Post-Concussive Syndrome (PCS)- The Unfortunate 10%
05/07/2013 // Concord, CA, USA // LifeCare123 // Greg Vigna, MD, JD, Joe Motta, JD // (press release)
Immediately after a concussion symptoms of confusion and amnesia occur after a head trauma or appearing several minutes after. There may be impairments in recalling events just prior to the injury or problems recalling events after the injury. There may be loss of consciousness, dizziness, and confusion. All of these symptoms are related to the acceleration and deceleration effect of the brain in the skull during and traumatic injury. Fortunately 90% of patients who have suffered a concussion recover with no residual symptoms within 7-10 days. The unfortunate 10% with persistent PCS can have significant alterations in their lives. Headaches and fatigue that is related to changes in cognitive function are the most frequent symptoms related to PCS. Persistent symptoms that extent past 3-4 weeks are likely to have profound impact in a patients psychosocial welfare affecting their work, interpersonal skills, and emotional well being. Families of a person who have suffered a concussion may notice irritability, memory impairments, and disorientation. PCS is defined by the World Health Organization International Classification of Disease as having at least three of the following symptoms: Headache, fatigue, irritability, dizziness, problems in concentration, and problems in memory.
Treatment for PCS in the acute stage has not been studied critically but there is agreement in the literature that a patient should rest for a short time and as symptoms improve they are advised to advance their activity by participating in the normal activities of daily living as soon as possible. Medications are indicated for headaches, which occur in most patients with PCS and include Tylenol and Amitriptyline. 85% of patients with headaches related to PCS are of the tension variety which may be related to primary myofascial pain which is pain related to the muscles themselves or secondary which are referred from other structures such as facet joints, temporomandibular joint injury, or interverterbral disc injury. Nearly one third of patients with PCS headaches persist for over a year. ?Physical therapy is a helpful modality because often musculoskeletal problems to the cervical spine, jaw, and shoulder related to the trauma may contribute to the symptom complex of PCS. These therapeutic modalities provided by licensed professionals may include stretching, electric stimulation, therapeutic heat or cold, ultrasound, and cervical traction. As the pain subsides with passive modalities a patient is encouraged to participate in active exercises and eventually a home program.
Neurocognitive rehabilitation by either a clinical psychologist or a neuropsychologist may be helpful to educate a patient and family regarding the problems associated with a concussion and support a patient during the acute and sub-acute stage, while encouraging a gradual increased exercise. Clinical psychologist and neuropsychologist are trained in objective testing, which can detect subtle cognitive deficits related to the brain injury. Psychological support during the sub-acute stages of patient with PCS is necessary to monitor for depression and other maladaptive behavior. Serotonin reuptake inhibitors such as Zoloft or Prozac are helpful to treat depression related to PCS. Patients with depression often appear to have cognitive deficits, which may be related to both depression, and decreased attention and antidepressants may benefit both of these clinical signs.
Speech therapy is an underutilized therapeutic intervention that provides great benefit for a patient with problems related to PCS. Patients may have problems with attention, verbal memory, and comprehension. A speech therapist is uniquely qualified to break down task into manageable parts, provide therapeutic workbooks to improve attention, concentration, and problem solving. They are instrumental at providing behavior skills to help with coping with deficits related to PCS. They are trained with testing cognition, attention, and language function, which are necessary to document deficits and monitor recovery following a concussion.
From my 15 years of clinical experience managing patients who have suffered concussion related to sporting injuries, bike accidents, motor vehicle accidents, and other traumatic injuries PCS is often a contributing cause to disability and often coexist with cervical and lumbar herniated disc, broken bones, and other injuries. It is necessary to look for subtle problems related to PCS at treat appropriately ?with a comprehensive strategy involving a variety of health care professionals prevent long-term disability.
Life Care Planner Perspective:
There are often long-term implications related to PCS and it is essential for a life care planner to understand its medical, physical, and psychosocial impact when developing a life care plan. A life care planner should not overlook problems related to PCS and attribute them to other associated injuries. Depression, chronic pain, and mild cognitive impairment may be long term squeal from a concussion and contribute to the disability of the patient. Failure to consider this in the life care plan will lead to inadequate long-term treatment of the patient, which may result in medical and psychosocial complications.
Serious Injury Lawyer Perspective:
Fair compensation is simply not possible if the jury does not understand the impact of the concussion on the patient and it the lawyer’s job to provide the medical evidence by way of medical testimony to prove these damages to get the necessary compensation to make a client ‘whole’.
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