Rehabilitation after a concussion

A concussion occurs with minor mechanical injuries. A fairly common pathology that occurs in every 3-4 citizens out of 1000. The occurrence of an injury can be associated with household chores, professional activities, or with a car accident. The course of treatment is long, recovery after a concussion occurs gradually. The rehabilitation period can take from several weeks to several months.

Clinical picture

Symptoms of the disease are easy to identify and correlate with the cause.
Develop:

• depression of consciousness from several minutes to several hours;
• short-term loss of consciousness;
• nausea;
• hypertension;
• tachycardia (heart rate more than 100-120 beats / min);
• dizziness;
• soreness in the occipital region or on the head;
• sleep disturbance;
• the occurrence of pain discomfort when reading or when looking closely at an object;
• changes in pupils (dilated / narrowed);
• asymmetric reflexes on the upper and lower extremities;
• symptoms of meningitis.

In this case, weakness, lethargy, disorientation in space, disruption of synaptic connections between the cortex and brain structures can occur.

Concussion in children and adolescents

For children of the preschool period, short-term fainting with memory loss for several minutes is characteristic. Children experience blanching of the skin, heart rhythm disturbances in the form of a palpitation sensation, fatigue, gag reflex and regurgitation. The child cannot sleep because of the constant headache and cries all the time. Some preschoolers develop horizontal-type nystagmus, hyperthermia, and high blood pressure. After a few days, the child's well-being improves, the symptoms subside or disappear completely.

Concussion in the elderly

In senile and presenile ages, pathology has its own distinctive features. Patients suffer from prolonged loss of consciousness and memory, lack of orientation in time and location, combined with sharp frequent headaches. In addition, the elderly often experience circulatory disorders such as ischemic strokes, the transition to the phase of exacerbation of pathological conditions of the heart, and the aggravation of the course of endocrine pathologies. The duration of recovery is increased.

Diagnosis of the disease is carried out in the first hours or even minutes after the incident. After confirming the diagnosis, a thorough medical care is provided by a neurologist, depending on the indications. The course of therapy is selected individually for each patient.

Recovery after a concussion

After a course of conservative therapy, restorative rehabilitation measures are prescribed that improve the general condition, normalize the functioning of the brain and other parts of the nervous system.

Rehabilitation after a concussion consists of complex measures aimed at the recovery of patients. It includes:

• therapeutic physical culture;
• medical gymnastics;
• breathing exercises;
• massage;
• physiotherapy procedures.

The rehabilitation process is divided into 4 periods:

1. elementary;
2. intermediate;
3. late recovery;
4. residual events.

Initial period

In the initial period, which begins on the 3-5th day, it is forbidden to engage in any physical activity. Movement should be limited. Use gymnastic passive exercises and breathing exercises. All exercises are performed in the supine position.

The tasks of physiotherapy exercises in the initial period are:

1. restoration of the mental status and psychological aspects of the patient;
2. prevention of the development of complications provoked by traumatic agents;
3. restoration and stabilization of the work of vital organs, especially cardiac activity and the respiratory system;
4. prevention and treatment of hematomas in the brain.

Therapeutic exercises with a slight concussion begin to be carried out in the first days, even if the patient is in the intensive care unit. When the patient is stabilized, there is no nausea and headache, he is given a semi-sitting position and special exercises begin. If the patient's condition is moderate or severe, the exercises are carried out in the "lying" position.

At the initial stage, exercises are used for the muscles of medium and small groups. Involves the muscles of both the upper and lower extremities. Exercises are carried out slowly, the number of repetitions is reduced. It is recommended to carry out exercises several times a day (3-5 times) for 5-10 minutes. This will prevent complications and not burden the patient's body.

The main exercises include:

1. squeezing and unclenching fingers and toes;
2. flexion and extension in the elbow joints;
3. slow tilts of the head to the sides.

Breathing exercises play a huge role. But with hyperventilation, tissue hypoxia of the brain can develop and provoke violations of the functions of the lungs and the hypothalamic-pituitary system.

You can not hold your breath, take deep breaths with an extended exhalation. When performing breathing exercises, the number of repetitions is not more than 4.

If there is a loss of skin, temperature or pain sensitivity or its decrease, the patient must be taught to transmit impulses through motor neurons.

In the initial period, to prevent the development or eliminate the resulting hematoma, a therapeutic massage is performed. The neck area is carefully massaged using a special technique. This massage causes the restoration of impaired blood persistence in the vessels of the brain and the resorption of the accumulated blood clot in the cerebral arteries.

Interim period

With craniocerebral injuries, when the patient begins to adapt to higher physical exercises, they move on to movements in large joints (shoulder, knee and ankle).

The intermediate stage begins. In order for the patient to take the “half-sitting” position, it is necessary to carry out a set of measures for this. It is forbidden to immediately force the patient to sit down, as there is a high risk of fainting or collapse. Exercises should be aimed at restoring vascular tone, eliminating the developed pathological reflexes. As they recover, patients perform therapeutic exercises of the initial period, which are joined by therapeutic exercises of the intermediate period.

If during concussion the functions of the flexor muscles of the forearm and hand, foot and leg extensors were impaired, it is necessary to oppose them to antagonist muscles. It is necessary to carry out exercises for flexion-extension of muscles in the shoulder, elbow, wrist, ankle, knee joints. Muscles should be in a relaxed state. You need to strengthen weakened muscles that have lost their functions.

You can not do exercises if the patient experiences pain during physical therapy.

Classes are held in combination with massage. It can be a point or local massage.

In case of impaired coordination, classes are used to restore the lost functions of the cerebellum. Using special objects, they improve the accuracy of coordinated movements in space.

In the second period, the patient is already in the ward of the neurological department. Clinical symptoms gradually subside, the patient can move around the territory of his department. Classes can be carried out in a lying or sitting position.

The patient needs to do:

• tilting the head to the side;
• torso to the right / left;
• abduction and adduction of hands;
• flexion and extensor movements in the joints of the upper and lower extremities.

It is also necessary to strengthen the vestibular apparatus. Carry out combined tilts of the head and torso in different directions. If the patient manages to make circular movements, then they are also recommended to be used.

The objectives of the second recovery period after a concussion are:

1. measures to restore walking;
2. maintaining balance and improving coordination;
3. memory stabilization.

When the patient is already strong and can get up, walking does not bring much discomfort, the patient needs to slowly develop the skill of walking.

First, special physiotherapy procedures are carried out: electrophoresis and foot massage. The doctor prescribes moderate dosed walking. (The doctor recommends that during the day he first walks 50 meters 1-2 times a day, for example, from the toilet to the ward or from the ward to the dining room, then eventually increases to 100 meters, etc.).

The duration of complex events in the second period is 30-45 minutes.

This time includes not only independent exercises, but also physical therapy measures carried out by a doctor.

late recovery period

In the third period, which is a late recovery period and is carried out a month after the concussion occurred, measures are taken to restructure and compensatory mechanisms.

Continue performing exercises from the previous complexes, preventing the development of cerebrovascular accident. These exercises are joined by exercises that are performed in the "standing" position. Tilts of the body are performed in different directions, in some cases touching the ground.

Exercises are performed to improve memory.

Residual or period of residual effects

During the period of residual effects, rehabilitation measures are aimed at eliminating the remaining consequences after a concussion has occurred.

Already begin to perform exercises with the help of special simulators and equipment. They use treadmills at a very low speed, exercise bikes, with slow exercises.

Prevention

Preventive measures are carried out after the patient is discharged from the hospital. The patient must comply with all the doctor's instructions so as not to aggravate his condition and not provoke the development of complications.

Complications of a concussion include:

• prolonged headaches that are not stopped by painkillers (sedalgin, analgin, etc.);
• frequent dizziness;
• neurasthenia;
• convulsive syndrome;
• unstable psyche: a tendency to depression, irritability, lack of sleep and neuroses.

The doctor prescribes certain medicines:

1. analgesics - ibuprofen, nimesil;
2. nootropic drugs - piracetam;
3. tonic drugs - preparations of ginseng;
4. preparations containing macro and microelements - magnesium B6, calcium gluconate.

Recommended vitamin therapy - taking vitamin complexes B and C groups.

With prolonged bouts of depression and neurosis, a psychiatrist's consultation is necessary. Antidepressants, amitriptyline, are used to treat depression.

Patients need to avoid stressful situations, eat right and engage in therapeutic exercise. Bad habits should also be avoided. In some cases, patients develop an aversion to alcohol and cigarettes.

After treatment and rehabilitation after a concussion (in 1-2 months), the patient, if desired and possible, should be provided with sanatorium-and-spa treatment.

A concussion is a dangerous pathological condition that can lead to disruption of the functionality of the structures of the nervous system. It is necessary to immediately contact a specialist for medical assistance after a head injury has occurred. After that, certain methods of rehabilitation will be prescribed to restore lost functions. Performing all the exercises and prescriptions will help to fully restore the body and get rid of the clinical symptoms of a concussion.