When we evaluate the cause of your persisting symptoms after concussion, it’s useful for you and your provider to differentiate between drivers and dysfunctions. Let me explain...

Drivers are things that drive your symptoms up. It could be a particular activity (i.e. driving, reading or running), a unique stress (i.e. when you’re watching your favorite show at low volume and a commercial pops on at TRIPLE THE VOLUME…why?!) or even sleep, hydration and nutrition.
Drivers are drivers for 3 reasons:
1️⃣ The system you’re using is sensitive
2️⃣ The system has a different threshold than before the concussion
3️⃣ The system has a dysfunction (see below)

Dysfunctions are actual impairments seen on examination. Some examples are: accommodative insufficiency in the visual system, vestibular impairments, exercise intolerance, and limited range of motion or impaired proprioception in the neck.

As you’d expect, there’s overlap between drivers and dysfunctions. If you have a dysfunction in one of your systems (i.e. visual, vestibular, cervical, exercise), your brain needs to work extra hard to interpret the information from this system, and at a certain point this dysfunction becomes a driver. If that’s the case, we’re extra diligent to manage our overall workload, because this creates bandwidth for the training and recovery needed to rehab this part of your concussion.

Once we identify drivers and dysfunctions, here’s our game plan:

✌️🫶 Manage the drivers.
🤘💪 Re-train the dysfunctions.