How to Heal a Shaken Brain

AHN treats concussions with customized, coordinated care

Expecting a concussion patient to keep track of multiple appointments is like asking a goldfish to do math. The brain power just isn’t there.

“Brain injuries impair the ability to organize and focus,” said Dr. Marco Alcala. “We coordinate their care so they can focus on getting well. Anything we can do to reduce the anxiety means a great deal to our patients.”

Marco Alcala, MD, is a sports medicine and concussion specialist who sees more than 200 concussion patients a month at the Allegheny Health Network Concussion Clinic. It is one of the few physician-led concussion programs in western Pennsylvania. Here, skilled doctors and therapists get to the bottom of troubling symptoms and develop a personalized plan of therapy so patients can get well and return to their lives.

Is it a concussion?

A concussion is a brain injury that can, come from a direct blow to the head, a violent shaking, or a sudden deceleration without any contact, such as whiplash. It often occurs after a sports injury, fall, or car accident.

When the brain is impacted it swells and nerve cells disconnect, disturbing the function of the brain. If it happens again before the brain has recovered, it is much more dangerous and can be deadly.

Teaching a brain to think

According to Dr. Alcala, the AHN Concussion Clinic takes an unusual approach to brain recovery.

“We teach our patients specific techniques that help them predict how symptoms will increase in intensity. We tell them to stop and rest their brain at the first sign, before it blows up into a crisis,” he said.

If patients don’t stop when they first become confused or dizzy and just push through it, it will develop into a headache, and ultimately, exhaustion. “But if you give yourself a short break, the thoughts will return on their own and the symptoms won’t escalate,” he said.

In this way, people with concussions can continue with work and school by providing small  accommodations for the limits of the recovering brain.

Different people, different therapies

The clinic staff takes time to get to know each patient — his or her own daily activities — to best treat personal symptoms and needs.

Patients may need physical, occupational, ocular (uncontrolled eye movement), vestibular (dizziness and balance), and specialized vision therapy. Speech therapy helps remedy cognitive deficits, which show up as “losing words” and not remembering what you were in the middle of saying.

“Our comprehensive approach pulls everything together,” said Dr. Alcala. “We aren’t treating just the headache, but also psychological problems like anxiety and depression.”

To manage this many therapies, the staff schedules and reminds patients of their appointments, removing a source of anxiety rooted in the very forgetfulness and inability to concentrate that comes with the condition.

The right therapist for you

Dr. Alcala has been able to help people who had concussions months or years ago and were told they would have to live with their symptoms. “Keep looking until you get the right program — the right specific therapist,” he said. “They are not all the same. You don’t want to waste time with the wrong therapist.”

“Some patients like us to be straightforward, others want to be coaxed into lowering their defenses,” he said. “We try to humanize medicine by individualizing the therapy, always with the utmost  compassion.”

“When their worlds collide, they think, I can’t get better. We help them understand that there are small steps they can take for big results,” he said.

A variety of symptoms

Many patients get headaches, which might be the first sign that their problem is a concussion. A concussion can’t be seen in medical imaging, but the clinic team may order a CT scan to rule out tumors or other injuries.

But symptoms can be varied and subtle. When people are “shaken up” by a fall but didn’t hit their head directly, they might not even consider that a concussion could be the problem.

Signs and symptoms of a concussion may include:

  • Headache or a feeling of pressure in the head
  • Forgetting the event that caused the head injury
  • Temporary loss of consciousness
  • Blurred vision
  • Confusion or fogginess
  • Dizziness, lightheadedness, or “seeing stars”
  • Ears ringing
  • Nausea
  • Vomiting
  • Slurred speech
  • Fatigue

Some symptoms may occur hours or days after the injury, including:

  • Concentration and memory lapses
  • Sleep disturbances
  • Sensitivity to light and noise
  • Irritability or other personality changes
  • Psychological problems and depression
  • Problems with taste and smell

If you think you may have a concussion, get evaluated by a concussion specialist within seven to ten days to get a diagnosis and a treatment plan.

Dr. Alcala sees patients at the Health + Wellness Pavilions in Wexford and Bethel Park, at offices in Cranberry, and at the Pediatric Orthopaedic Institute in Wexford. He is a team physician for the Pittsburgh Pirates, Pittsburgh Riverhounds, and Avonworth High School.

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