PCS,

A decompensation would be when she exercise to hard or otherwise stresses her brain and symptoms return. When she bumps her head getting in the car, I would consider this to be an new concussion, albeit, a concussion due to her brain being very sensitive to even mild trauma. A term that is beginning to be used is sub-concussive impact or event.

The time frame for an end to decompensations would be entirely personal. It would be very difficult to put a time to it due to the individual nature of concussions.

In your daughter's case, the primary focus should be reducing the risk of a subsequent concussion or decompensation.

She should be lead toward an understanding of some lifestyle changes to minimize the risk of multiple impacts and stresses than cause a decompensation. It will be hard for her to project into the future, but if she looks back, she will begin to notice the cause and effect of stress.

For example, she may notice that intense study and taking an exam may leave her struggling for a while afterward. Attending a loud music concert may leave her with after effects. She may need help with the observations of her struggles. She will likely go on ignoring the symptoms of a decompensation. As her mom, you may notice the subtle changes in behavior, lack of attention, a change in her eyes, etc.

Decompensations can be self fulfilling. The more one has, the more frequent they become. The efforts to reduce the stresses that cause them will be very worthwhile in the long run.

It takes some very truthful introspection to catalog the stresses that cause decompensations. I would categorize a roller coaster ride that causes symptoms to be a concussion. The sea sickness would just be a decomp. A loud rock concert would be a decomp. Dancing hard at a rock concert would likely be a concussion.

These risks can be moderated without having to shut down her life. Some activities can be replaced with others, like replacing loud music with other styles that are less problematic. There will be choices she will have to make, at least eventually. The youth culture promotes a lot of activities and behaviors that are not beneficial to a stable life, whether one has PCS or not. For example, she could replace some of the more aggressive activities with dance or ballet. Ballet is a lot more challenging that it appears.

I hope this helps.

My best to you,