WHEN CONCUSSION SYMPTOMS ARE NOT GOING AWAY A GUIDE FOR ADULTS WITH CONCUSSION 3d illustration of headache human. HAVE YOU HAD A CONCUSSION? If you have had a concussion, also called a mild brain injury, there are things you can do to feel better. Usually concussion symptoms will go away by three months. Most people feel better in two to four weeks. However, some people have symptoms that last longer than three months. Remember: You don’t have to hit your head to get a concussion. A hard bump to the body can also cause a concussion. If you have an active lifestyle, three months may be too long to wait to see if symptoms go away. You need to act sooner to safely and successfully return to school, work and physical activity. Go to the doctor or hospital. Rest for the first one to three days as needed. Follow the doctor’s care plan. Watch carefully for changes. Have someone else watch, too. FIRST THING AFTER INJURY FIRST FEW DAYS TO WEEKS AFTER INJURY After three days, start to ease back into daily routine, but try not to do too much. Too much activity can make symptoms last longer. Did you know that research also shows that too much rest can do the same? It is safest to find a balance. If you can, put off big work, legal or financial decisions during this time. Get a doctor’s letter saying that you have a concussion (or mild brain injury) and when you may return part-time or full-time to school or work. TRY NOT TO PUSH THROUGH YOUR SYMPTOMS An injured soccer player goes to the doctors office for help RETURNING TO COLLEGE (OR OTHER TRAINING AFTER HIGH SCHOOL) Ease back into school. You may need to start with a shorter schedule. Leave class as symptoms get worse and before they become too bad. Take a break when you need one. Start by talking to each teacher. Show them the doctor’s note. Tell them what happened. Let them know how you are feeling and what you think may help you or what you may need to do. Examples of helpful changes: •“I may need to wear sunglasses because I’m sensitive to light.” •“I may need to put my head down to rest. I’d like to do this rather than leave so I can still listen.” •“I can’t handle a whole class yet, so I may need to leave early.” •“I may need extra time for this test/project because it takes longer for me to think and plan.” Let teachers know that you do not expect these changes to last long, but you do need them now in order to do your best. If you need help in making these changes, talk to the school’s Disability Services office. Tennessee’s TBI Service Coordinators are people who can help you at no cost. They know about concussion (brain injury) and can help with what you need. 800-882-0611 Group of young business people and designers.They working on new project.Startup concept. RETURNING TO WORK You may need to give your employer the letter from your doctor that tells why you were out and gives the okay to return. If possible, work with your employer to return slowly (half day at first) to see if your symptoms get worse. In some jobs, you can make changes without asking the employer. Maybe you can turn off your private office light, turn down the brightness on your computer, or close the door? Make any changes that you know are okay to make on your own. Work with your employer to make other changes. Tell them that these changes may not last long. It may help to talk with your Human Resources office. FOUR TO SIX WEEKS AFTER INJURY If your symptoms have not gone away by four weeks after injury, you may need to see a symptom specialist. What is a symptom specialist? New research shows that there are different types of symptom groups like having problems with thinking, headaches and balance. Treatment for your symptom group can help you feel better sooner. Talk to your doctor about sending you sooner if needed. Talk about your injury and problems that have started with the specialist. Below are some of the problems and who your doctor might send you to see: Problem Referral (Specialist who can help) Thinking (Cognitive) and Tiredness (Fatigue) Neuropsychologist, specialized concussion clinic, brain trauma clinic, Speech Language Pathologist Balance (Vestibular) Physical Therapist, specialized concussion clinic Problem with eye movement (Ocular-Motor) Neuro-ophthalmologist, Occupational Therapist Headache/Migraine Neurologist Neck pain (Cervical)* Chiropractor, Physical Therapist Changes in feelings, Sad, Angry (Mood, Anxiety) Psychologist, Counselor, Neuropsychologist, Psychiatrist *If the neck is out of place, it can cause headaches and other concussion symptoms. ONGOINGContinue to use your helpful changes at work and school. If you start new classes and jobs, you may need to think of new changes for those. Look at a strategy list like the Strategies and Accommodations Tool at: https://tndisability.org/resources/strategies-accommodations-tool/ for ideas or talk to a specialist. Choose a key person in your life to help you with ideas for helpful changes while you heal. It is good to know and to ask for what you need. DANGER SIGNS If you see any of these signs, CALL 911 or go to the hospital immediately Nausea (very sick stomach) or vomitingOne pupil larger than the otherHeadache that does not go awaySeizures: eyes fluttering, body going stiff or shaking, staring into space Loss of consciousness, even briefDisoriented/confusedHands shake, body shaking, muscles get weak, loss of muscle tonehttps://www.cdc.gov/heads-up/?CDC_AAref_Val=https://www.cdc.gov/headsup/ basics/concussion_danger_signs.html OLDER ADULTS As we age, changes can take place in our brains. A fall or other accident is more likely to cause a concussion or even a brain bleed. A bleed may take more time to show up in someone who is older, so they need to be watched more closely over several days. If any danger signs are seen (see box) - in anyone at any age - call 911 or go to the hospital right away. WHAT’S GOING ON? IS THERE REALLY ANYTHING WRONG WITH ME? Concussion symptoms can seem to come and go or get worse. Sometimes you may even doubt if there is a problem. When symptoms seem to change, it is usually because your body or your mind is tired. Symptoms can also change if you drink alcohol or take a drug (even legal medicine). Being sick, being upset, in pain, or stressed can also cause changes. The better you can manage these other things, the better your symptoms will be. Symptoms are real. They tell you that the brain is still healing and needs time. Take time to make helpful changes at home, school and work until you don’t need them. -TN Statewide Crisis Phone Line: 855-CRISIS-1-See t he Personal Guide for Everyday Living after Concussion/Traumatic Brain Injury at: https://tndisability.org/resources/personal-guide-to-everyday-living-after-a-concussion/ Picture of computer with Doctor showing signs of a concussion. BEHAVIOR CHANGES Sometimes angry behavior, like yelling at others, is the first sign that you have had a brain injury. You may be mad or sad that you can’t do something that was easy before the injury. Others may not understand. Be patient with yourself. Try to figure out what the real problem is. Ask yourself these questions: Can I pay attention? Has my vision changed? Am I in pain? Maybe you just can’t handle things like you used to. Try to figure out if there are any helpful changes you can make. Talk with someone who can help you - a trusted friend, family member or a specialist. RETURNING TO SPORTS AND OTHER PHYSICAL ACTIVITY AND PHYSICAL JOBS Student athletes, recreational athletes and people with physical jobs should be cleared by a medical professional before going back to their sport or to a job. •You should not return to sports (or a physical job) if you still have concussion symptoms. •You should also not return when you are still taking medicine for pain or other concussion symptoms. See the National Collegiate Athletic Association guidelines: https://www.ncaa.org/sport-science-institute/concussion THINGS TO WATCH FOR OVER TIME Check all those that you see: .Mood swings, getting mad easier, changes in how you act .Trouble with staying on task and thinking .Memory problems - things that just happened .Anxiety, depression, or problem handling stress .Headaches .Behavior that doesn’t fit the time, place or people (loud in a library) .Poor sleep and feeling tired too easily .Later: Problems with work at school or job EVERY BRAIN INJURY IS DIFFERENT. There is no set time that getting better takes. DOMESTIC VIOLENCEIf your injury is the result of someone you know who is hurting you, ask for help. Tell the doctor. Call 911 if it is an emergency. Call the Tennessee Statewide Domestic Violence Helpline at 800-356-6767. You can find help at the Tennessee Coalition to End DomesticViolence and Sexual Violence: https://www.tncoalition.org/. For a child: https://www.tn.gov/dcs/program-areas/child-safety/report-child-abuse.htmlor call 877-237-0004For an older person: https://www.tn.gov/humanservices/adults/adult-protective-services.html or call 888-277-8366 ALCOHOL ABUSEMany people feel that alcohol changes them more than it did before their injury. Thinking becomes harder and their emotions are more out of control. It is wise to avoid alcohol and drugs while you are getting better. Never drink or use drugs and drive. Red hand with the word stop in the middle. FREE RESOURCES Tennessee Traumatic Brain Injury Program: https://www.tn.gov/health/braininjury.html Tennessee Traumatic Brain injury Service Coordinators: https://www.tn.gov/health/braininjury.html Tennessee Vocational Rehabilitation: https://www.tn.gov/humanservices/ds/vocational-rehabilitation.html Supported Employment: https://www.tn.gov/behavioral-health/mental-health- services/ips-supported-employment.html WorkAbleTN: https://www.tndisability.org/workabletn Brainline: https://www.brainline.org/ Brain Injury Association of America: https://www.biausa.org/ https://www.tndisability.org/brain @BrainLinksTN Brain Links is supported by the Administration for Community Living (ACL) of the U.S. Department of Health and Human Services under Grant No. 90TBSG0051-01-00 and in part by the TN Department of Health, Traumatic Brain Injury Program.