Without proper diagnosis and treatment, the life-disrupting symptoms from a concussion, or traumatic brain injury (TBI), can linger on for weeks, months or even years. In Summit County, world-class concussion care helps patients overcome these challenging obstacles and get their lives back. 

Occupational Therapist Melissa Volkert, who works with both concussion inpatients and outpatients at Avalanche Physical Therapy, has helped revolutionize concussion care in Summit County since arriving here in 2011. 

Volkert earned her Doctorate in Occupational Therapy from Washington University in St. Louis  in 2007. Afterwards, she worked in intensive inpatient rehabilitation at Penrose Hospital in Colorado Springs. There, she worked on a multidisciplinary team with doctors, nurses and therapists, treating severe brain injuries, strokes and spinal cord injuries. She helped develop their inpatient vision clinic where a neuro-optometrist assessed patients in the hospital and therapists could implement treatments immediately.

“That experience gave me the expertise to develop a comprehensive brain injury rehabilitation program at Avalanche Physical Therapy,” she said.

“A concussion is considered an invisible injury, not like a broken bone where you can see the injury, have surgery and heal. People [with concussions] might appear uninjured and walk normally, but they’re really suffering inside,” she said. “Because I work with inpatients and outpatients, I get that unique perspective of people who have been newly injured and what happens after they’ve been discharged from the hospital.”

Concussions look different in every person, and that’s why they are complex to diagnose and treat. Thanks to research and collaboration between Avalanche PT and local healthcare providers, people who have sustained a concussion in Summit County have access to specialized care. 

Reducing missed diagnoses

Quicker recovery from concussion involves early assessment and education in the hospital, primary care, orthopaedic or therapy office and community settings. Volkert spearheaded a research project at Summit Medical Center, which contracted Avalanche Physical Therapy  during its candidacy for the Joint Commission Orthopaedic Trauma certification. Physical and Occupational therapists at Avalanche PT helped identify orthopaedic-trauma inpatients who had delayed or undiagnosed traumatic brain injuries. From 2016-2019, the rate of delayed or undiagnosed TBIs in those patients at Summit Medical Center dropped from 13% to 2%. 

On behalf of Avalanche, Volkert has also educated the community about concussion awareness and prevention, such as to the Frisco summer camp staff and campers on a weekly basis in 2019. 

“Avalanche Physical Therapy’s education and outreach in both the healthcare and local community have provided a solid foundation for concussion care and awareness,” she said.

Collaboration as central to successful brain injury recovery

Most concussions will resolve on their own within 1-2 weeks. However, when a person’s symptoms and difficulties persist, the person is recommended to get a thorough assessment and appropriate treatment. 

“Concussion care is not a silo type of care — many different specialties may need to contribute expertise,” Volkert said.

Vail-Summit Orthopaedics & Neurosurgery (VSON) and Avalanche PT employ Athletic Trainers to serve as the front-line service in the initial sideline identification and screening for youth and student-athletes who sustained concussions. 

VSON’s Community Outreach Coordinator, Rachel Freeman, also serves as the Athletic Trainer for Team Summit, Team Breck, Loveland Ski Club and Summit Youth Hockey. Rob Courtney heads up Summit High School, and Cory Hester provides the athletic training at Vail Christian High School. Freeman, Courtney, and Hester help manage the athlete’s return to sport under the supervision of sports medicine trained, orthopaedic surgeons at VSON.

If an athlete is having a prolonged recovery or complicated presentation, the Athletic Trainers will refer the athlete to Volkert for concussion rehabilitation.

Beyond therapy: Brain injury Support Group

Volkert also facilitates the Summit County Brain Injury Support Group, which is backed by Avalanche Physical Therapy, Summit Medical Center, and the Brain Injury Alliance of Colorado. 

This free, monthly group provides brain injury survivors and their families or loved ones medical education and support through restorative and social activities such as yoga, meditation, sound healing, therapeutic art and music, group hikes, Nordic lessons and gardening. 

“Survivors talking to other survivors and normalizing their experiences is so powerful,” Volkert said. “It’s also a unique opportunity for me to learn, and it helps inform my practice.”

Occupational therapy’s crucial role for concussion recovery

When a patient presents to Volkert for concussion rehabilitation, symptoms range from physical to cognitive to emotional difficulties, such as headache, dizziness, nausea, balance issues, light sensitivity, sleep disturbances, difficulty with memory, feeling short-fused and more. The patient will also report difficulty doing everyday activities, such as basic self-care, managing a daily routine, cooking, reading, going to the grocery store, parenting or working. The role of an occupational therapist comes into play with two interconnected approaches.

First, Volkert assesses the potential causes of the patient’s symptoms. The symptoms of headache, dizziness or decreased concentration may be caused by specific areas of the brain not working properly after the injury, such as eye muscle weakness, decreased vestibular functioning or impaired executive functioning (the cognitive skills to plan, adapt, regulate emotions and to be self-aware that are controlled in the frontal lobe of the brain). Treatment is focused on remediating or strengthening those areas.

An occupational therapist has specialized training in understanding how a single activity or a day’s routine can be made easier or more difficult. Next, Volkert assesses if the sequence or strategy for which the patient completes the activity is contributing to the symptoms and difficulty. Volkert problem-solves with the patient on how the difficult activities can be more efficient, less time consuming or less effortful. 

By improving the patient’s awareness of his or her symptoms, treating the deficits and strategizing how the activity or routine is executed, Volkert can help the patient better manage those symptoms.

“I also discuss with the patient about coping skills, adaptability and resilience, and then build upon those strengths. Symptoms can be temporary if we make the smart decisions,” Volkert says. “The strategy is about getting patients back into their normal life in a progressive, thoughtful and intentional way, finding the just-right challenge. Occupational therapy has this unique role of integrating the big picture and details about the person. For me, the passion is helping people restore their life, lifestyle and livelihood.”