Hey folks,

Posting on behalf of my girlfriend who is avoiding screens during her recovery.

She fell and hit her head in mid-November. She had a diagnosed concussion two years ago (2014), from which her recovery seemed fairly quick and routine. In mid-October 2016 she got hit in the head/face with a heavy plate, but at the time it seemed more like a face bruise than a small concussion. Since her 2014 concussion, she's had some mild vertigo.

Current Symptoms:

• Fatigue (far and away her primary symptom)
• Increase in vertigo that pre-existed from 2014 concussion
• hyper-sensitivity to loud noises and screens

Here's what she is doing to recover:

• taking a leave from work (like most of us, she stares at screens for a large part of her work day)
• Sleeping a lot (averaging 14+ hours a day)
• avoiding screens (TV, computer and Smartphone) and reading
• avoiding any kind of strenuous activity
• Asian herbal medicines (sorry, don't know what kind)
• Did I mention sleeping?

Here's what she's looking into:

• Neuro-optometry coupled with physical therapy
• FL-41 glasses (or cheaper equivalents)
• Accupuncture
• mild exercise

She's seen a neurologist and primary care physician, neither one of whom seemed well versed on concussion treatments. I welcome feedback on the lists above to see if there are other things she can explore, or if there are cautions on these items. Her work is expecting her back in January, so she's feeling some pressure, although if she needs to go on disability for a while, that's an option.

Thanks in Advance!

The one thing I recommend is not getting the Fl-41 glasses before finding out if that's the right tint. I bought two pairs, one indoor and one outdoor. I felt that they were decent, but not better than a normal pair of tinted glasses.

I recently found at my optometrist, who is a behavioral optometrist, that green is the best color for me. Everyone's brains respond differently, so I would recommend going to a behavioral or neuro optometrist and finding what color works best for her.

Another thing that my optometrist does is syntonics, and that has been very helpful for me.

Todzilla,

Welcome to NeuroTalk.

Where did she get her recovery protocol information ? Some of it is very old. She should not be sleeping any more than normal. Sleeping needs to be quality sleep not quantity sleep. The brain recovers best when it cycles through all of the stages of sleep with REM and slow wave being the most important. REM and slow wave are best when the brain's normal sleep cycle and mechanism is used.

She should be getting up at normal times, having a healthy meal, then keeping busy with low stress activities. Inactivity is just as stressful as too much activity. She should be avoiding naps other than a short nap if an activity caused fatigue and sleepiness.

She should be doing the activities she is avoiding but in short periods. She will never know if she can return to work unless she learns how to pace her use of screens and such.

The important issues are:
Quality sleep, not quantity sleep
Proper activity to stimulate blood flow in the brain
Proper nutrition, see the Vitamins sticky at the top.
Moderating but not avoiding those things that may be triggers or stressors.
Walks or swimming can be good exercise.
Foam ear plugs can help when she needs to be in noisier environments.
Mack's brand are good. Walgreens sells them.

When you say 'hit with a heavy plate' do you mean a serving platter or such ? What immediate symptoms did she have and what were her symptoms a day or two later ? Did the impact cause her head to whip back in a whiplash motion ?

Has she tried using a computer screen with the brightness dimmed ? Laptops have this built in based on the Fn key and a solid sun (dimmer) and hollow sun (brighter). FLux.com offers a free software program that can dim other screens.

Are there any concussion clinics where you live ? Most high schools and college athletic departments have access to them. The team trainer will know who is good.

Where do you two live ? Maybe we can find a concussion specialist in your area.

This idea of shutting down everything in her life can lead to anxiety and depression. Moderating those things is healthier.

She should be OK using the computer for 10 minute periods so she can post her own comments. It will be good for her to make contacts.

My best for you both.

JBuckl, thanks for the input on the glasses. I will relay that to her

She's gotten her information from a number of sources, neurologist, her boyfriend (me) reading the Internet, friends whose children have been concussed, but she is very eager to get more information, hence this site.

That is interesting. She has gleaned that sleep is important. As far as I know, she is getting very good quality sleep, but lots of it too. As someone with sleep issues, I am envious of her somnambulistic skills.

Good info, thanks.

This was a recent recollection, the plate incident. I don't think it was a full serving platter, just something from a shelf when she was getting something out.

As I recall, it just hurt like hell on her face, between her eyes.

As far as I know, no.

No, but I'll suggest this.

Cool. I'm an IT guy, so I'll investigate.

I don't know. We live in Durham, NC, home of Duke University Medical Center and a world class Sports Medicine program, so I would assume so.

Good point.

I will convey that. thanks.

If she is getting quality sleep, she should be waking up alert. If she is not getting quality sleep, there is often a tendency to snooze. Fatigue is often an indicator of less than quality sleep. Excessive snooze sleep disrupts the sleep mechanism so proper sleep is harder to achieve. There are two things she could try. A fit bit and/or a recording pulse oximeter (better choice). Google recording pulse ox. They are affordable.

When I was getting lousy sleep, I could sleep 14 hours a day and still feel fatigued. Now that I know how to get quality sleep, I never need more than 8 hours unless I have been stressed.

What Asian supplements is she taking ? Some can be counter to her needs.

You might want to see if you can find a physiatrist. They are specialists in rehabilitation. I found mine to be much more helpful than either my neurologist or primary care doc.

I second Eowyn's comment about finding a physiatrist, especially if you can find one who truly understand concussions. They are commonly listed under Physical Medicine and Rehabilitation in the yellow pages.

I also found at least 3 concussion clinics in Durham, Duke, etc. I would not recommend the functional neurologist / chiropractic neurologist in Durham until you have tried the other options.

It is not uncommon for children and youth who have had a concussion to be told no screens at all. This is because they often struggle to follow a limited screen time protocol.

Thanks for this great information!

There are a number of physiatrists in the Duke system, where her insurance will probably cover her.

As other have stated in other posts, her Neurologist seems to be clueless about concussions and is likely to be obstructionist in referring her to specialists. Luckily, her PCP seems eager to help and learn more about concussions - much more likely to refer her to the right specialist, with a little prompting.

Still pondering Idaho Mark's comments about not getting excessive sleep. She's getting lots of other advice to sleep as much as she can.

I attend a brain injury support group. Last February, we had a brain injury rehab specialist who emphasized the need for quality sleep but no excessive sleep or snoozing. When the brain goes through all of the stages of sleep, one stage is slow wave sleep. It is only during slow wave sleep that the brain can detoxify. It does this when the neurons and axons shut down and shrink in volume by 40%. These creates a space for the glymph system to open up and let the toxins flow away from the neurons and out of the brain. The glymph system is the brain's version of a lymph system. It was only discovered in 2012.

Proper sleep stages only happen when the brain's sleep mechanism functions properly. There can be a catch 22. Fatigue creates a sense of tiredness but not sleepiness. They are different. Tiredness is a body function. Sleepiness is a brain function. Sleeping for tiredness disrupts the sleep cycle so proper quality sleep is difficult to achieve. Tiredness can also be a blood sugar issue.

So, as I said, she should be getting up at a normal time and having a proper breakfast. Engage in moderate effort, low stress activities. If she becomes sleepy where her eyes become heavy and it is no later than early afternoon, she can take a short nap, 10 to 15 minutes maximum should resolve her need without disrupting her sleep cycle that she needs for proper over-night sleep. If she feels tired, a brisk walk should resolve it. She should not nap at all in the afternoon or evening. It will disrupt her overnight sleep.

If she is getting quality sleep, 10 hours per day maximum will be all she needs. She should not be going to bed because it is bed time unless she feels sleepy and can fall asleep within 5 to 10 minutes.

The sleep needs of a child will be more than those of an adult so don't let people tell you a sleep protocol based on children and youth.

The goal is two things. Activity during the day that causes good blood flow through the brain and quality sleep at night so the brain detoxifies.

Hand oriented activities, knitting, painting, sewing, solitaire with a deck of cards, etc, can be great as they keep the body active but do not put cognitive load on the brain.

Thanks, Mark!