As public health officials reaffirm the importance of physical distancing measures during the COVID-19 outbreak, those who are dealing with post-concussion syndrome (PCS) in isolation are also contending with complex physical and psychological hurdles associated with their injuries.
Post-concussion syndrome (PCS) is defined as the persistence of concussion symptoms after a mild to moderate traumatic brain injury that stretches beyond the normal course of recovery. It is typically diagnosed when a patient experiences three or more concussion-like symptoms that last longer than one month, including headache, dizziness, sleep problems, depressed mood, irritability, anxiety and/or cognitive problems involving memory or concentration.1
Overcoming these hurdles can be incredibly challenging for people under normal circumstances, as PCS patients adjust to a new reality. They may find it difficult to re-engage in personal and professional relationships or notice the deterioration of certain skill sets. This could lead to a lack of confidence, hindering them from participating in the same tasks or activities as before the concussion.2
These challenges have become amplified amid a global pandemic. PCS patients find themselves without a conventional support system and limited means to access medical intervention or mental health assistance.
While this is a stressful time, we are offering a few helpful tips for how PCS patients can cope with their diagnoses while in isolation:
1) Implement a structured routine
Many people are implementing their own structured routines as they adjust to working from home or caring for their children who are out of school. This is especially important for PCS patients. One of the many symptoms of a traumatic brain injury or concussion is the difficulty for patients to plan and organize their daily tasks. Whether it be the result of memory loss, multi-tasking or sleep deprivation, PCS patients have greater difficulty re-orienting themselves to a routinized schedule. Predictability can reduce anxiety and increase feelings of independence.3
Maintaining a consistent routine includes performing hygiene tasks in the same order, eating scheduled meals, exercising, committing the same number of hours to work-related activities and allotting time to connect with friends and family. Using checklists, whiteboards or Smartphone apps can be extremely helpful in setting daily reminders and monitoring daily progress.
2) Embrace Digital Connectivity
Contact with friends, family members and co-workers is essential for PCS patients to help return to a sense of normalcy. Disassociation is a common symptom of head trauma, with patients feeling disconnected or “spaced out” from the world around them.4 These feelings of disassociation can be compounded with heightened feelings of depression and anxiety, which can have profound consequences for PCS patients.
Exploring ways to stay connected while in isolation, such as FaceTime, Skype, Zoom or other video conferencing technologies, is important to mitigating feelings of disassociation. Friends and family can be important resources during concussion recovery, and daily digital connections can help provide much-needed emotional support. Some physicians may encourage PCS patients to limit screen time depending on their condition. Communicating with family via telephone is a safe, yet effective alternative.
3) Explore Telehealth Solutions
The COVID-19 outbreak has made it difficult to access in-person healthcare services. In lieu of in-person appointments, medical professionals and med-tech companies have implemented innovative telehealth solutions to ensure those in need of medical care can access healthcare professionals. That includes those suffering from PCS and associated mental health symptoms.
According to the Journal for Nurse Practitioners, telehealth visits can be just as effective as in-person visits for certain conditions, including concussion management. They also help decrease emergency room visits and illness severity, resulting in improved health outcomes. Given that telehealth solutions can be accessed from anywhere in the world, they are also valuable for PCS patients who live in underserved communities.5 While in isolation, it is a good opportunity for PCS patients to explore the potential of telemedicine for concussion care.
4) Track health and activity
Keeping a journal of day-to-day activities can be beneficial for PCS patients for a variety of reasons. Using a journal can help patients plan their days ahead of time to ensure they are sticking to a routine or following concussion management guidelines if they are having trouble with memory loss. A journal can also be useful for PCS patients who may want to reflect back on their days and determine any causes or effects of setbacks which have occurred throughout the day.6
Documenting symptoms can also be extremely beneficial to healthcare professionals, who will be better equipped to assess symptoms and severity if they are recorded daily. For those seeking online PCS support groups while in isolation, it is common for participants to read their journal entries aloud. Sharing obstacles, challenges and successes with other survivors of brain injury can be extremely empowering on the road to recovery.
5) Avoid media saturation
Now is not the time to continuously refresh your web browser for the latest COVID-19 news or watch hourly news coverage for updates. PCS patients are already combatting heightened anxiety levels as a result of their injuries and continuous updates on public health crises or a spiraling global economy will only serve to aggravate the situation and could result in increased bouts of depression, sleep disturbance, fatigue, irritability and agitation.7 Explore alternatives to keep your mind active and entertained, including online exercise videos, household chores, arts and crafts, trying new recipes, listening to audiobooks or podcasts, medication or playing a musical instrument.
An invisible illness, PCS can often be overlooked or misunderstood. For those managing symptoms in isolation, support is needed now more than ever. For guidance managing relationships with loved ones during this changing time, read our blog addressing the preservation of relationships post-TBI.
1 “PCS Resources,” Concussion Legacy Foundation. www.concussionfoundation.org/PCS-resources/what-is-PCS, April 14, 2020.
2 Center of Excellence for Medical Multimedia, “What impact will moderate or severe TBI have on a person’s life?” Brainline, www.brainline.org/article/what-impact-will-moderate-or-severe-tbi-have-persons-life, August 9, 2018.
3 Johnson, Melissa. “31 Strategies for Living with a Brain Injury,” Brainline, www.brainline.org/article/31-strategies-living-brain-injury October 25, 2016.
4 “A guide to recovering from mild head injury, concussion and mild traumatic brain injury,” Head Injury Symptoms. www.headinjurysymptoms.org/dissociation/4591477452, April 12, 2020.
5 Marckmann, Cynde and Diane John, “Telemedicine, Quality Initiative for Concussion Management,” The Journal for Nurse Practitioners, vol. 16 (2020).
6 Fowler Kennedy Sport Management Clinic & St. Joseph’s Healthcare London. “Post-concussion symptom management guidelines,” www.fowlerkennedy.com/wp-content/uploads/2017/02/Post-Concussion-Treatment-Guidelines.pdf, April 13, 2020.
7 “Study: Playing smartphone app aids concussion recovery in teens,” The Ohio State University Wexner Medical Center, ScienceDaily, www.sciencedaily.com/releases/2017/08/170816110133.html. 16 August 2017.