December 2, 2015

Thanks to professional athletes and the military, concussion has become a household word. But comprehensive care for concussion, also known as a mild traumatic brain injury (mTBI), is not so well-known. Kate Bechtold, director of the Johns Hopkins Brain Rehabilitation Program, works closely with her colleagues to unravel whether a patient’s symptoms are due to an mTBI or something else.

Headaches, dizziness, nausea, blurred vision and difficulty concentrating are acute symptoms of an mTBI that can last for several weeks. If they persist longer, however, there may be injuries to other areas of the body, says Bechtold. “The majority of patients who have an mTBI will recover within just two to four weeks,” she says.

The events that lead to an mTBI, like a motor vehicle accident or a fall, can also damage other areas of the body and cause a cascade of similar symptoms. “The symptoms get lumped under the ‘concussion’ umbrella, leading to a lot of confusion,” says Bechtold.

Specifically, the same incident that causes an mTBI can injure the muscles and nerves in the neck, she explains. When these injuries occur, patients may have lasting headaches. A fall or auto accident can also stretch the muscles around the eyes, affecting the ocular motor system. When the eyes don’t work in unison to focus, they can cause convergence insufficiency, leading to dizziness, or blurred or double vision.

In addition, the incidents that result in an mTBI can damage the vestibular system and cause such symptoms as dizziness or changes in balance. 

As a rehabilitation neuropsychologist, Bechtold sees patients who have had an mTBI and are experiencing cognitive dysfunction, anxiety or difficulty emotionally adjusting to their symptoms. Depending on her assessment of the patient’s symptoms, she may also seek out evaluations with other Johns Hopkins clinicians, including neuro-ophthalmologist Eric Singman, neurologist Dan Gold, neurologic physical therapist Margaret French or physiatrist Ashot Kotcharian.

The inclusion of each of these clinicians ensures that the patient receives the comprehensive care needed to manage the plethora of symptoms that can occur following such injuries.

“We evaluate what else the incident may have caused and what interventions are going to be most helpful,” says Bechtold. “Patients don’t have to live with headaches or dizziness. We can help them get back to their healthy hum.”