Concussion Support for Early & Persistent Symptoms

Therapeutic Care and Cognitive Rehabilitation Support

Support throughout concussion recovery

Cognitive rehabilitation, education, and therapeutic support for individuals navigating concussion recovery, whether in the early stages after injury or experiencing persistent symptoms. Support includes addressing symptoms such as cognitive fatigue, brain fog, cognitive difficulties (e.g., attention and memory), headaches, and challenges returning to everyday activities, including return to work.

Dr. Heike Dumke has worked with individuals with concussion and brain injury since 2008, including work within WorkSafeBC concussion programs (2008–2021) and community-based rehabilitation. She helps people understand how concussion symptoms can affect everyday life, work, relationships, and overall functioning, while using cognitive rehabilitation and practical strategies to address cognitive difficulties, manage symptoms, support recovery, and gradually return to meaningful activities, including work.

→ Discuss Your Symptoms with Dr. Heike →

ICBC Concussion Care After a Motor Vehicle Accident

If you have experienced a concussion following a motor vehicle accident in British Columbia, counselling and cognitive rehabilitation support is available through ICBC. For the first 12 weeks post MVA, early access services allow many individuals to seek support without waiting for additional approval.

Support for individuals experiencing persistent concussion symptoms through cognitive rehabilitation, education, and counselling focused on managing cognitive challenges, fatigue, emotional adjustment, and return to daily activities.

For information about Dr. Heike’s ICBC-funded concussion and physical injury rehabilitation counselling services, including access and getting started, visit the ICBC Client Services page.counselling and cognitive rehabilitation services.

Common Symptoms After Concussion

Symptoms can occur across physical, cognitive, emotional, and behavioural domains, and may include:

• Fatigue and reduced cognitive endurance (getting tired faster)
• Headaches and dizziness
• Slowed thinking
• Attention and memory difficulties
• Visual or noise sensitivities
• Visual difficulties (affecting reading)
• Emotional changes, such as irritability, anxiety, or feeling overwhelmed

Concussion symptoms can affect physical functioning, thinking, emotions, and everyday activities. Some people experience symptoms for only a short time, while others need more support as symptoms continue. Early support can be helpful for understanding symptoms and learning how to manage them, adjusting activities and demands while gradually building cognitive endurance, developing effective strategies, and supporting a gradual return to everyday activities and work.

Part of my practice involves assisting you in figuring out the underlying factors that create the emotional challenges following the brain injury, and guiding you through the maze of recovery and improved well-being (emotional, physical, and cognitive).

Why Seek Support Early After a Concussion?

Many people recover well after a concussion, but knowing how to manage symptoms and gradually resume usual activities can be challenging in the early stages. Symptoms may fluctuate, and returning to usual activities too quickly—or not knowing how to adjust activity and manage symptoms—can make everyday functioning more difficult.

Early rehabilitation support can help you understand what you are experiencing, identify factors that may be contributing to your symptoms, develop practical cognitive and symptom-management strategies, and gradually resume everyday activities, including return to work.

Cognitive rehabilitation can be particularly helpful when changes in attention, memory, thinking speed, mental stamina, or cognitive endurance make everyday activities more difficult. Together, you can develop strategies to manage cognitive demands, structure activities and rest, and gradually increase activity as tolerated.

Connect with Dr. Heike About Your Symptoms →

When Concussion Symptoms Persist

While many people recover within a relatively short period, some continue to experience symptoms for longer. Persistent symptoms may include fatigue, headaches, dizziness, cognitive difficulties, sleep disruption, emotional changes, and difficulties returning to usual activities or work.

When symptoms persist, it can be helpful to look beyond the symptoms themselves and understand the factors that may be contributing to ongoing difficulties. Dr. Heike provides cognitive rehabilitation and therapeutic support to help you understand your symptoms, develop individualized strategies, manage cognitive and emotional demands, and improve everyday functioning and quality of life.

→ Discuss Your Symptoms with Dr. Heike →

How can a person with a concussion be supported?

How can you help: If the person becomes irritable, be patient, and ensure that the person takes a break (rest period) before continuing with the task. In addition, you can assist a person to become aware of these situation, i.e. irritability usually results when the brain receives more stimulation than it can handle for too long, e.g. too much noise or too many people around; or if a given task is too difficult/ complex. By allowing a person to learn these connections between the environmental circumstances and one’s emotional state, the person can gain more control to identify the difficulties and learn to take appropriate action/ strategies.

Examples of such strategies include:

Pacing – taking breaks regularly and before symptoms become overwhelmin

Managing stimulation – removing oneself from noisy or busy situations to take a brain break when becoming irritable

Managing distractions – removing auditory or visual distractions from the environment, for example by closing a door, turning off the TV or radio, or tidying up the work area before starting a task

Breaking tasks down into manageable parts – reducing cognitive demands and focusing on one step at a time

Planning and prioritizing – scheduling more complex tasks when energy and concentration are typically better

Gradually increasing activity – adjusting cognitive, physical, and everyday demands as tolerance improves

What is a Concussion?

The word concussion is derived from Latin- to concuss means ‘shaking’. When the term is used in the context of traumatic brain injury, this ‘shaking’ of the brain leads to a neurometabolic cascade (e.g. injury response at the brain cell level). The effects may be expressed as changes in physical, cognitive, and emotional functioning. These changes, along with other signs and symptoms, are considered as part of the clinical assessment of a concussion or traumatic brain injury (TBI). TBI refers to a brain injury caused by a traumatic (i.e., mechanical) event to the head, such as the head striking or being struck by an object, a fall, or the physical forces involved in a motor vehicle accident or similar event.

In mild TBI, the diagnosis is based on the signs and symptoms that follow the injury, together with clinical assessment.

The severity of a traumatic brain injury is usually diagnosed by three specific injury markers: 1) Loss of consciousness (or altered state of consciousness) that is not caused by other factors, 2) Glasgow Coma Scale (GCS), and 3) post-traumatic amnesia. To be considered a mild TBI, a person’s injury markers need to remain within the following ranges: loss of consciousness [LOC] =/< 30 minutes, Glasgow coma scale = 13-15, and post-traumatic amnesia =/< 24 hours. A mild TBI can be diagnosed when a person experiences an altered state of consciousness caused by the injury itself (as opposed to medication or other reasons), meaning that there does not have to be a loss of consciousness for a mild TBI.

Concussion and Mild TBI?

Mild TBI is the most common type of traumatic brain injury (TBI), with moderate and severe traumatic brain injuries making up only a small percentage of all traumatic brain injuries.

Concussion is often used interchangeably with mild TBI, although the terms are not synonymous. According to Giza and colleagues (2016), concussion refers to a clinical syndrome (collection of symptoms) whereas the term traumatic brain injury is a diagnostic entity.  Concussion can occur across the spectrum of TBI severity, although most concussions are classified as mild TBIs.

Importantly, not every “bump to the head” will result in a concussion, and many concussions resolve within days to weeks, although recovery can take longer for some people depending on a range of individual and injury-related factors. Early support can help people navigate the recovery process effectively by understanding symptoms, adjusting activity and cognitive demands, developing practical strategies, and gradually returning to everyday activities, including return to work.

Why concussion can be difficult to see

Mild TBI and concussion have been described as a “silent epidemic” because many of the difficulties that can result from brain injury—including cognitive changes, fatigue, and emotional difficulties—are not readily visible to others.

For example, a cast or brace makes an injury to an arm or wrist visible to others and provides an obvious explanation for why certain activities may be difficult.

However, with a brain injury, there is usually no comparable visible sign. As a result, others may treat the person as they would anyone else, without realizing that the person may need additional support or adjustments—for example, shorter and clearer communication, fewer distractions, less noise, or more time to process information.

Most of the time we can only know by inference, i.e. the brain is encased in the skull and one can therefore not see whether or not it is injured. Moreover, given the present state of technology (low resolution), oftentimes visual imaging will not reveal any ‘damage’ to the brain despite obvious symptoms (e.g. headaches, fatigue) when they follow a TBI. The effects of an injury therefore cannot always be determined from imaging alone and are often understood through the person’s symptoms, changes in functioning, and clinical assessment.

In short, the person may look well while experiencing significant fatigue, headaches, slowed thinking, attention difficulties, sensory sensitivities, or emotional changes. This can make it difficult for both the individual and others to understand why usual activities have suddenly become more challenging.

Brain imaging may also appear normal despite significant symptoms following a concussion or other TBI. The effects of an injury therefore cannot always be determined from imaging alone and are often understood through the person’s symptoms, changes in functioning, and clinical assessment.