A concussion can present with a wide array of symptoms that can vary quite a lot among people. Recognizing this variability, concussion experts have identified several distinct types of concussion, called phenotypes, to better understand and treat the diverse manifestations of that injury. This classification allows for the patient to understand better the reason why they suffer from a specific symptom, and how to modify their lifestyle to minimize any flare ups. For the clinician, it allows to tailor specific treatment strategies to each patient’s unique presentation, promoting a more effective and comprehensive care.
1. Cognitive phenotype
Often described by patients as “brain fog” or “feeling out of it”, cognitive impairments are common post-concussion and may include difficulties with short term memory, following a conversation, expressing thoughts, organizing tasks or keeping track of time. It is one of the most common phenotype and one of the most important to get fixed, as it often impairs one’s ability to work, read/write emails, communicating with co-workers or clients, multitasking,…
2. Oculomotor/Vision phenotype
This phenotype includes visual disturbances such as blurry vision or double vision (diplopia), difficulty focusing when reading, light sensitivity and eye strain. These symptoms often result from impaired eye movements or coordination. Oculomotor assessments such as using the VNG (videonystagmography) can identify specific dysfunctions, and vision retraining may be recommended to address these issues.
3. Affective phenotype
Mood-related symptoms, including anger, getting irritated easily, anxiety, sadness or depression characterize the affective phenotype. These emotional disturbances can originate from the injury itself, by damaging the neural networks that regulate the neurotransmitters dopamine, serotonin or norepinephrine. However it could also be a secondary issue, resulting from the stress of coping with other concussion symptoms and the uncertainty of when those symptoms will resolve.
4. Cervical/somatic phenotype
Neck pain or stiffness, decreased range of motion, but also dizziness, nausea or headaches (especially in the back of the head) can be indicative of the cervical phenotype. These symptoms often occur from whiplash-type of mechanism, such as when being rear-ended in a car accident.
5. Headache/Migraine phenotype
Persistent headaches or migraine-like symptoms are prevalent after concussions. These can be tension-type headaches or migraines, often exacerbated by physical exertion, prolonged working time (especially in front of a computer) or high cognitive demand such as in conversation, meetings,…
6. Sleep phenotype
This phenotype involves sleep disturbances: difficulty to fall asleep, waking up often throughout the night, restless sleep. In the other hand, one might experience oversleeping after a concussion. In both cases, the patient doesn’t feel fully rested during the day and will have a hard time to perform their activities of daily living.
7. Vestibular phenotype
This phenotype will include symptoms such as dizziness, vertigo, balance problems, and motion sickness. These symptoms can result from issues in the inner ear, the visual system, the proprioceptive system or the cerebellum and other part of the brain areas responsible for balance. Vestibular rehabilitation therapy can help retrain the system and alleviate the symptoms.
8. Autonomic phenotype
The autonomic nervous system (or ANS) encompass all the involuntary, reflexives functions of our nervous system, such as blood pressure, heart rate, body temperature, sweating, breathing, hormone release, or digestion. When suffering from autonomic dysregulation, you might experience light headedness (especially after standing up quickly from sitting position), heart racing, exercise intolerance, fatigue that worsen with activity, excessive sweating, poor appetite, cold hands and feet,…
Integrative Management Approach
Assessing and understanding these phenotypes will allow a more individualized treatment plan, addressing the specific challenges each patient faces. At KOS Integrative, we emphasize a holistic approach, to facilitate a more comprehensive and faster recovery.
If you or someone you know is experiencing persistent symptoms following a concussion, consider consulting with healthcare professionals experienced in managing these diverse phenotypes. Early and targeted intervention can significantly enhance the recovery process.
