For patients with concussion, the old advice to rest in a dark room until symptoms resolve no longer applies. Today, evidence-based treatment includes early education, guided activity, and targeted rehabilitation when needed.
The Nebraska Medicine concussion clinic brings that updated approach into a weekly, team-based visit. Held Wednesday afternoons on the main campus, the clinic brings physical therapy and occupational therapy together in the same visit, with speech therapy available when screening suggests a need.
Amy Wagenknecht, PT, DPT, and Michaella Mendick, OT, MOTR/L, co-lead the clinic, working together to evaluate patients and connect them with the right therapy or specialty support.
What has changed in concussion management?
Concussion treatment has moved away from prolonged, passive rest and toward guided activity. The Amsterdam 2022 international consensus statement and CDC guidance support relative rest for the first 24 to 48 hours, followed by a gradual increase in daily activity and light aerobic exercise as tolerated.
“Years ago, the standard treatment was to put people in a dark room,” Wagenknecht says. “Research has evolved to be the complete opposite – treatment has done a total 180.”
Rather than removing patients from all normal activity, the clinic helps them return safely to school, work, household tasks, exercise, and social routines. The team also works with patients to identify specific impairments that may be slowing recovery.
Who should be referred?
The clinic accepts adults with suspected concussion, recent concussion, or ongoing symptoms after a prior head injury or mechanism consistent with concussion. Patients do not need to be athletes, and symptoms may arise after falls, motor vehicle crashes, work-related injuries, or polytrauma.
Refer patients with any of the following symptoms or scenarios:
- Headache, dizziness, nausea, or visual symptoms after an injury
- Symptoms that are not resolving as expected
- Sleep disruption after a suspected concussion
- Difficulty tolerating work, school, screens, driving, or physical activity
- Polytrauma in which concussion symptoms may have been overlooked
- Persistent symptoms weeks or months after injury
“If you suspect anyone has had a concussion, send them on over,” Wagenknecht says. “I don’t care if they’re day one or day 100.”
Early referral can help prevent patients from losing ground at work or school while waiting to see whether symptoms improve on their own. The team emphasizes that patients who do not need ongoing therapy will not be kept in therapy unnecessarily.
What happens in the clinic?
During the weekly clinic, patients undergo a thorough evaluation to determine the most appropriate therapies. These include:
- Occupational therapy: Commonly addresses vision-related symptoms; return to work, driving, or school; and work and school accommodations.
- Physical therapy: May address cervical spine pain, upper back or shoulder pain, vestibular impairment, BPPV, balance issues, and graded return to activity
- Speech therapy: Can assist with cognition, attention, memory, or auditory processing when needed
The team also collaborates with other specialists when symptoms require additional support.
“We work closely with neuro-optometry for more complex vision concerns, for example,” Mendick says. “They help guide some of the therapy we do, and when patients need additional support, we collaborate with specialists such as the pain clinic, ENT, and audiology.”
This whole-person approach is especially important because concussion symptoms often overlap and may involve visual, vestibular, cervical, cognitive, emotional, and sleep components.
Common misconceptions to address with patients
Patients may arrive with outdated or inaccurate expectations about concussion recovery. The clinic team often spends part of the first visit validating symptoms and reframing recovery with current education.
- “My imaging was normal, so I can’t have a concussion.” CT and MRI may be normal in concussion unless there are red flags for structural injury.
- “Symptoms should start right away.” Some patients feel symptoms the next day or later, especially after adrenaline and acute injury concerns fade.
- “Activity is harmful until symptoms are gone.” Light to moderate activity can support recovery.
- “I should be better in two weeks.” Recovery timelines vary, and persistent symptoms can still be concussion-related.
- “Concussion is mostly a sports injury.” The clinic frequently sees adults after falls, motor vehicle crashes, and work-related injuries.
How PCPs can support recovery
Primary care remains essential in early recognition, referral, and medical management. Providers can help by:
- Offering updated education
- Addressing migraine symptoms when present
- Screening for anxiety, depression, or sleep disruption, which are common with concussion and may slow recovery
Early therapy evaluation is especially useful when the next step is not obvious. The concussion clinic can screen for therapy needs, identify the main symptom drivers, and coordinate next steps with the referring provider.
How to refer
For adults with suspected concussion or persistent post-concussion symptoms, consider referral to the Nebraska Medicine concussion clinic for timely, multidisciplinary evaluation and follow-up.
“Concussions really do take a village sometimes,” Mendick says.
If you have a patient with suspected or persistent concussion symptoms, email physicianoutreach@nebraskamed.com or call 402.559.5600.