Concussion recovery rarely follows one predictable timeline.
Two people can experience similar accidents and have very different symptoms, treatment needs, and recovery periods. Their health before the injury, emotional state, sleep, nutrition, physical fitness, and previous head injuries may all influence what happens next.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, legal nurse consultant Kiley Como spoke with Dr. Eric Reese of the Neural Connection about his personal connection to brain injury care, the importance of listening to patients, individualized rehabilitation, and the role of exercise in concussion recovery.
From Concussion Patient to Brain Injury Advocate
Dr. Reese’s interest in concussion care began with his own experiences in contact sports.
Growing up playing hockey and soccer, he remembers taking hits that left him feeling foggy, confused, or unable to remember conversations clearly. At the time, those symptoms were not always recognized or treated with the seriousness they might receive today.
Looking back, those experiences helped shape how he now approaches patients.
He describes himself as a patient first, a doctor second, and an advocate and educator third.
That perspective gives him a better understanding of how confusing and isolating a brain injury can feel, especially when the person appears healthy to everyone around them.
Patients Are More Than Their Diagnoses
Many brain injury survivors arrive at a new provider after feeling ignored, rushed, or misunderstood elsewhere.
Dr. Reese believes the first step is creating enough time and space for the patient to feel heard.
A person is not simply a concussion diagnosis, a headache, or an abnormal test result. The provider must consider the patient’s physical symptoms, emotional health, stress level, relationships, daily responsibilities, and personal goals.
A medically appropriate rehabilitation plan may still fail when the patient does not feel safe, trusted, or emotionally involved in the process.
Dr. Reese emphasized that understanding the person in front of the provider can be just as important as selecting the therapy itself.
Why the Bedside Examination Still Matters
Telehealth can improve access to care and allow patients to discuss symptoms with specialists from a distance.
However, Dr. Reese does not believe virtual visits can completely replace an in-person neurological and orthopedic examination.
A bedside evaluation allows the provider to assess areas such as:
- Reflexes
- Balance
- Eye movements
- Coordination
- Neck function
- Posture
- Strength
- Sensory responses
- Symptom reactions during testing
The provider can also observe the patient’s energy, movement patterns, communication, and comfort level in ways that may be difficult through a screen.
Virtual consultations may explain the clinic’s approach, but a complete treatment recommendation often requires hands-on evaluation.
Using Eye Movements to Measure Brain Function
The Neural Connection uses video nystagmography as part of some evaluations.
This test records and measures eye movements while the patient completes specific visual tasks.
The provider may examine whether the eyes can remain steady, follow a moving target, or move accurately between two points.
These tasks may appear simple, but they depend on several neurological systems working together.
The results provide information that can be measured and compared over time. They also allow patients to see evidence of what the provider observed rather than relying only on verbal descriptions of dizziness, visual difficulty, or poor concentration.
Treatment Frequency Should Fit the Patient
There is no single treatment schedule that works for every concussion patient.
Dr. Reese may see some people several times a week during the early stages of rehabilitation. Others may travel long distances and attend only once a week.
The purpose is not to keep patients in treatment indefinitely.
Visits should occur often enough to guide progress, adjust therapy, and teach the patient what to do at home. As the person improves, the number of appointments should decrease.
Home exercises are an important part of this process because most recovery happens outside the clinic.
The patient may spend only a few hours with the provider each week. The rest of the time, they are practicing skills, managing symptoms, and gradually returning to daily life.
Recovery Goals Should Be Personal
Successful rehabilitation is not defined only by better scores on a test.
The patient may want to return to work, drive safely, prepare meals, exercise, or spend time with family without developing severe symptoms.
Dr. Reese described a patient who wanted to watch her daughters participate in gymnastics. After an accident and subdural hematoma, busy visual environments triggered major headaches.
For that patient, meaningful progress involved being able to return to an important family activity.
Understanding what the patient wants to regain helps the provider select therapies that connect directly to everyday life.
Honest Expectations Build Trust
Brain injury recovery is unpredictable.
Dr. Reese warns patients to be cautious of anyone who promises an exact recovery timeline or guarantees a particular outcome.
A responsible provider should explain:
- What the examination suggests
- What remains uncertain
- Which treatments may help
- What progress should be monitored
- When the plan needs to be reassessed
- When another specialist may be more appropriate
When treatment is not producing progress, the answer may be changing the approach or referring the patient elsewhere.
Continuing the same plan indefinitely simply because it was the original recommendation does not necessarily serve the patient.
Health Before the Accident Can Affect Recovery
A person’s condition before the injury may significantly influence recovery.
Dr. Reese discussed a patient who had been physically active for years before suffering a serious rear-end collision and subdural hematoma. Her strong physical and metabolic health may have helped support a faster recovery.
Another patient with diabetes, high blood pressure, poor sleep, limited exercise, chronic stress, or nutritional deficiencies may face a more difficult process, even after a similar injury.
That does not mean an unhealthy person cannot recover.
It means the treatment plan may also need to address inflammation, metabolic health, nutrition, sleep, and physical conditioning.
Recovery cannot always be measured by a standard number of appointments or weeks because the person’s starting point matters.
Gender May Influence Concussion Outcomes
Dr. Reese discussed research suggesting that women may be more vulnerable to prolonged post-concussion symptoms.
Possible explanations include differences in reporting, neck strength, and hormonal changes.
A smaller amount of neck muscle may affect how force is absorbed during an impact. Hormones such as estrogen and progesterone may also influence inflammation and recovery.
Dr. Reese emphasized that this area remains complicated and does not provide a simple explanation for every patient.
It does reinforce the need for individualized treatment rather than assuming all concussions should follow the same protocol.
Managing the Effects of Repeated Head Injuries
People with a history of contact sports or multiple concussions may worry about future neurological problems.
Dr. Reese cannot change the impacts that occurred years ago, but he focuses on what the patient can do today to support long-term brain health.
He emphasized foundational habits such as:
- Regular physical activity
- Strength training
- Cardiovascular exercise
- Consistent, high-quality sleep
- Proper hydration
- Nutritious food
- Supportive relationships
- Stress management
More advanced treatments or supplements should not distract from these basic habits.
For many people, improving movement, sleep, nutrition, and emotional support may provide more value than immediately turning to every new device or therapy.
Why Exercise Is Now Part of Concussion Care
Older concussion advice often involved staying in bed, avoiding light, and limiting nearly all activity until symptoms disappeared.
Current approaches may involve a short period of relative rest followed by gradual, medically guided movement.
Dr. Reese discussed protocols such as the Buffalo Concussion Treadmill Test and Buffalo Concussion Bike Test.
These evaluations monitor heart rate and symptom changes to determine how much activity the patient can tolerate.
The goal is not an intense workout.
It may begin with walking or another low-level cardiovascular activity that increases blood flow without significantly worsening symptoms.
Blood Flow and Brain Recovery
Dr. Reese explained that neurological activity and blood flow normally work together.
When part of the brain becomes active, blood flow should increase to provide oxygen, nutrients, and other resources.
After a concussion, that relationship may become disrupted. Neurological activity may increase while blood flow fails to respond appropriately.
Carefully prescribed cardiovascular exercise may help improve that connection.
The patient is exposed to a manageable physical stressor, the body adapts, and the provider gradually increases activity as tolerance improves.
The process must remain controlled because excessive exertion can aggravate symptoms.
Recovery Is a Partnership
Effective concussion care requires more than advanced equipment or a standard treatment protocol.
It requires a provider who listens, a patient who understands the plan, and open communication about what is and is not improving.
The patient’s goals, health history, emotional state, daily environment, and ability to complete home exercises all matter.
No two brain injuries are exactly alike.
Personalized care recognizes that reality and focuses not only on reducing symptoms, but also on helping the person return to the parts of life that matter most.
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