[xxxxcrystalxxxx]

I'm four months into my recovery. This week I decided come hell or high water I was going to do my walking. I got some gel inserts in my sneakers to limit the shock to my brain.

The first two days I had head pain but I muddled through. This is the fifth day and for the last three days I've had no head pain.

This has lead me to dream that maybe the worst is behind me. I do get clumsy and almost fell three times so far. I had to slow my pace down and make deliberate steps to avoid this.

My question is:

Is the clumsyness something that gets better with time? Will I be able to run again. I dont now due to the headache and clumsyness.

I was saying to my husband last night that maybe I can go back to work soon. He reminded me that I had four days of no headaches then woke up with a migrane that landed me in the ER. It lasted nine days.

When do we know we are able to go back? How does the MD determine this? I can maybe see me doing some light duty desk work but I wonder if my days of working up 25 patients (ekg's, med lists, holter monitors) are in the past. I just cant move that fast without getting clumsy and a headache.

I also fear dealing with the high levels of stress. I wonder is my anxiety and anger will be a problem. I was told that it would be at least six weeks before I can start seeing a therapist. I haven't even started that process.

Maybe it's hopeful thinking but if we dont have hope than what's left..

Thanks for any input. I really appreciate it...

[greenfrog]

My doc said go back to work when you feel 90% and have no symptoms (at which point you should start back slowly, for example, on a stepwise return to work plan).

I met with him a few weeks ago and said I was up to around 7.3/10 (at the 5.5-month mark). He said let's see where you are in 2-3 months.

[Mark in Idaho]

I don't see how a doctor can rate someone as 7.3 out of 10, much less the PCS sufferer self diagnose at 90% recovered.

Recovery for returning to work should be all about function. Can you do the tasks required for the job?

I suggest getting strong with your walking and other exercise as a first criteria. Then, walk through the mall or even the hospital/clinic where all of the sights and sounds are. Try to read sitting in a such a busy location.

Build up these skills. Try to due Sudoku or work on a crossword puzzle in these environments.

I would be very hesitant to take on health care tasks until I was confidant in my brain's ability to accurately complete the tasks required.

It is much easier to wait and work on strengthening the required skills outside the work environment that to go back to work too soon and have a few crashes/brain farts when patients are depending on you.

I understand these issues dearly because I have to daily evaluate my ability to drive or work in a risky situation. Lately, driving has been a challenge. I suffered my 15th concussion about 6 weeks ago while working under my pick-up truck. My abilities have been very haphazard since. I am just now getting back to my normal PCS condition.

Keep in mind that once you return to work, you may still have times when you need to take a day or two off to recover from a stressful event.

These are tough decisions to make, especially when the welfare of others is at stake. .

My best to you.

[greenfrog]

I rated myself at 7.3 - my doctor didn't supply the rating.

I think people can tell when they're feeling 90% (more or less), and whether or not we're still experiencing symptoms like headaches, tinnitus, dizziness, etc.

However, a more nuanced and objective assessment of one's cognitive abilities and balance and other physical skills, might require a neuropsych, BESS, IMPACT, or other concussion-related test.

In other words, PCS seems to involve both a subjective element (how the patient feels) and an objective element (how he or she performs on standardized tests and/or tasks).

[Mark in Idaho]

I agree with the subjective and objective elements. But, using the subjective elements to make return to work decisions is problematic.

Even a BESS or iMPACT or other simplified test will likely fall far short in determining return to work condition. A full, day long Neuro Psych Assessment would be more accurate in assessing return to work readiness.

Recovery assessment is a 24/7 issue. It needs to include performance/function over the long term. Eight hour shifts, stressful events, and the myriad of other influences on a worker need to be considered.

A worker may be fully capable of doing their full job assignment but need a quiet environment to last 8 hours. The many permutations of functions and limitations need to be considered.

Any grading of recovery level is always relative to the current assessing environment and recent history.

One of my Neuro-Psych Assessments was performed in a very sterile environment (quiet and without visual stimulation) . I know that I performed much better on some tests than I would have performed in a more normal work environment.

I find it interesting how doctors often struggle to diagnose a concussion but often have no problem diagnosing a complete recovery. They usually rely upon subjective information and the history of the impact to diagnose a concussion. What information do they use to diagnose a recovery?