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What Are the 6 Stages of Concussion Recovery?

Article by Moody Neuro

Recovering from a concussion differs for every person. Some return to their normal life days after their injury, while others suffer physical and mental effects months or years after the incident. 

Fortunately, 80% of concussed patients recover in 10 days, on average. In this case, the recovery period only has two stages: an acute phase (the period wherein concussion symptoms manifest) and a recovery phase (a period of healing where patients experience a gradual decrease in symptoms).

The recovery takes longer for patients whose symptoms persist and increase in severity. This blog covers the six stages of concussion recovery for patients with long-term symptoms. 

What You Need To Know About Concussions and Post-Concussion Syndrome

A concussion is a form of traumatic brain injury (TBI) that occurs when a strong force hits the head or upper body and causes the head and brain to move forward and backward rapidly. Such an event disrupts the brain’s normal function and affects the patient’s memory, consciousness, speech, muscle coordination, balance, and memory. 

People who get a concussion experience immediate side effects and symptoms like dizziness, nausea, confusion, a headache, double or blurry vision, ringing in the ears, and vomiting. Other short-term symptoms are memory loss, balance problems, loss of smell or taste, and trouble sleeping. Patients should seek medical care if they experience these symptoms after getting into an accident, falling, or bumping their heads against a hard surface.

Concussion symptoms may not appear severe, but two or more at once are debilitating. Worse, patients may experience post-concussion syndrome wherein mild TBI symptoms continue to show long after the incident. 

Post-concussion syndrome often develops during the stages of concussion recovery. It occurs when neurovascular coupling (NVC), or the process of neurons receiving oxygen and nourishment from blood vessels, gets interrupted. 

When you get a concussion, the site of the injury gets inflamed, and the tiny structures around the neurons that help establish NVC temporarily break. Neurons don’t get enough oxygen and cannot power the brain to send signals as quickly as usual. As a result, people with post-concussion syndrome have trouble retaining new memory or keeping up with a rapid-fire conversation because their neural pathways aren’t functioning correctly. 

Post-concussion syndrome can go on for weeks, months, or even years. It is a tough situation because the symptoms can significantly affect your everyday life. Moreover, there is no particular treatment; specialists can only treat the symptoms and help patients manage them. 

Getting Well: The Six Stages of Concussion Recovery

Concussions are challenging because you don’t receive a prescription to restore your body’s physical condition before the injury. Doctors will only tell you to rest, avoid physical activities, and allow your brain and neurological functions to recover from the trauma. 

You should know that recovering from TBI can take a long time. The recovery period can also vary per patient. Some go through the stages of concussion recovery within a year; for others, it takes years. 

With that in mind, people who suffered a concussion typically experience these six stages: 

Stage 1: Acute injury

Doctors call the next 24 to 72 hours after a concussion the acute phase. They will strongly advise resting and cutting back on all activities. This means calling in a sick day at work or school and refraining from doing any housework. Patients should also refrain from drinking alcohol and taking any medication, including painkillers, without getting clearance from their doctor. 

People who’ve sustained minor concussions may start feeling better hours after the incident. Some will even feel well enough to get back to their regular activities. Still, they must take things slowly and not jump into physically strenuous activities like lifting heavy objects, playing sports, exercising, or doing manual labor for at least three days.

Stage 2: Physical rest

Contrary to popular belief, sleeping won’t do further damage in a concussion. In fact, sleep is necessary for the brain to heal. Shaking awake a person suspected of having a concussion every hour is counterproductive to their healing. Doctors will recommend rest and sleep unless they have good reason to say otherwise (i.e., the patient needs further treatment requiring them to be conscious). 

That being said, patients should always have a companion within the first 48 hours who’ll help observe for symptoms and call the doctors if the patient’s condition turns bad quickly.

Stage 3: Observation period for post-concussion syndrome

Patients with active lifestyles or who are used to working will find it challenging to do nothing during the resting period. At some point, they will feel like they’re back to normal and can already go back to work, drive around and do errands, resume physical activities, continue their travel plans, etc. That would be good news, but to be safe, patients should still check in with their doctor and get an all-clear. 

Why is a follow-up check necessary? Because sometimes the symptoms don’t appear until days or weeks after the incident. Moreover, there is a risk of developing post-concussion syndrome. Symptoms persisting months after the injury is a red flag for that.

Once diagnosed with post-concussion syndrome, the patient will have more frequent visits with their doctors as the latter will do their best to address the symptoms.

Stage 4: More physical rest

The hardest part about having post-concussion syndrome is there is no single cure for it. Patients may experience similar symptoms, but the duration, severity, and how they respond to treatment differ. So it will be frustrating, but expect doctors to recommend even more rest. What they want more than anything is to prevent any incident that might aggravate the patient’s symptoms. 

This is a difficult period for most patients as post-concussion syndrome can affect one’s lifestyle. It might even affect your work life because it will prevent you from engaging in physically strenuous activities. It might also impair your focus and decision-making abilities. In this stage, it is crucial to have a support system of loving family and friends who can lend a hand with your housework, help you prepare meals, take care of your shopping and errands, and offer financial assistance if necessary. 

Stage 5: Therapy and rehabilitation

The best way to manage long-term concussion symptoms is to undergo brain injury rehab and therapy. While rest is necessary for the brain to heal, it is also crucial that patients do cognitive exercises to recover.

Studies show that participating in cognitive games like puzzles and word games after a concussion increases heart rate variability – a sign that the parasympathetic nervous system (PNS) is activated. 

One consequence of concussion is that it drives a person’s sympathetic nervous system (SNS), which stimulates the “fight or flight” response, into hyperdrive after the injury. PNS and SNS work harmoniously and activate at different times of the day depending on the circumstances (i.e., PNS is active during rest time while SNS is during high-tension moments at work or when driving during rush hour). A concussion disrupts their rhythm. Moreover, many patients seem to experience hyperactive SNS after their injury. 

Engaging in cognitive tasks will trigger the PNS into action and engage the parts of the brain that facilitate decision-making and critical thinking. 

How long before you can start doing physical therapy? Some researchers say patients can begin 48 hours after their injury. It should be gradual, starting with light activities like walking and slowly increasing the intensity or duration until the patient can perform them without experiencing any symptoms. If a headache forms and quickly intensifies, or other symptoms like severe nausea and dizziness occur, that’s a clear sign of stopping the activity. The patient must scale back and give themselves more time before scaling up again. 

The goal is to ease the brain and body into moving again without aggravating the TBI. Hence, it might be long before a patient can comfortably run, play sports, and do other physically demanding activities again. Moreover, symptoms sometimes appear hours after an activity. 

Patients must also constantly communicate with their doctors and therapists at this stage of concussion recovery. They should:

  • Assess how much physical activity the patient can safely engage in at present.
  • Decide which exercises and therapies a patient can safely explore (preferably under the supervision of licensed therapists).
  • Determine the right pace of physical therapy.
  • Identify the triggers of the patient’s worst symptoms.
  • Document how well or poorly the patient responds to therapy.

Depending on the symptoms and their frequency and severity, patients might receive other forms of therapy like interval training and neurofeedback therapy. They may also have to consult a psychologist and neuro optometrist. Some see improvements with yoga, changing their diets, and continuously doing cognitive exercises. 

Stage 6: Gradual return to normal activities

The final stage of recovery is transitioning to life before the injury. The brain can heal itself even years after a TBI, but the road to recovery will be difficult for some. A proper diagnosis and holistic therapy will be crucial to recovery and ensuring the patient’s quality of life won’t deteriorate drastically.

Seek Specialized Care and Rehabilitation From Experts

TBI Patients need highly specialized treatment and care that address their unique needs. For some, it takes a team of specialists, therapists, and trustworthy caregivers to help achieve a breakthrough and recover sufficiently, if not entirely, from TBI.

Moody Neurorehabilitation can provide more information about TBI, the recovery process, and what it entails for patients and their families. We are a leading rehabilitation institute specializing in brain injury treatment and patient care since 1982. We use techniques, strategies, and therapies from all over the world and provide the best care possible for brain injury patients and survivors. 

Our modern facilities utilize state-of-the-art technology such as the Hocoma Lokomat and Bionik InMotion Robotic Arm to facilitate our patients’ recovery journey

Moody Neurorehabilitation can help you or someone you love overcome the challenges of long-term concussion symptoms and power through recovery. Contact us to learn more about our programs, services, and facilities. 

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Strokes are medical conditions that affect millions globally. In the United States, more than 795,000 people have a stroke each year, with about 610,000 cases being first or new strokes. 

These can lead to a wide range of physical and cognitive impairments. Speech and language disorders are among the most common and most challenging consequences of strokes, occurring in about a third of stroke survivors. 

Understanding Stroke-Induced Speech & Language Disorders

Stroke-induced speech and language disorders significantly impact communication abilities. Among these, aphasia, dysarthria, and apraxia of speech are prevalent. Understanding how they are diagnosed and their specific symptoms can aid in prompt and effective management.

Aphasia

Aphasia is a common outcome of stroke, manifesting as difficulty in speaking, understanding, reading, and writing. There are many different types of aphasia, depending on the affected brain area, and are categorized based on the symptoms present:

  • Expressive Aphasia (Broca’s Aphasia): Characterized by broken speech, limited vocabulary, and difficulty forming complete sentences. Patients often understand what is being said to them but struggle to verbalize responses.
  • Receptive Aphasia (Wernicke’s Aphasia): Patients can produce fluent speech but may lack meaning or include nonsensical words. They often have significant difficulty understanding spoken language.
  • Global Aphasia: A severe form of aphasia where individuals have extensive difficulties with both speech production and comprehension.
  • Anomic Aphasia: Individuals have difficulty finding words, particularly nouns and verbs, making their speech sound vague.

Dysarthria

Dysarthria is a speech disorder that affects 20-30% of stroke survivors. It occurs when stroke impacts the muscles responsible for speech, leading to slurred or slow speech that can be hard to understand. It is typically diagnosed through a physical examination and a series of speech evaluations conducted by a speech-language pathologist (SLP). 

It is characterized by the following symptoms:

  • Slurred or slow speech that can be difficult to understand
  • Monotone or robotic-sounding speech
  • Difficulty controlling the volume of speech, which may be too loud or too soft
  • Challenges with the rhythm and flow of speech, including rapid speech that’s hard to interrupt or slow, drawn-out speech
  • Respiratory issues affecting the ability to speak loudly or for extended periods

Apraxia of Speech (AOS)

Apraxia of speech is a neurological disorder characterized by difficulty sequencing the movements needed for speech. This is caused by the impact of the stroke on the brain’s pathways involved in producing speech. 

Patients with AOS know what they want to say but struggle to coordinate the muscle movements to articulate words correctly. This results in distorted speech, difficulty initiating speech, or the inability to accurately produce speech sounds or sequences of sounds. 

How Long Is the Stroke Speech & Language Recovery Time?

According to one study on post-stroke speech and language therapy, approximately one-third of stroke patients experience speech problems after a stroke. Many of these individuals begin to recover within a few months, with significant progress typically observed within three to six months.

In another study, 62% of subjects had speech challenges after suffering from a stroke. By six months post-stroke, 74% were able to completely recover their communication abilities. 

However, the figures above provide a general timeline for post-stroke speech and language recovery. Stroke speech recovery time is highly individualized and can vary depending on several factors. These can include the following:

  • Severity of the Stroke: More severe strokes often lead to extensive brain damage, resulting in longer and more challenging recovery periods for speech.
  • Location of the Brain Injury: The brain’s specific regions control different speech and language functions; damage to these areas directly impacts recovery complexity and duration.
  • Age and Overall Health of the Patient: Generally, younger patients with better overall health before the stroke tend to experience faster and more complete recoveries.
  • Pre-existing Conditions and Comorbidities: Conditions such as diabetes or hypertension can slow down recovery by complicating the overall health scenario and rehabilitation process.
  • Individual Variability and Resilience: Personal resilience, the support system’s strength, and the individual’s motivation significantly influence the pace and success of speech recovery efforts.

The first three months after a stroke is a crucial period for recovery, as a majority of stroke patients see the most significant improvement during this period. However, it’s also important to note that, although at a slower pace, recovery can continue well past the 6-month mark with continued therapy and practice. 

This underpins the importance of early intervention and ongoing rehabilitation efforts, including speech therapy, to maximize each patient’s recovery potential. 

What Does the Stroke Speech & Language Recovery Process Look Like?

The journey to regain speech and language after a stroke is multifaceted and varies significantly from one individual to another. Understanding the structured phases of recovery can provide insight into what patients and their families can expect during this challenging time. 

Here’s a closer examination of each phase in the stroke speech recovery process.

Initial Assessment and Diagnosis

Before recovery can begin, a thorough evaluation is conducted by a team of healthcare professionals led by an SLP. This assessment aims to identify the type and severity of the speech and language disorder, be it aphasia, dysarthria, or AOS. The evaluation may include cognitive-linguistic assessments, comprehension tests, speech production analysis, and functional communication measures. 

Based on this assessment, a personalized therapy plan is crafted to address the patient’s specific needs.

Acute Phase

The acute phase typically occurs within the first days to weeks following a stroke. During this period, medical stabilization is the primary focus, with healthcare teams working to manage the immediate effects of the stroke. 

Speech therapy may begin with simple exercises or assessments to gauge the patient’s abilities. However, intensive therapy usually does not start until the patient is medically stable. During the acute phase, the goal is to support overall recovery and prevent complications immediately after the stroke.

Subacute Phase

The subacute phase generally spans from two weeks to three months post-stroke and is characterized by more intensive speech therapy interventions. As the patient’s medical condition stabilizes, the focus shifts to active rehabilitation. Therapy during this phase is tailored to the individual’s specific speech and language deficits and may include:

  • Exercises to improve articulation, fluency, and voice control for those with dysarthria.
  • Language therapy to enhance understanding, speaking, reading, and writing skills in patients with aphasia.
  • Motor speech exercises and strategies to improve speech planning and production in apraxia of speech.

The subacute phase is crucial for taking advantage of the brain’s natural recovery processes and neuroplasticity, where the brain begins reorganizing and adapting to the loss of function.

Chronic Phase

The chronic phase of recovery extends from several months to years after the stroke. It focuses on long-term rehabilitation and adjustment to any residual speech deficits. During this time, patients may continue to see gradual improvements in their speech and language abilities, although the rate of recovery may slow. Therapy in the chronic phase often includes:

  • Advanced communication strategies to cope with ongoing challenges in daily life.
  • Maintenance exercises to preserve and enhance speech gains achieved in earlier phases.
  • Supportive technologies and aids, such as communication devices, to assist in effective communication.
  • Community reintegration activities to help patients return to as normal a life as possible, engaging in social, vocational, or recreational activities.

What Is the Role of Neuroplasticity in Speech & Language Recovery?

Neuroplasticity refers to the brain’s fundamental property to change and adapt its responses to new experiences, learning, and environmental changes. This adaptive capacity enables the brain to reorganize itself by forming new neural connections.

When the brain, or a part of the brain, is damaged after a stroke, neuroplasticity is what allows the other parts of the brain to take over the functions of the damaged area. Through targeted rehabilitation and therapy, such as speech therapy for stroke survivors, patients can retrain other brain areas to perform the lost functions and facilitate recovery.

Enhancing Stroke Speech & Language Recovery Time

Adopting a comprehensive approach involving several key strategies is vital to enhance the stroke speech and language recovery time. This multifaceted approach can maximize the chances of regaining speech and communication abilities.

This comprehensive approach must incorporate the following strategies:

  • Early intervention to leverage the brain’s highest potential for neuroplasticity in the initial period following a stroke, significantly improving the chances for recovery.
  • Alternative communication strategies, such as gestures, writing, and visual aids, to help maintain communication during the recovery process. 
  • Adopting technology, including speech-generating devices and software applications designed for speech rehabilitation, for personalized exercises and continuous practice, which is vital for progress.
  • Providing continuous support from psychologists, support groups, and therapy to help manage feelings of frustration, depression, and anxiety, fostering a positive mindset essential for rehabilitation.
  • A healthy diet and lifestyle to supply essential nutrients that support brain function, along with regular physical activity, adequate sleep, and management of medical conditions.

Begin Your Post-Stroke Recovery Journey With Moody Neurorehabilitation

Moody Neurorehabilitation understands the complexities and challenges that come with post-stroke rehabilitation. We are dedicated to supporting patients and their families through this critical time with specialized care and personalized treatment plans.

Since our inception in 1982, Moody Neurorehabilitation has been a leader in brain injury rehabilitation. Our approach centers on providing comprehensive care tailored to each patient’s needs and goals. We believe in treating the whole person, not just the symptoms, to improve overall quality of life.

We invite you to start your recovery journey with us. Contact Moody Neurorehabilitation today to schedule a consultation with our experts. Let us help you navigate the path to recovery with care, compassion, and expertise.

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