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Patient Rehab Resources

The concussion patient rehab resources on this page are a compilation of journals/diaries/logs and other resources that the Toronto Concussion Clinic’s rehab team may ask you to use during the course of your therapy.

  • The content is broken up by section.
  • Click on the relevant section to access its contents.
  • Click on the necessary file (in green) to download it.

Relaxation

PROGRESSIVE MUSCLE RELAXATION (PMR):

WORKSHEET 1 –  Tension-Release WORKSHEET

WORKSHEET 2 –  Recall & Counting WORKSHEET

WORKSHEET 3 – Differential Relaxation WORKSHEET

 

AUTOGENIC TRAINING (AT):

WORKSHEET 1 – Autogenic Training

WORKSHEET 2 – Autogenic Training Tips and Tricks

 

ATTENTION-DIVERSION AND IMAGERY TRAINING (ADI):

WORKSHEET 1 – Imagery Vividness & Imagery Control

WORKSHEET 2 – Imagery Vividness & Five Senses

WORKSHEET 3 – Internal and External Attention-Diversion

WORKSHEET 4 – Attention-Diversion Directing and Redirecting

Cortical Hyperexcitability

 

Conditions of cortical hyperexcitability include conditions such as headache, chronic fatigue, insomnia, PTSD, persistent concussion symptoms and more.  There are many non-pharmacological (behavioural & lifestyle interventions) that help improve and manage conditions of cortical hyperexcitability.  Below are some options to consider that can help retrain your physiology.  Doing all at once may not be feasible, but please consider the following options.

 

1. Sleep improvement.

Improving your sleep can have significant benefits to your mood and overall psychological wellbeing. You can do a sleep assessment at the Toronto Concussion Clinic.  In the interim, here are some general Sleep Guidelines to help reinforce efficient sleep:

  • Go to bed when sleepy (e.g. heavy eyelids, yawning, dozing off, etc), get up if you cannot sleep after 15-20 minutes
  • Get out of bed every day at the same time
  • Keep the bed for sleeping and sexual activity only
  • Avoid making up for a “bad” night of sleep by going to bed too early the next day, sleeping in or taking long naps to “catch up” (except for safety naps)
  • Safety naps: early afternoon, 45 minutes maximum (set an alarm to wake up), in your bed/bedroom
  • Have a regular, quiet bedtime routine

Sleep Hygiene consists of the following:

  • Limit fluid intake to 8oz 1-2 hours before bedtime.
  • Limit caffeine intake to 200-300mg per day, and avoid it 4-6 hours before bedtime
  • Avoid alcohol at least 3-4h before bedtime.
  • Avoid heavy snacks 4h before bedtime or snacking during overnight awakenings
  • Avoid vigorous exercise 4h before bedtime.
  • Keep your bedroom cool (18.5 C), dark, quiet and comfortable.

If interested, you can request participation in CBT-i Group Counselling Sessions (not OHIP) funded by emailing team@torontoconcussion.ca.

 

2. Nutritional Support.

Recommend nutritional support by working with a naturopath or dietitian.  This is not an OHIP-insured service.

Recommend maintaining hydration (2 L of fluids a day unless advised by physician to limit fluid intake).

This dietary journal has some helpful information you can try to implement on your own.

 

3. Exercise.

Recommend regular cardiovascular exercise. Regular exercise is shown to be as effective as pharmacotherapy for treating mild to moderate depression. In the context of concussion, the ideal regimen is progressive sub-symptom threshold exercise program.

This can be booked at the Toronto Concussion Clinic privately (i.e., not funded by OHIP):
a. Physiotherapy
b. Occupational therapy

This can also be done a the Toronto Concussion Clinic under OHIP:
a. Exercise counselling
b. Follow-up with Dr. Narges Nassirinejad

 

4. Relaxation training.

There are several strategies including breathing techniques, mindfulness training, Progressive Muscle Relaxation.

This can be booked at the Toronto Concussion Clinic privately (i.e., not funded by OHIP):
a. Psychotherapy
b. Occupational therapy

You can also request Relaxation training at the Institute for Behavioural & Functional Medicine by emailing team@ibfmed.ca and asking them to participate in Progressive Muscle Relaxation group counselling training.

 

5. Biofeedback training.

You can read more about biofeedback training here.  For most people, this starts with Heart Rate Variability training.

This can be booked at the Toronto Concussion Clinic privately (i.e., not funded by OHIP):
a. Physiotherapy
b. Occupational therapy

 

6. Pacing/energy management.

Pacing and energy management can help you get on with things better in the face of your current impairments.  It can also help alleviate any stress and anxiety caused by “falling behind” or “not keeping up”.

This can be booked at the Toronto Concussion Clinic privately (i.e., not funded by OHIP) through Occupational therapy.

 

7. Cognitive compensatory strategies and other strategies to improve performance.

Learning strategies to better leverage your cognitive capacity can be helpful until your cognitive faculties come back online.

This can be booked at the Toronto Concussion Clinic privately (i.e., not funded by OHIP) through Occupational therapy.

 

8. Psychotherapy.

Psychotherapy can help you develop for coping strategies and perspectives that lead to more adaptive ways of facing your day-to-day challenges.

This can be booked at the Toronto Concussion Clinic privately (i.e., not funded by OHIP) through Psychotherapy.

 

9. Education.

You can learn more about your impairments in a virtual OHIP-Funded Group Counselling appointment called Dr. Chugh Q+A. You can sign up here.

 

10. Work planning/accommodations.

When deemed appropriate by the team, consider vocational rehabilitation/occupational therapy for evaluating appropriate job modifications and making a return-to-work plan.

This can be booked at the Toronto Concussion Clinic privately (i.e., not funded by OHIP) through Occupational therapy.