Defining Moment They Call Me the Queen of Concussions I earned the title the hard way, but now I'm sharing everything I learned. By Lauren Ziaks, PT, DPT, ATC | June 2016 Listen to 'Defining Moment' A profile about me appeared earlier this year in the Deseret News, 1 of Utah's biggest daily newspapers. The headline was "The Queen of Concussions." While I assure you that I don't consider myself royalty, I do have a lot of experience with concussions—as a physical therapist (PT) and as a patient. In fact, it was my ninth and worst concussion that defined my life afterward. (I've always been very physically active, and a bit unlucky!) In January 2014, while snowboarding at a resort, I turned a blind corner and fell after swerving to avoid my husband. I was wearing a helmet, and it wasn't the hardest I'd ever gone down, but when you've been concussed as many times as I have it doesn't take much to get your bell rung. My neck and head hurt so bad afterward that I went straight to a hospital emergency room. The CT scan of my neck showed no damage, which was fortunate. I never lost consciousness, but it's important to note that loss of consciousness has no predictive value when it comes to the severity of, or projected recovery from, a concussion. I was to become a case in point. Despite headaches that could reach 8 on a scale of 10, I continued my work at an orthopedic and sports medicine physical therapy clinic. Two months, 6 months, 8 months went by. I was experiencing daily pain. I went from being someone who'd once been a 3.9 GPA student at a top-tier university to a woman who sometimes was unable to retain things she'd just read. The headaches continued. I considered myself fortunate that, despite all the issues I was having, I was able to continue working. The pain actually, in a way, helped me even better connect with my patients. The daily effort took its toll, however. I went home exhausted, having left everything on the table. At first, I took halfway measures and trusted that things would get better. They didn't. When I finally started practicing the self-advocacy that I preach to my patients, I discovered that anyone with a shingle can claim to be a "concussion specialist." I had some bad experiences. I spent my entire $5,000 health care out-of-pocket maximum seeking solutions. Finally, I connected with a trio of professionals—a neuropsychologist, a speech-language pathologist, and an occupational therapist—who got me back on track. The neuropsychologist identified a right vestibular hypofunction, or weakness, as the reason that I constantly was misjudging doorways and running into them if I was even slightly distracted. My vestibular deficits were why my vision would blur or I could get dizzy simply from turning my head too quickly. Cognitive therapy with the speech-language pathologist taught me compensatory strategies to build on small successes in my brain and promote healing. A simple but effective strategy to correct my difficulty in judging time, for example, was to place a clock in every treatment room and consciously think to consult it. The occupational therapist determined that I had oculomotor dysfunction and convergence insufficiency. That explained why I would succumb to fatigue after just 10 minutes of reading and fall asleep, why my eyes felt so dry, and why the clinic's fluorescent lights felt so punishing. I learned that I'd have to address my oculomotor deficits before I could begin habituation therapy for my hypofunction. This is an important new piece of information I would like vestibular therapists treating concussions to understand! If your patient doesn't tolerate simple habituation exercises, make sure someone looks deeper. My path to recovery had begun. But that wasn't the only path I now saw stretched in front of me. The day that my visual pathologies were diagnosed—about a year after my fall—I pledged that I'd do everything I could to help other people with concussions get the answers and help they need. I never want another patient to have to endure the exhausting search for answers I had experienced. I want patients to have an option to get better despite the current opinion in the medical field that healing is finished at 6 months to 1 year. Crazy, right? How could the brain's plasticity have been discounted for so long? I worked my tail off to get better and to educate myself. I attended courses. I read a lot—once I could do that again without great difficulty. I attended vision-specific conferences and soaked in knowledge from Jen Thomas, my occupational therapist and personal instructor of vision therapy. In concussion management, you need a village. She was my chief! My goal was to open my own clinic for concussion management. I knew that this is an area of practice in which dedicated and knowledgeable PTs can and are playing important roles across the country, but I'd experienced firsthand the need for vigorous PT engagement in my area of Utah. My boss believed in my mission, and in me. In May 2015 the concussion management program of Wasatch Physical Therapy and Sports Medicine opened in Park City. I am the director, providing visuo-vestibular rehabilitation services to individuals with mTBI—mild traumatic brain injury, which is the science-based and increasingly used term for the condition. My patients' injuries stem primarily from motor vehicle accidents, falls, and sports and playground injuries. Ours is the first comprehensive concussion management program in the Salt Lake City area to include vision therapy—the missing puzzle piece. In addition to providing physical therapy treatment for oculomotor, vestibular, and cervical spine dysfunctions following concussion, we work with area physicians, doctors of optometry, and neuropsychologists to ensure that all of the bases are covered. The program has a strong working relationship with Think Head First, a local medical practice specializing in treatment of head injuries. They refer athletes to me after a comprehensive examination that includes impact testing. We work together on baseline testing and other needs these athletes might have. We collaborate weekly on our shared patients to ensure that no element of their recovery is missed. Think Head First signs off on return-to-play decisions, providing a team approach to such determinations. Mere words can't express the joy and gratitude I feel for the opportunity to take my struggles and very long learning curve and turn them into something positive. Many of my patients feel as lost and confused as I did for far too long, but I typically can start them on the path to reclaiming their lives within a span of 6 to 12 weeks. My injury was such that, even now, I have days when exhaustion sets in and I stumble over my sentences by day's end. But if I'm still not 100% healed, I am 100% thrilled by the professional journey that sprang from my personal one—and excited about the future. Lauren Ziaks, PT, DPT, ATC, directs the concussion management program at Wasatch Physical Therapy and Sports Medicine in Park City, Utah. Go to www.apta.org/TBI for more on physical therapy's role in the management of mild and severe traumatic brain injury, and on APTA's involvement with this major public health issue.