A Long Hike Back

Her active lifestyle had caused some predictable minor injuries before, but this time the young hiker needed professional help getting back on track.

Between playing Ultimate Frisbee and doing some serious hiking, Linda* led a very active life and didn’t worry about the occasional bumps and bruises. Linda was traveling abroad when she sustained several head injuries — she didn’t worry about them very much at first, but when she still felt “off” many months later she realized that something was very wrong. Back in the United States, she did some research on concussions and found Dr. Kenneth Perrine at the Weill Cornell Concussion Clinic.

“At that point it had been a year since my injuries,” says Linda.  “Dr. Perrine and I carefully went through my history and he did some tests. I didn’t know which services I would need as I didn't have a good understanding of my situation, but we worked together to create the right recovery path for me.”

“When I met Linda, she was feeling very stressed by her continuing symptoms,” says Dr. Perrine. “She was extremely sensitive to noise — in fact she said that any sound was unbearable— and she found it difficult to block out distractions and focus on a task. Then, during times when she was able to focus, she experienced excruciating pain as a result.”

Linda’s symptoms made it impossible for her to participate in the activities that she enjoyed most, including sports, dancing, and listening to music. She also reported having trouble at work; although her supervisors had no complaints about her performance, Linda reported “blanking out” a lot and needing to constantly remind herself what she was doing. She found it difficult to come back to a task if she was interrupted and found that she was unable to think and speak at the same time.

Complicating the issue was that Linda had suffered not one but two concussions, a month apart. She had taken some computerized tests, the results of which Dr. Perrine was able to evaluate alongside the results of his own individualized testing. After the first concussion Linda’s greatest complaints had been head and neck pain and pressure, and feeling in a fog. A month later, after the second concussion, she reported that those symptoms were all more severe. The symptoms had lessened but not completely resolved when she took a third computerized test eight months later, and by the time a year had passed she was still confounded by the light sensitivity and the difficulty concentrating.

“The computerized testing results helped me a bit, but they hadn’t been scored correctly and they didn’t fully explain her ongoing problems,” says Dr. Perrine. “The individual neuropsychological testing I performed revealed no deficits whatsoever in any domain. That’s good news, of course, but it doesn’t help someone who’s experiencing symptoms — she still needed help.”

Dr. Perrine recognized that Linda was dwelling excessively on her concussions and on their lingering symptoms, and she was attributing some non-specific symptoms to the concussions that may have been unrelated to them. That phenomenon has become more common due to all the media attention to head injuries these days. Linda was reassured to learn that her symptoms, although real, were not signs of permanent brain dysfunction or damage. She accepted Dr. Perrine’s recommendation that she start treatment with Dr. Amanda Sacks-Zimmerman.

Linda describes herself as having been a bit resistant at first, but she respected Dr. Perrine's judgment so she decided to give it a shot.

“Linda reported both emotional and cognitive difficulties when she came to treatment,” says Dr. Sacks-Zimmerman. "She perceived memory and attention difficulties even though testing did not reveal such deficits. Together we planned a course of integrated cognitive remediation and psychotherapy to enhance her working memory, attention, and short-term memory skills."

That integrated approach emphasized building awareness of the connection between Linda's anxiety about her symptoms and her difficulties with focus and attention.

"The immediate goal was to increase her confidence and allow her to perform better at work," Sacks-Zimmerman continues. "Linda was also suffering — understandably — from anxiety and low mood after her experience, and we were also able to address those in treatment as well.”

“It took around four months before I could say that the majority of my main symptoms went away,” says Linda. “I'm not sure if I'm 100 percent 'back to normal' yet, but I’m working on it.”

“There’s a complex interplay of cognitive and emotional symptoms that can occur after a concussion,” says Dr. Sacks-Zimmerman. “In Linda’s case there were thought patterns that increased her anxiety and led her to avoid certain activities. Once she became aware of these patterns and understood the source of her emotions, we were able to develop emotional coping strategies that helped diminish the impact of her anxiety and low mood on her everyday functioning.”

Through her combined treatment, Linda has been able to re-engage in both work and her social life. Part of the process included learning to take advantage of times when her symptoms subsided, and using those periods to work on re-integrating herself into daily life.

Linda is glad that her research lead her to Weill Cornell. “Every situation is different,” she says, “but Dr. Perrine and Dr. Sacks-Zimmerman have a perspective and methodology that worked extremely well for me.”

 *Not her real name; this patient requested we use a pseudonym to protect her privacy.

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