Mindfulness & Concussion: How can we use it effectively?


As PTs, OTs, and SLPs who work with people who have sustained a concussion of mild brain injury, we are very well acquainted with ‘traditional’ treatment strategies, including vestibular rehabilitation, visual impairment interventions, and even headache management.

In a busy and functional-goal-heavy environment, it can be easy to get so focused on measurable outcomes that we do not consider slowing down and integrating mindfulness and meditation as a skilled concussion intervention… But should we?


Concussion and mTBI

Concussion/mTBI and PCS – the persistent constellation of symptoms that can impair function for those post injury – present a wide range of symptoms. Many of these can be ‘invisible’ symptoms, such as headache, sensory intolerance?, difficulty in executive function, metacognition, and concentration. Difficulty or inability to perform at this higher level can have a devastating effect on the individual– deeply impacting their self-esteem.

In fact, depression can occur in over 50% of people who have sustained a concussion. This suggests a link between brain health and mood, as well as between perceived self-efficacy, or difficulty completing tasks, with mood. This correlation is high enough to be a real concern to clinicians working in the mTBI population.


Why mindfulness?

Mindfulness has received attention in the medical and scientific community for the past few days, as it has been shown to have a direct effect on grey matter growth.

Mindfulness has been proven in  a variety of fields to boost neuroplasticity and actively work on brain regeneration post injury. It is also shown to increase brain activity in areas that may be protective against cognitive decline related to aging– another important consideration for those post mTBI, as dementia is more prevalent in this group.

Integrating mindfulness into your practice with patients’ post-concussion/mTBI can have multiple benefits! 

Mindfulness is shown to improve many of the areas that can be impaired post-concussion; including attention, memory, frustration tolerance, mood, metacognition, and executive function.

How can I incorporate mindfulness into concussion practice?

Using mindfulness may seem intimidating initially, but can be straightforward to include in practice in many ways – no matter what profession you approach it from!


Balance

In the realm of Concussion rehab, physical and occupational therapists may be targeting dizziness, balance impairment, and oculomotor function. Balance impairment and increased falls risk is reported in 30-50% of those who sustain a concussion.

Traditional balance rehab programs may have a place, but consider including mindfulness-based-practices into your therapy as well!

The positive link between mindfulness and body awareness, pacing, balance, and falls risk has been well established – brief sessions of ‘mindful movement’ can have lasting effects on body awareness, postural control, and balance. Mindful movement refers to engaging in different movements and exercises while engaging full attention to the movement of the body and breath.

The practice of mindful movement can even begin seated, where the person may notice the weight of their limbs and then transition into movements. Physical Therapists can assist their patients with these interventions and set them up with HEPs that include mindful walking programs, meditations, and yoga.

This study even demonstrated increased use of external focus strategies in those whose balance was impaired, supporting that even the shortest of mindful attention practices can greatly improve balance overall! 

Read more about how to use attentional focus here!

Mindfulness based yoga has a plethora of benefits to improve balance and decrease falls risk, as well as improve overall mood and self-efficacy.


Pain

Pain, specifically headache, can be a recurring complaint for those post-concussion. Mindfulness practices that focus on breath work, relaxation of tense and tight muscle areas, and release of stress associated with chronic pain, can help alleviate this with your patients.

The link between pain relief and mindfulness is more complex than at first glance – and works on a multitude of neurophysiological pathways! Opioidergic mechanisms have been shown
to mediate analgesia through attentional control, meaning that the using attentional control can quite literally change the brain mechanisms to be able to control pain.

This astounding fact may have clinicians asking – why hasn’t mindfulness been taught to therapists as a keystone intervention?


Sleep

mindfulness concussion sleepSleep disturbances are a common complicating factor for those post mTBI- and are thought to be related to circadian rhythm shifts. Up to 70% of people post-concussion continue to show sleep disruptions months post injury, with consequential fatigue impacting their daily life.

Mindfulness meditation practice has been shown  to have a significant effect on sleep quality in the treatment of those with sleep disturbance.

It goes without saying – if our patients are unable to sleep, or are extremely fatigued, that they are going to be less able to engage in a therapy program; be more at risk of falls and accidents, and have a domino effect of undesirable consequences. Therefore, addressing sleep hygiene should be top of mind for clinicians who work with those post mTBI.

How can you incorporate mindfulness into sleep therapy? Teach your patients Progressive Muscular Relaxation, diaphragmatic breathing, and attentional focus strategies that they can use at night. If they have a device that can play a podcast or music, they can incorporate this as a guided meditation to further improve their practice.


Depression

Mindfulness Concussion DepressionIt is no doubt unsurprising that depression is an issue that affects about 50% of those post mTBI. As stated previously, depression can occur because of physical changes in the brain post injury – suppressing neurotransmitters that regulate mood; from trauma related to the injury; or as a response to low self-esteem and self-efficacy, and what the person perceives as “lost.”

Knowing, as we do, that mindfulness can effect actual changes in brain chemistry, it follows that it can be a powerful tool in assisting with depression management. MBCT (Mindfulness Based Cognitive Therapy) has been shown in some research to prevent depression recurrence as effectively as antidepressant medication.

Powerfully, mindfulness can teach our patients how to recognize their unhelpful thinking patterns, and engage with their mood in a more constructive and empowered way; as well as emphasizing self-compassion.

As therapy professionals, we may be familiar with the term ‘therapeutic use of self;’ practicing self-compassion and mood stabilizing mindfulness with your patients can fall squarely into this category. Furthermore, it may have knock on effects to the rest of your patients function and engagement in both their therapy and their community.


Cognitive impairment

Mindfulness Cognitive ImpairmentFinally, the cognitive impairments associated with mTBI and concussion can also respond extremely well to the integrations of mindfulness. Mental fatigue has shown to be improved through use of mindfulness based stress reduction; and cognitive performance overall also shows improvement with use of these techniques.

Verbal learning, memory capacity, and attention correlate positively with treatment; which again is incredibly important to clinicians working rehab – if our patients are having trouble with concentration, recollection, or processing of instructions, then incorporating brief mindfulness breaks or mediation prior to challenging tasks may boost their outcomes.


As you can see, many of the functional goals that we may set in therapy can be complemented hugely through the incorporation of mindfulness-based practices. Given the strength of the research, it makes sense that every clinician working with concussion and mTBI should consider mindfulness as a therapeutic complement.

To learn more about Practical Approaches to Concussion Management, check out our course on the topic, right here!

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One thought on “Mindfulness & Concussion: How can we use it effectively?

  1. Greetings! Very helpful advice within this article! It is the little changes that will make the most significant changes. Thanks a lot for sharing!

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