Occupational Therapy for Concussion: When Does It Help?

Occupational Therapy for Concussion: When Does It Help?

Occupational therapists work to improve patients’ participation in daily activities. Occupational therapy is most commonly used after severe traumatic brain injury, during a debilitating illness, or for a serious chronic condition. For example, severe TBI patients might struggle to tie their shoes, brush their teeth, remember faces or names, make decisions, and so forth. An occupational therapist works with them to find compensatory behaviors and workarounds to increase their proficiency with activities of daily living (ADL).

While this approach may be helpful for concussion patients with severe, persistent symptoms, its efficacy for treatment of acute concussion depends on what you’re seeking and what the particular occupational therapist you’re seeing has been trained to offer. For example, if you’re struggling with short-term memory, an occupational therapist could help you build habits to remember important information. If you’re anxious about returning to work, your therapist can help you design a return-to-work plan that helps you gradually resume your responsibilities in the workplace.

However, these techniques are focused on increasing quality of life and wellbeing. They aren’t necessarily going to help the brain to heal after a concussion (unless you’re working with an occupational therapist who is specifically trained in post-concussion rehabilitation).

A more effective treatment alternative for acute concussion patients is to use an active rehabilitation approach, which is the method we use at Neural Effects. This involves using aerobic exercise combined with multiple therapies, such as cognitive, vestibular, and neuromuscular therapies to promote brain healing.

In this article, we’ll answer frequent questions about the use of occupational therapy to treat concussed patients. We’ll address:

If you live in Provo, Salt Lake City, or anywhere else in the Utah Valley area, we can help you recover from your concussion and reduce your chance of long-term symptoms. We are in network for most types of medical insurance. Schedule your evaluation today.

What Is Occupational Therapy?

Occupational therapy for concussion can be helpful, but it depends on the therapist's training and the patient's needs.

Occupational therapy is a type of rehabilitation therapy that aims to help patients with specific medical issues — including concussions — overcome challenges in their daily life. The term “occupation” is used as a broad concept to include any activities related to personal care, home life, leisure, school, work, and other situations.

In general terms, the role of the occupational therapist is to assess patients’ cognitive, psychological, and physical state, then develop ways to help them attend school, go to work, take care of themselves or their home, play sports, and stay active. Many occupational therapists are specialized based on the age of the patient (think geriatric vs pediatric patients) or the type of injury or illness.

These health care professionals work in collaboration with the patient to find out what areas of their daily routines have been affected by the injury or illness and what factors may be aggravating symptoms. This information will be used to develop a personalized plan.

Occupational therapists can assess aspects like:

  • Physical symptoms: Balance, dizziness, posture, range of motion, and strength.
  • Cognitive symptoms: Memory, concentration, problem solving skills, brain fog.
  • Emotional status: risk of developing anxiety and depression or other mental health conditions.
  • How to deal with the environment at home, work, school, etc.
  • Options available for patients to reach their goals: Apps, devices, home adaptations, etc.

Occupational therapists are trained to look both at the activities you need to do every day and the challenges that you face in your environment. These therapists are trained in an assortment of anatomy, neurology, physiology, and mental health topics so that they can address limitations that may arise from a wide variety of symptoms. These therapists have the ability to facilitate re-engagement in normal activities after a concussion at the appropriate level for each patient.

Can Occupational Therapists Treat Concussed Patients?

Concussion specialists will walk you through therapy.

Occupational therapy may be beneficial for patients after a concussion (mild traumatic brain injury, or mTBI), especially if symptoms are getting in the way of participating in the day-to-day activities that are important to them. For example, in a study with 220 students, about half of them reported problems related to their occupation as students. The authors suggest that concussion management via clinical practice of occupational therapy could help these students return to the classroom.

It’s important, however, to find an occupational therapist trained in concussion rehabilitation, which may not be easy. A study found that only about a quarter of occupational therapists have experience dealing with concussed patients. If your post-concussion symptoms have persisted for more than three months, occupational therapy likely will not resolve them. (In that case, you likely need appropriate treatment for post-concussion syndrome.)

Occupational therapists use both remedial and compensatory methods to allow patients to return to their occupations. Remedial techniques help patients relearn how to perform a particular task they’ve struggled with since the brain injury. In contrast, compensatory tactics teach patients alternative ways of doing a particular task which they can’t yet do the way they did before the concussion.

Both these approaches can be used in concussed patients. For example, remedial interventions include playing board or computer games that require executive function, attention, planning, and working memory. The aim is for the patients to be able to transfer some of these skills into their everyday occupations. On the other hand, when occupational therapists teach patients how to use devices like mobile phones and tablets to check a to-do list, for example, that’s a compensatory intervention. Occupational therapists use remedial techniques whenever possible because it puts more emphasis on patient recovery and relies less on devices.

Occupational therapy services related to concussion management could include:

  • Improving cognitive skills: Occupational therapists can help patients with cognitive skills such as memory, concentration, visual perception, problem-solving, and executive functions. To improve cognitive skills after a concussion, an occupational therapist will use cognitive rehabilitation exercises to stimulate neuroplasticity in the brain. Therapists may also resort to compensatory techniques, such as using daily planners or checklists to help patients remember daily tasks. This won’t heal your brain or help you recover short-term memory, but it will help you function more effectively until you can improve your skills.
  • Learning about energy conservation: Occupational therapists can work with patients to develop a plan to control levels of fatigue during the day. This includes, for example, prioritizing important tasks and fitting in rest periods during the day. The aim is for the patient to gradually increase their endurance so they can cope with more complex tasks without triggering symptoms.
  • Establish a healthy sleep routine: Occupational therapists can look at sleep patterns for each patient and suggest ways to improve sleep, such as establishing a daily routine or avoiding caffeinated drinks before bed time.
  • Help with a gradual return to work, school, or sports: Occupational therapists can assess work demands and create a plan for a paced return to the workplace. Therapists can also help educate others at the workplace or school about the patient’s specific needs, such as a reduced timetable at school or frequent breaks at work. The same holds for sport-related concussions and students recovering from concussion.
  • Non-pharmacological pain management: Occupational therapists can review the patient’s medication and suggest possible non-pharmacological alternatives where possible. This includes, for example, breathing and mindfulness or physical exercises to help keep headaches and neck pain under control.
  • Improve visual and vestibular skills: Therapists with the appropriate training can assess the patient’s visual and vestibular skills and offer strategies to help with issues found during the assessment. Occupational therapists work on improving meaningful everyday tasks that rely on vision, such as working with a computer, finding items at home, or reading recipes to cook a family meal. This is done using a variety of exercises, such as eye tracking, eye teaming and others.
  • Driving rehabilitation: For many patients, driving is an essential daily activity. However, a brain injury can affect cognitive abilities (including attention, memory, and reaction time), vision and depth perception, as well as physical abilities such as strength and range of motion. As a consequence, many concussed patients avoid driving because they don’t feel right, or are experiencing headaches, pain, and dizziness. To deal with these issues, there are occupational therapists specialized in developing ways to help patients get back behind the wheel. Driving rehabilitation includes driving simulations and practicing cognitive and physical skills required to drive.
  • Support for mental, behavioral and emotional problems: Mental health is also a crucial part of occupational therapy interventions. Occupational therapists can’t diagnose or treat mental health disorders, but some of them are especially trained to help patients with these issues, using a variety of approaches including methods used in cognitive behavioral therapy and other behavior management strategies. The aim is to assist patients and their families in learning how to cope with mental and emotional problems before they escalate.

Further reading: How long it takes to recover from a concussion

A Multidisciplinary Therapy Approach Is More Effective

Vision therapy may be necessary.

The right occupational therapy provider can help a concussed patient, especially if they’re part of a multidisciplinary team capable of offering  customized treatment. That said, it can be difficult to find an OT who specializes in concussion treatment and who knows the best remedial techniques to help your brain heal from the head injury.

While occupational therapy is definitely a better approach than doing nothing after your concussion, it isn’t the strongest approach to post-injury recovery. A combination of aerobic exercise and a variety of therapies — such as cognitive therapy, vestibular rehabilitation, and neuromuscular therapy — is the most effective option. For patients with acute concussion, it’s better to focus intensely on making a full recovery vs. learning compensatory behaviors.

At Neural Effects, we use this combination of physical activity and cognitive exercise to promote faster recovery and decrease the chances of long-term symptoms following concussion.  We do include some aspects of occupational therapy in our treatment plans, and may include more or less depending on your specific needs.

Ideally, patients should start treatment with us as soon as they’ve finished the 48-hour, post-concussion rest period, but it’s still possible to start at any time after the concussion. Each patient receives three one-hour sessions over two weeks, but this schedule can be adjusted according to specific needs.

Treatment at our clinic starts with a detailed physical examination and assessment of your concussion symptoms by one of our clinicians. The physical examination includes assessment tools and practices such as:

  • A cranial nerve exam to assess nerves in the head that control facial movements;
  • A cervical spine exam to check for fractures of herniated discs
  • A balance exam called Balance Error Scoring System (BESS) to test balance and posture

We also ask each patient to list and rate their symptoms from zero (no symptoms) to six (most severe symptoms) on a symptom questionnaire. This helps our therapists understand which systems have been affected by your head trauma.

This initial examination also includes a review of your medical history, which may influence the treatment you receive. For example, if we know that you have a knee injury, our team can adapt physical exercises to what you can do. If you have referral paperwork, brain imaging results, or anything else that might be relevant, we will look at that, too.

Once this initial examination is completed, we gather the results and devise a treatment plan for you. If we’ve noticed that you’re struggling with balance issues, we focus a bit more on vestibular therapy; or, if you struggle with concentration and short-term memory, we can weight the session more heavily to cognitive therapy.

Gentle aerobic activity is always part of therapy.

Our sessions typically include:

  • Physical therapy: This involves short bursts of aerobic exercises, usually on a stationary bike or treadmill. The aim is to raise blood flow to the brain without severely increasing your symptoms. This is called exercising at the sub-symptom threshold and is a key part of our post-concussion therapy. A physical therapist will monitor you the whole time in the interest of safety.
  • Vestibular therapy: Our therapists use a variety of exercises to address vestibular dysfunction. If you struggle with dizziness, lightheadedness, difficulty with balance, or trouble stabilizing vision, this type of therapy should help.
  • Vision therapy: This therapy is used to address symptoms related to vision, such as eye strain, blurry vision, or headaches when reading.
  • Neuromuscular therapy: Neuromuscular therapy uses massage and therapeutic exercises to relieve muscle pain caused by trigger points, muscle soreness, and other problems. The aim is to relax neck muscles and increase head stability and mobility.
  • Cognitive therapy: During cognitive therapy, patients do a series of cognitive exercises such as logic puzzles, memory games, and pattern-finding puzzles. These exercises can improve cognitive deficits such as memory loss, brain fog, and difficulty concentrating.

After each session, patients receive a series of exercises to complete at home, including aerobic exercises, cognitive activities, and relaxation techniques. Completing these exercises increases your chances of a fast and complete recovery.

Occupational Therapists Can Help Patients with a Concussion (but There Are Better Options)

Occupational therapists are experts in finding ways to improve patients’ quality of life after an injury by helping them relearn skills or compensate for their impairments. This approach is helpful, especially for illness or injury that produces long-lasting physical or cognitive problems.

But patients looking for occupational therapy need to remember a few key points:

  • The therapist will be most helpful if trained in management of concussion. They should be able to offer rehabilitation, not just compensatory strategies.
  • Occupational therapy often does not address the root issue of concussion (the need for healing and healthy neuroplasticity in the brain). 

At Neural Effects, we look beyond symptom management. Our rehabilitation services combine cardiovascular exercise and multidisciplinary therapy to help your brain heal from the damage sustained after the concussion and reestablish normal functioning.

If you live in Provo, Salt Lake City, or anywhere else in the Utah Valley area, we can help you recover from your concussion and reduce your chance of long-term symptoms. We are in network for most types of medical insurance. Schedule your evaluation today.