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Forging Unchartered Territory: Developing a Complex Concussion Clinic for the Invisible Injury

For Michelle Pett, a slip on the ice in 2015 changed the trajectory of her life. She received a few stitches in the emergency room but no information or treatment for a concussion. She thought her initial prognosis was very optimistic, but the days and weeks passed and her symptoms worsened. She attended therapy for whiplash and her vestibular system. Her symptoms began hindering her ability to work as a pre-school teacher, and she moved to a part-time status. Multiple visits to her family physician, neurologists and therapists couldn't give her the answers she so desperately wanted. 

Michelle isn't alone - many concussions go undiagnosed, but the symptoms are debilitating: headaches, dizziness, feeling unsteady or off balance, increased irritability and difficulties with vision, reading, memory and attention. Many of these symptoms can last weeks, months and even years after the initial concussion diagnosis, leading to post-concussive syndrome. 

Such was the case with Michelle. Nearly 14 months after her fall, she was still experiencing severe symptoms. She found On With Life through a social media post and took a chance at On With Life's Outpatient Neuro Rehabilitation program, more than two and a half hours away from her hometown of Fredericksburg. She began a long rehabilitation journey, one that has allowed her to get her life back, and she couldn't be more thankful for

what the On With Life program and therapists have done for her.

"I had tried therapy before coming to On With Life, but On With Life is different," said Michelle. "The therapists have

additional training on brain injury, they collaborate together and they integrate my goals, interest and family into my sessions. This organization is special." 

Developing a Complex Concussion Clinic
Because of stories like Michelle and many others, On With Life is developing a special clinic dedicated to helping those with complex concussions. Complex concussions are not just limited to athletes playing a contact sport. Many individuals experience a concussion from a fall or car accident, but many of these concussions are not diagnosed or treated. In sports-related concussions, there are strict protocols for identifying a concussion and returning to play, but no such protocol exists for nonsports-related concussions.

"Concussions are often described as an invisible injury because so many of the symptoms are not outwardly visible," said Jillian Jones, physical therapist at On With Life's outpatient program. "Concussion symptoms can be prolonged and persistent for weeks, months or even years after the trauma and can be life-changing for the individual." 

To help with the development of the complex concussion clinic, On With Life received a $50,000 Telligen Community Initiative grant, one of nine organizations in Iowa to be recognized by the foundation that supports health  innovation. Grant administrators viewed On With Life's proposed concussion clinic as an incredibly innovative proposal and thought the stories of those the clinic would impact were profound and powerfully conveyed the need for this work. The stories are those like Michelle's - a fall down the stairs, a car accident, a fall on the ice - all leading to a concussion and post-concussive symptoms. And the stories all share the same sentiment - finding answers and help is more difficult than they expected.

"Michelle's symptoms did not fit neatly into one discipline or area of expertise but were widespread between physical therapy, occupational therapy and speech therapy," said Jones. "Michelle experienced success because she had a team of therapists working for her and with her throughout her journey at On With Life."

While On With Life has treated post-concussive symptoms since the beginning of its outpatient program in 2011, the Telligen grant will allow for additional education and training for therapists, provider integration, specialized equipment and community education all related to complex concussions.

"A complex concussion requires a multidisciplinary approach to be successful, and with our new clinic, we will have the opportunity to continue our education and the development of our approach to this challenging diagnosis," said Jones. 

Moving Forward 

Even though Michelle's returning to her passions with accommodations and in moderation, it's because of On With Life that she's returning to work as a pre-school teacher, traveling to the Hamptons, reading books, shopping and attending concerts. These simple pleasures she thought were gone forever, but because of On With Life's unique approach to her therapy, she's regaining her life back. 

"I thought the things I loved doing were gone for good until I came to On With Life. They helped me retrain my body, and I ultimately regained my confidence," said Michelle. "On With Life truly carries through with the meaning of their name. The life I live today is not the life I was living prior to January 2015, and it never will be, but it's a close resemblance of that ife, and I owe that to On With Life." 

For more information on our Complex Concussion Clinic, please contact our Outpatient Neuro Rehabilitation program at 515-289-9696 or email