JAVS Fall 2022

Example 3: Demonstration of VOR exercise.

K: It’s been three years since the concussion: what suggestions do you have for a musician recovering from a concussion? D: Each concussion is unique, and it can be difficult to articulate your symptoms to doctors, employers, and colleagues. Head injuries are not well understood, difficult to test for and assess, and the severity of the injury doesn’t always correspond to the severity of the symptoms. Resting early on is important, including rest from screen time, blue and white light, socializing, noise, reading, and anything else that requires focusing. It helped me a lot to wear earplugs grocery shopping, riding the bus, and whenever I could in orchestra until I could acclimate. I also wore sunglasses even when it was cloudy to limit light exposure. Most people make a full or very good recovery, but it can take a long time! It took me about a year and a half to feel normal despite being diagnosed with a mild concussion. I’d suggest finding a doctor or neurologist who is familiar with concussions or can refer you to someone who is. At first, I tried to get an appointment at a concussion clinic, but the wait times were at least several months, and they weren’t covered by insurance. I also feel lucky to have found the OT and to have worked with you! Both of you were extremely helpful. I would also recommend checking out the Buffalo Concussion Treadmill Test, optokinetic training, the Brock String, and vision training. 9 Every concussion has some degree of whiplash, so it is important to assess for that, especially for violinists and violists. The significance of whiplash in post concussion syndrome may be under assessed, especially regarding the vestibular-ocular reflex. It may be a contributor to brain fog and chronic fatigue syndrome. If you can take time off, you should, and it may be helpful to try to go back with easier concerts, familiar repertoire, or part time at first. Daniel Stone is starting his fourth season with the Seattle Symphony and is doing well! He holds degrees in viola performance from Indiana University and Yale University, and previously was a member of the Calgary Philharmonic. Footnotes: 1 “What is PCS?” |Concussion Legacy Foundation, Accessed August 15, 2021. https:// concussionfoundation.org/PCS-resources/what-is-PCS?

K: Once you started doing sessions with me and the Occupational Therapist, when did you start seeing improvements? D: Things didn’t improve right away, but I noticed the exercises were getting easier, even though daily life was tough. I wasn’t 100% better but after a few months off, it was time to go back to work, and initially it was very challenging. This was March of 2019: I still felt off for the rest of the season, but the summer of 2019 really helped and by the beginning of the next season, I felt at about 90% of my normal capacity. D: Treadmill walking and running was recommended to increase the heart rate on a daily basis. 8 Walking on an incline also challenged my balance and vision stability, which was good to work on in a low-risk environment where I could hold onto the rails. I’d base the intensity of the workout based on my symptoms, roughly 20 minutes daily during that time. The exercises I did with you on the Pilates reformer were also extremely helpful. K: You also had been diagnosed with whiplash: how did that show up for you? D: My neck wasn’t painful at all. I noticed that I would get nauseous when I’d move my head in different positions including extension. Turning the head to play the viola didn’t hurt but other head movements did trigger nausea. K: What was the most helpful amongst all the things you were doing?

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Journal of the American Viola Society / Vol. 38, No. 2, Fall 2022