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- Vol. 17 | Recovering from brain injury
Vol. 17 | Recovering from brain injury
Integrating Psychological Care in Concussion Healing
Recovering from a concussion isn’t just about resting and waiting for the headaches to fade —there's so much more to the process. While most of us focus on the physical aspects, the emotional and psychological side of recovery plays a huge role in how quickly and effectively someone bounces back.
Let’s dive into how integrating psychological care can make a world of difference in concussion recovery, helping patients not just heal, but truly thrive.
Let’s start with the basics:
A concussion is a type of mild traumatic brain injury (mTBI) that occurs from a direct blow to the head, face, neck or elsewhere on the body with an ‘impulsive’ force transmitted to the head. This can happen in sports, car accidents, or even a simple fall.
Concussion symptoms can vary widely and may include:
Assessing your concussion:
The road to recovery can vary significantly depending on the severity of the injury and how it’s managed. There is no single diagnostic test for concussion, therefore health professionals rely on a multifaceted approach including:
Clinical History: Mechanism of injury, symptom presentation
Physical Examination: Neurological exam, balance testing
Cognitive Assessment: Memory, concentration, reaction time tests Symptom Scales: e.g., Post-Concussion Symptom Scale PCSS
Specialised Tests:
Vestibular/Ocular Motor Screening (VOMS)
Computerised neurocognitive testing
Neuroimaging: Typically normal in concussion, used to rule out more severe injuries i.e intracranial bleeds.
The six-type system is a way to classify concussions and reflect the complexity of the injury (Kontos et al., 2020). Specific interventions will be required based on your concussion type, including vestibular rehabilitation for balance issues, vision therapy for ocular symptoms, cognition rehabilitation for memory/attention issues and psychological interventions for mood/anxiety symptoms.
Recovery Process:
Traditionally, concussion management was all about physical rest—think dark rooms and no screens. But as we’ve learned more about concussions, it’s become clear that this approach is not always the best fit. Moreover, the emotional and psychological effects of a concussion can be just as significant, if not more so. Ignoring these aspects can prolong recovery, making it harder for someone to return to their normal life.
Sub-Symptom Threshold Exercise
Studies have shown that introducing light aerobic exercise within 48 hours after a concussion may lead to faster recovery times compared to strict rest. This is particularly true for young adults.
The concept of "sub-symptom threshold exercise" involves engaging in physical activity at a level that doesn't exacerbate symptoms, gradually increasing intensity as tolerated. This concept has gained traction in recent years. A 2019 randomised clinical trial on ‘Early Subthreshold Aerobic Exercise for Sport-related Concussions’ of 203 adolescents found that those assigned to aerobic exercise recovered 4 days faster than those assigned placebo-like stretching (Leddy et al., 2019).
Psychological Aspects of Concussion
After a concussion, it’s common to experience irritability, mood swings, anxiety and depression. These feelings often stem from the sudden removal from normal activities, uncertainty about when things will go back to “normal,” and the loneliness that can come with enforced rest.
Social isolation is a big challenge. Many people find themselves pulling back from friends and family, either because they’re too exhausted to socialise or because others don’t fully understand what they’re going through. This isolation can slow down recovery and make the whole process feel even more daunting.
But here’s the good news:
There’s a growing recognition that recovery should be about more than just physical rest. By incorporating psychological care—like counselling, social support, and even light social activities—into the recovery plan, people not only recover faster but also feel more supported and understood along the way. Engaging in social activities, when done carefully, can be incredibly beneficial. It provides emotional support, helps combat feelings of isolation, and gently stimulates the brain in a positive way.
Everyone’s tolerance for social interaction and emotional support varies, so what works for one person might not work for another. There’s also the challenge of overcoming the stigma that still surrounds mental health, especially in environments like sports, where toughness is often prized.
Moreover, while we’re seeing positive trends, more research is needed to fully understand the best ways to integrate psychological care into recovery plans. We’re on the right track, but there’s still a lot to learn about how to optimise this approach for each individual to ensure they gain the benefits of social interaction while avoiding overstimulation during recovery.
That said, the shift towards a more holistic, well-rounded approach to concussion recovery is a positive and necessary evolution. By treating the mind alongside the body, we’re giving patients the best chance to fully recover and regain their quality of life.
Integrating Mental Health Care:
Healthcare professionals are increasingly integrating mental health care into concussion recovery. Here’s how:
Multidisciplinary Team Approach: Include mental health professionals (e.g., sports psychologists, neuropsychologists) in the core treatment team. Regular case conferences discuss psychological aspects of recovery alongside physical symptoms.
Psychoeducation: Provide information to patients and families about potential psychological effects of concussions.
Cognitive-Behavioral Therapy (CBT) Integration: Offering CBT sessions focusing on managing negative thoughts related to recovery, developing coping skills, and addressing fear of re-injury. There’s growing research on applying the chronic pain fear-avoidance model to concussion recovery and return to play.
Peer Support Programs and Family Involvement: Offering group therapy sessions for concussed athletes to share experiences and coping strategies; Providing guidance to family members on supporting the athlete’s psychological recovery; Including family sessions in treatment plans to address systemic impacts of the injury.
Return to Play Psychological Preparation: Develop individualised plans addressing specific psychological barriers to return, including visualisation and mental rehearsal techniques.
Final thoughts:
If you’re a healthcare provider, coach, or someone supporting a loved one through a concussion, remember that recovery is more than just physical rest. Make sure to incorporate psychological support, encourage gentle social interaction, and create a recovery plan that addresses the whole person.
For those going through it, don’t hesitate to reach out for help—whether it’s talking to a professional, leaning on friends and family, or simply staying engaged with the world around you. Your recovery journey is personal, and you deserve every tool available to make it a successful one.
Our inbox is always open and we’d love to hear from you if you have any concussion stories to share - what was your experience with recovery like? did anything from this melon mag surprise you?
💙 The MM Team
