Concussion Rehabilitation (Post-Concussion Syndrome Physio)

Concussion is a functional rather than structural injury — standard CT scans are usually clean, but neurometabolic cascade, reduced cerebral blood flow, vestibular and oculomotor impairment, and an irritable autonomic nervous system drive the symptom cluster. Headache, dizziness, slowed thinking, noise and light sensitivity, mood change, and exercise intolerance are typical. For decades, the advice was 'dark room, no screens, no activity' until fully better. Current MOH-aligned practice — mirroring the Amsterdam 2022 international consensus — flips that: 24–48 hours of relative rest, then graded sub-symptom-threshold aerobic activity from day 3, because prolonged rest actively slows recovery and feeds a deconditioned, anxious, exercise-intolerant loop. The cohorts we see in Seremban and Nilai: INTI International University and Nilai University student-athletes after contact-sport knocks in rugby, netball, or futsal, Senawang Industrial Park shift-workers after warehouse bumps, Port Dickson Navy families after training mishaps, and daily Seremban–KL commuters with rear-end road traffic accident (RTA) concussions where the whiplash and concussion overlap. Diagnosis is clinical; imaging at HTJ or KPJ Seremban Specialist Hospital is reserved for red-flag presentations.

First session 60–75 minutes, RM 120–200 in a Seremban or Nilai private clinic; home visits are possible for student-athletes whose exertion triggers symptoms on the commute. Expect: symptom inventory using the PCSS (Post-Concussion Symptom Scale) or SCAT6 subscales, a Vestibular/Ocular Motor Screen (VOMS) covering smooth pursuits, saccades, convergence, VOR, and visual-motion sensitivity, cervical assessment for range, joint-position error, and deep-neck-flexor endurance, and the Buffalo Concussion Treadmill Test (BCTT) — a graded walk-to-run protocol that establishes the heart-rate at which symptoms exacerbate, then sets a training ceiling about 80% of that rate. Plan in the acute-to-subacute phase (days 3–21): 20 minutes of sub-threshold aerobic work 5–6 days a week (stationary bike, treadmill walk, or pool), vestibulo-ocular drills matched to VOMS findings (gaze stabilisation, habituation), cervical manual therapy and deep-neck-flexor endurance work, sleep-and-hydration coaching, and a written return-to-learn plan for students (shortened sessions, screen breaks, extra assignment time). Subacute-to-persistent phase (weeks 3–12): progressive exertion loading, visual-motion exposure graded by tolerance, sport-specific drills without contact, and graded return-to-sport following the Amsterdam 6-step stages. INTI and Nilai University student-athletes typically work toward medical clearance at their campus health services; Senawang Industrial Park workplace-injury cases coordinate with occupational health for return-to-duty.

Most concussions resolve in 10–14 days without structured rehab, provided the first 48 hours are relative rest followed by graded activity. Days 0–2: relative rest, hydration, paracetamol only (avoid NSAIDs in the first 24 hours because of bleed risk), no alcohol, no driving if still dizzy. Days 3–7: sub-symptom-threshold walking 15–20 minutes daily, screens allowed in short blocks, return-to-learn planning, return to light non-contact activity. Days 7–21: most student-athletes and shift-workers are back to baseline; those who aren't enter formal concussion rehab here rather than waiting a full month. Weeks 3–12: post-concussion syndrome — this is where BCTT-guided aerobic work, VOMS-guided vestibular retraining, and cervical loading make the single biggest difference compared with waiting-and-hoping. Around 80% of persistent cases resolve by 12 weeks with structured rehab. Months 3–6: persistent or cervicogenic-dominant cases, dual-task drills, sport-specific return-to-play, and for RTA cohorts the whiplash load usually drives the timeline as much as the brain side does. Daily Seremban–KL commuters with rear-end RTAs who kept driving and pushing through are typically the slowest to settle — we ease them back step by step. Return to contact sport is the last step and only after full clearance of all other steps — premature return risks second-impact syndrome, which is rare but can be catastrophic.

Go straight to HTJ (Hospital Tuanku Ja'afar) A&E / 急诊 within the hour after any head injury if any of these develop at any point: worsening or severe headache, repeated vomiting, increasing drowsiness or confusion, any seizure, unequal pupils, weakness or numbness in an arm or leg, slurred speech, clear fluid from the nose or ears, or loss of consciousness for more than a minute. On blood-thinners or with a bleeding disorder, head injury means A&E review even without those signs. For a typical concussion — no red flags, symptoms stable or improving after 48 hours — see a GP, Klinik Kesihatan, or the HTJ outpatient clinic for baseline documentation and a return-to-learn/return-to-work letter. Physio referral is warranted from day 3 if: symptoms persist beyond a week, there's cervical pain or vestibular complaints, exercise provokes symptoms, or the athlete or worker needs structured return-to-play or return-to-duty staging. Escalate back to HTJ or a neurologist at KPJ Seremban Specialist Hospital or Columbia Asia Seremban when: a new neurological sign appears, headache pattern changes substantially, recovery stalls beyond 6–8 weeks despite structured rehab, or repeated concussions stack up (more than one in a 3-month window). Persistent vestibular-dominant cases without cervical overlap sometimes benefit from ENT referral; mood and sleep complaints that persist past 12 weeks benefit from psychology co-management.