion syndrome, so those that are taking longer to get better, that a more active approach has been shown to really be beneficial.
We notice a lot of our patients who have post-concussion syndrome have issues with their balance and they have neck pain and neck spasms. So we get them into some physical therapy to work on their balance and work on their neck and upper back. We also note that a lot of these patients have issues with their vision and they have trouble focusing on their computer screen and their cell phones and that near work activity, and we can give them vision exercises on the direction of an occupational therapist.
And then they also, like we mentioned before, have issues with memory and concentration and multitasking. You can exercise those mental skills, just like you exercise those physical issues. And those are done under the care of a speech and language pathologist or a speech therapist.
So what a day rehab program is, it's a team approach to treating post-concussion syndrome where the rehab physicians such as myself, the physical therapists and occupational therapists and speech therapists all work together. And then as we know that when people aren't getting better as fast, often it starts to affect their mood. So they get some depression or anxiety. And we also have a neuropsychologist to help with kind of the behavioral and mood issues that are associated with prolonged recovery.
And the best success stories for helping people who are suffering these prolonged sentences is that team approach. And we call that a day rehab model. And that's why we've been very successful in taking that 10 to 30% of patients who have lingering symptoms and helping them get over the hump and get back to their sport and back to their job, back to school, get their grades back up with this day rehab program to treat post-concussion syndrome.
Scott Webb: That's great. I love that team approach. And you're so right. Boy, things have come a long way. It does seem that the recommendation back in the day was sit in a dark room, close your eyes, you know, and lay there until you feel better. But that's not the approach today, right?
Dr. Sachin Mehta: That's exactly right. And that's how it used to be. It's very recently when those recommendations changed. And what we were finding out is that the longer we laid in bed, if you were an athlete, you became very deconditioned and maybe you set yourself up for further injuries. And then if you were in school and it was not a sports-related injury, you weren't around your friends and you're getting behind in school. And then when you're getting stressed out about trying to get caught up on school, you get more depression or anxiety. And so now we're setting our patients up for further problems down the road because we're getting behind physically and mentally and getting deconditioned. We're getting very weak, almost debilitated and we were actually causing more problems.
So what research has shown is that a more active approach, let's start moving. Let's start walking. Let's get back to school with some accommodations. Let's give you extra time to take your tests and quizzes and have you sit at the front of the room so we don't get too distracted by my other noises and lights. And let's start exercising and getting your heart rate up a little bit every day and build up your endurance. So we're not actually going back to full activity, but we can start low and then go slow. We're actually speeding up recovery in the long run.
Scott Webb: That's great. And as we wrap up here today, doctor, you know, we're talking about all the pros and cons and things we should do or not do and all of that, but maybe just like to have you give us a takeaway here, what are the downsides? What can really happen if concussions aren't treated properly?
Dr. Sachin Mehta: The number one priority is if we've had a concussion, we need to diagnose it and get it treated so you can get better. And with the right rehabilitation and active recovery program, almost everybody should make a full recovery. What we do worry about is without the right treatment is it just prolong symptoms.
If we get to a point where now it really starts to affect our mood and now it's going to impact our ability to work, it's going to impact our ability to drive. It's going to impact our social interactions, our hobbies. We're not able to perform in athletics or other activities as we would like. So the key is to really get treatment, get diagnosed if we think we have a concussion. You get the right treatment and get better so we can prevent some of those long-term issues down the road of headaches and sleep dysfunction and mood disturbance and balance issues and vision issues.
Scott Webb: Yeah, that's a great way to wrap up. And great conversation today. And we know that concussions are common and they're also highly treatable. And I guess that's really the message here is people need to be diagnosed and treated. And the sooner we do that, the better off we'll be longterm. So doctor, thanks so much for your time today and you stay well.
Dr. Sachin Mehta: Thank you very much.
Scott Webb: For more information, go to FranciscanHealth.org/blogs and search concussion. And we hope you found this podcast to be helpful and informative. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well. And we'll talk again next time.