Thanks.
Well, i rest sometimes during the day, but i sleep good at night also. And i agree that sleep is the most important for healing of neurons, etc. (And just resting sometimes during the day, taking it easy.)
Might just take a while until fully recovered.

And yeah, i agree that low stress brain stimulation might be the best. That's why i'm learning to meditate also. It might be fine to do puzzle games.. I'm not fully sure.. I have put that on hold for some reason, until i'm not feeling dizzy when walking outside. (I might heal faster with sound books, chill movies, etc.)
I will try and learn stuff with sound books instead for a while. That's fine with me.
Anyways. Thanks for the answer. It's late here and i need to sleep now. Take care. Peace out

Hey all, and Temporary

My recommendation to all concussion sufferers:

Meditation, if you never have, find a group, or an audiobook to teach you, practice Meditation every day. Start small, then go for longer periods of time.

Go in for a Vestibular Therapy right away after a concussion for an assessment, and then you would be given recommendations and possibly you will be given exercises. Some exercises might seem silly, but do them as prescribed, these exercises are REALLY important.

My Sports Medicine physician managing my concussion recently went to a conference in Boston in May 2017, on recent advancements and discoveries in concussion management.

At the Boston conference, my doctor told me two NFL team doctors spoke at this conference about how they have discovered that when their athletes with concussions go in for Vestibular Assessment and Therapy early on, meaning shortly after the concussion, even when the Vestibular Therapy made them feel really terri ble and some felt nauseous with a lot of symptoms triggered, the athletes recovered much faster.

My Sports Medicine doctor realized at that conference that he was perhaps managing my concussion too conservatively.

The recommendations my Sports Medicine doctor made after attending that conference, is for me to get more active, and get into Vestibular Therapy and don't stop if it makes me feel terrible. If I felt terrible, track for how long the symptoms stayed with me, and let the Vestibular Therapist know.

Vestibular assessment and Therapy is VERY important right away for faster concussion recovery.

I had to edit the following and delete links because I'm not yet allowed to post links because I just joined this forum. (silly rule, I think)

GOOGLE

Parachute Canada, look at the concussion management informtaion.

GOOGLE

Concensus Statement on Concussion Management in Sport


VESTIBULAR THERAPY:

For me, Vestibular therapy at first was mostly upper Cervical spine physical therapy and range of motion manipulatiin by a physiotherapist trained in Concussion management. The ligaments up in the Upper spine where the spine connects to the base of the skull, if those ligaments are injured, they can trigger symptoms of headache and other symptoms that seem like brain injury and concussion symptoms but are actually neck injury symptoms.

This physiotherapist also gave me a lot of take home daily eye and Vestibular and balance exercises.

Eye exercises included early on:

Pencil push ups (convergence work)

Hold a pencil vertically, straight ahead of your nose, focus your eyes on the pencil as you slowly move the pencil toward your nose. When you can't focus on the pencil and it becomes blurry/two pencils, stop, move the pencil slowly away until you can focus on it again, and hold for 3 to 5 seconds.

Simple eye muscle exercises from left to right, up and down, and diagonally both directions

The simple eye exercises all were really tiring at first for me because I had spent 3 months of quiet rest in a quiet dark room with no screen time (no TV, computer, phone) and I rarely left the house, because I felt so terrible with symptoms.

Eye focusing exercises such as near and far

I did this sitting outside on my deck, looking at a tree and then a house, pick something near and far, and repeat it.

Eye exercises progressed to turning my head while looking at the last line I could read on an eye chart and reading that line of letters forward and backward while turning my head.

Hold my arms straight out in front of me, clasping my hands. Look at my clasped hands, then rotate my torso from left to right, all the while I am looking at my clasped hands held straight out front. I started that exercise sitting down because I was so dizzy.

Look at an object straight ahead, focus on that object (like a picture on a wall) and then turn my head side to side while focusing my eyes on the object on the wall. I had to staer that one sitting down because it made me so dizzy.

BALANCE EXERCISES

For me, that meant standing in a corner with my hands holding the wall for balance, trying to stand without needing to touch the wall. I gradually could make it more challenging by standing on one leg, then with two feet on the ground but eyes closed, then graduate to a wobble board or just standing on a couch cushion on the floor on two feet then one foot, first eyes open, then eyes closed when safe to do so and I was confident I would not fall down.

PACING POINTS

There is a points system designed to measure activities so it is easier to determine how much activity is too much for an injured brain.

For example, a person, depending on where they were in their concussion recovery, could have a maximum of 15 points for the day if they are really having problems with their symptoms being triggered.

Watching TV would be 2 points per hour, going out to a restaurant with one person would be 5 points. Attending an appointment would be 3 - 5 points. Meal preparation would be 3 - 5 points, grocery shopping 5 points, talking on the phone 2 points per fifteen minutes.

I still find in person conversations draining and difficult because I struggle withprocessing the conversation cognitively as well as I sometimes struggle with word finding. The best way for me to communicate right now is by text, so I can think out a measured response.

For information on Pacing and the Pacing Points, google pacing points and click on the PDF that is titled:

GOOGLE

Pacing and Planning with Becky Moran

Reading and downloading that PDF I found was very helpful in understanding what is more draining to our concussed brain, and helps with having a tangible way to figure out how much stimulation and activity is too much for me.

JOURNAL

Journal everything you do, for how long, and if you feel okay or not. this is especially important if litigation is involved.

SYMPTOM MANAGEMENT:

PHOTOPHOBIA:

GLACIER RATED SUNGLASSES, HATS:

I bought a pair of Glacier rated sunglasses (let in only I think 5 % of the light) with those side blinders . I wore those sunglasses everywhere at first, when going outside the house, it helped a lot because visual stimulation was overwhelming for me, especially in a place like a grocery store.

I also wear hats all the time to block light indoors like overhead fluorescents, and outdoors like streetlights and the sun. The hat also limits visual stimulation.

PHONOPHOBIA:

HEARING PROTECTION:

At first I used arplugs AND external hearing protection (from a hardware store) in cars,, going out anywherer, really, and also when I walked around my neighbourhood.

Someone mentioned noise cancelling headphones are good for phonophobia.

COGNITIVE OVERSTIMULATION:

GROCERY STORES:

Hat, glacier rated sunglasses with side blinders, double hearing protection at first, and looking down at the floor when walking around. (but I did so safely) I also learned to go 30 minutes before closing when my grocery store was quiet with almost no customers.

CROWDS:

Crowds were very difficult to navigate because it was too much visual and auditory stimulation for me, for example at a street festival. I ended up holding onto the arm of my companion and looked straight down at the ground ahead of me and my companion navigated us through the crowd. I would look up when we were at a booth of interest for example.I also wore a hat, sunglasses, and at first double hearing protection meaning earplugs and external hearing protection.


WALKS

At first, I discovered it was best for me to walk the neighbourhood when it was not busy, and looked down at the sidewalk in front of me to avoid too much visual stimulation. (only do in a safe neighbourhood and it is good to walk with someone, I carried bear spray with me for safety).

PHONE SCREEN DIMMING APP

I use Night Owl, it's awesome for dimming out light that can be harmful and disruptive to sleep patterns.

MEDITATION APPS

There are a lot, I ended up using the fifteen minute meditation in the Deep Relax APP but just try an APP and see if it works for you.

I tried those coping strategies to get to a point where symptoms were not triggered, then gradually increased stimulation when I was feeling well, like purposely not wearing the glacier glasses and trying my regular sunglasses instead, then see if my symptoms were triggered.

Sometimes it takes a day for me to feel crappy after doing too much, for me, anyhow, and then I had no idea why I felt terrible, what I did that was too much.

I think that's it for now.....Good luck with your recovery....

Thanks allot for the help and answer. I also tried Night Owl, it rocks.
But i have read all you wrote. And i will try and just take it easy. I have also read on wikihow.. I might have been to active after the concussion. It's my first one ever..
But also a hard one.
Good to hear how you worked through stuff, and i appreciate all of the advice, etc.
I'm working on mindfulness or meditation also.. It needs work. But i read on wikihow that rest and sleep is very good/important also, which i also believe it is. But also doing stuff gradually as you wrote, and not doing to much, and get headaches, etc.
I hope you feel better also. Best of luck. Take care! Peace out

Canada,

Welcome to NeuroTalk.

Glad to hear you are seeing improvement. Wow, Your regimen is far too aggressive for many with concussions and PCS.

The NFL doctors like those at the Boston conference, are usually focused on return to play, not return to the kind of daily activities most with PCS deal with. Players are driven to get back on the field at the earliest opportunity.

"The simple eye exercises all were really tiring at first for me because I had spent 3 months of quiet rest in a quiet dark room with no screen time (no TV, computer, phone) and I rarely left the house, because I felt so terrible with symptoms."

Your recovery was not only delayed but maybe even extended by the 3 months of rest. As the consensus statement acknowledged, non-activity rest should not extend beyond 48 hours. To take it a step further, bed rest is not recommended outside of normal sleep periods. Then, return to activity as symptoms allow. The goal is low stress activity that keeps good blood flow to the brain. Excessive and improper rest lend to toxins collecting in the brain causing further levels of symptoms and delays.

Not everybody has vision and/or vestibular issues. Getting assessed is worthwhile but some vestibular therapists see the patient as a source of billings and may push therapy that is more than is needed thus adding stress to the patient's day.

It is helpful to remember that in the past 10 years, especially since computerized neurocognitive testing has become widely promoted, concussion management has become an 'industry.' Doctors attend weekend conferences and learn how to increase billings as they hang out a sign saying concussion specialist.

The Berlin Consensus, though improved over the prior Zurich Consensus, still acknowledges there are many questions to be answered, especially regarding concussion symptoms that last beyond 2 weeks or so. 85% recover during the first 6 weeks, most within 2 weeks. Notice the statement recover from a clinical perspective. This is important because return to play is determined from a clinical perspective. Recovering to return to work or intense classroom studies is a different issue.

Berlin did make a strong statement about the part upper cervical injuries play. It would be great if those who do not have access to a sports trainer or even team doctor had access to the cervical assessments that athletes have. Medicine outside of sports has not adopted the cervical injury concept since those injuries are often very subtle in the mind of the doctor.

Neck strengthening has been a consideration for those at risk of concussion in sports so neck rehabilitation is likely different for such athletes than for those who do not have pre-morbid strong necks.

It takes about 6 weeks or longer for ligaments to heal. Therapy without postural discipline during sleep and rest is usually inadequate.

Other than the 'push vestibular therapy even if it causes symptoms' concept, we have discussed all of the issues you mentioned. Pushing through symptoms is controversial and not broadly supported.

The points system you mention is highly subjective to the individual and environment. I don't see how it can be broadly applied. The attempt to make everything into a statistical number is impossible. It there is one thing we know for sure, it is this. Every concussion is different. The matrix of symptoms varies from one person to the next. The matrix of recovery from those symptoms is just as different.

Excessive journaling can be problematic. Too much focus on symptoms can increase anxiety levels. Litigation is known to increase symptom levels, especially if journaling is done. A less intense tracking of symptoms is good.

I see you are still struggling with visual and auditory stimulation. This suggest you are still early in your recovery and understanding. The points system may be misleading you in your understanding.

Hopefully, there is a lot we can help you with.

Has anybody mentioned nutritional issues like brain health supplements ?

Please feel free to start your own thread using the New Thread link at the upper left of the index page.

My best to you.

Maybe a "stupid question".. But. I sleep kinda good. Like 8-9 hours a night.. That's enough.
But my day and night are messed up right now..
I'm not fully healed, but it's getting better. Mostly headaches.. And what i wrote before.

But can i be awake like 24-30 hours and then sleep when night falls, instead of like right now, i sleep during the day.. I'm a night owl/vampire at the moment.

Is it harmful to the brain or neurons/cells, or recovery if i stay awake for that long, etc?
Getting my sleeping routine better then it is right now.
Or perhaps it's mostly the body that is affected i don't know the science behind it and staying awake for that long, i did it sometimes before i had a concussion, because i sometimes have a "wrong"/shifted sleeping pattern. It's both the brain and body that gets affected i guess with staying awake for 24-30h, but not that harmful when not having a concussion, but i don't know how it is when healing after my last blow to the head. It's been over a months now so it might be alright to try it out.

I'm already tired now though.. I feel tired all of the time atm. Don't know if i will change my rhythm today or some other day. But i guess it's no big deal if i stay awake for that long. Might just have a headache, fall asleep at the night, and then be tired the next day, but then sleep during the night instead the days after like i want.

I just want to recover the best. But also sleep during the night and stay awake during the days. I thought i would ask. Maybe some of you know stuff like this, but i'm guessing it might not be a big deal to stay awake if/when i want to get my sleeping pattern more optimal.
Thanks

EDIT:
Found this on google:
h**ps://uhs.berkeley.edu/sites/default/files/Head_Injury_Concussion.pdf

(This link rule. I don't like it. Head_Injury_Concussion.pdf , uhs[dot]berkeley[dot]edu)

"Rest your body: Avoid any exertion which increases symptoms. Resume normal activitie gradually, and as tolerated. Avoid pulling “all nighters” as sleep will help recovery. Take naps or rest breaks when you feel tired or fatigued."

Might have been the first 7 days, or longer. But i'm not going to change my rhythm today, to tired. Good to know for some other time. But i understand that rest and sleep is the best, so it's a kinda "stupid" question.
But i'm alright with being a night owl at the moment.

Yes, staying awake for 24 to 30 hours is not good for the brain whether you have had a concussion or not. The mental fatigue can cause a slow deterioration and slow your recovery.

If you are doing odd schedule work that requires working during normal sleep periods, your recovery could be quite long and incomplete. If you are staying awake out of choice, you should stop it. If you stay up playing video games or doing other stimulating activities, you should stop until you are symptom free.

Sleep schedule at night is based on wake-up time in the morning. Getting up the same time each day will help you sleep at regular hours. Over time, maintaining the same sleep schedule should help with your headaches. You should not be sleeping during the day.

The Berkeley web site is not totally accurate based on the latest research. Take a break and have a rest period away from excessive stimulation when you experience fatigue. That just means lower your physical and mental activity level. An occasional 10 or 20 minute nap is OK as long as it does not become a daily habit. Habitually napping will disrupt your night time sleep schedule.

Proper quality night time sleep is important because it is when your brain heals and when it cleans out the toxins. But, you need to sleep through all of the stages, especially REM and slow wave sleep.

Recovery is not a 5 out of 7 days effort. It is a 14 out of 14 days effort. A few bad and undisciplined days can undo weeks of recovery.

I've lived with Post Concussion Syndrome for 52 years and been digging up the research for 20 years. It takes time to sort through all of the incomplete or outdated information. Most doctors have been trained at weekend concussion seminars and have less than a decade of experience with concussed patients. They do not have time to keep up with all of the advances. Take the time to find experienced help.

Alright. Thanks for the answer.

I have been following this post closely as that is my constant question. Rest or push myself? I've been to doctors, neurologists, neuropsychologists, cognitive therapits, physical therapists, ordered several books, listened to several podcasts and documentries, and what I've determined is the brain is still very much new territory, the "final frontier" in medicine if you will...and anyone that pretends to have all the answers is naively misinformed. The most frustrating theory to me is the theory that says if you still have symptoms after a couple months- it's anxiety or depression. This has not been proven. This is to sell anti-anxiety and anti-depression medication...pharmaceuticals benefit from this theory. IF those drugs help you, great! But they are not a quick "fix" and many people cannot handle the side effects. From my experience and research, I think it's a balancing act. Stay as active as you can without activating symptoms. The "suck it up" "It's all in your head" theory can prolong recovery.

LettingMyLightShine,

Welcome to NeuroTalk.

Yes, there is still a lot to learn about the brain but there is some sound science that is valuable.

I don't think there is a drug pushing concept in most of the concussion treatment community. There is plenty of evidence that benzos are counter to recovery. The only two drugs that are routinely prescribed are amytriptyline and nortriptyline. Both are recommended in much lower than normal doses when treating PCS headaches and insomnia. Some unknowing doctors will think that more is better.

Actually, there have been studies that show anxiety has a big impact of concussion recovery. They can actually predict most outcomes based on pre-concussion anxiety or depression levels. Those who have no history of anxiety or depression statistically recovery faster.

There are a lot of things that can be done to avoid drugs but improve the brain's tolerance for stress. Many have great results with a brain health vitamin and supplement regimen. B-12, the rest of the Bs including folic acid, D-3, Omega 3, Cal-mag, Curcumin and avoiding caffeine, alcohol, msg, sugars and the inflammatory foods can all help.

Please feel free to start your own thread so you can tell us about your experiences and your successes and struggles.

Thank you Mark. I do need to start a thread an introduce myself and my story. I only recently have admitted my problems and I am still in a bit of denial as I thought I wouldn’t have lasting impact. I am new to this and still learning but am very bitter by a neurologist that said that Cymbalta was the quick fix and that all symptoms were due to anxiety (even fine motor movements, memory loss, nausea, dizziness, brain fog, overstimulation, flooding....all symptoms). He actually yelled and said to take the Cymbalta every day no matter how it made me feel. If that’s not pushing drugs by someone that supposedly specializes in brain injury, I don’t know what is. All other doctors I’ve seen since 100% disagree with him!! He has that biased about all brain injury symptoms being linked to anxietybecause of those studies, but I have NO history of anxiety what so ever!!!!!! And I do not believe that my continued symptoms are due to anxiety.

And yes, my chiropractor put me on the B-complex, Fosh Oil, Magnesium, Vitamin D, and Tumeric. Also- light exercise as tolerated.

Sorry to hi-jack the post. I’ll start my own soon and tell my story. I just had to get that frustration off my chest. Thank you so much.