Options for post-concussion home care, when you can’t come for a session

In this time when we aren’t able to practice with clients in person, I’ve had the opportunity to work with a few people on Zoom. This was not something I ever thought I’d do. I’ve been surprised and intrigued about the kinds of changes these clients have experienced. (Something I’ll be pondering and exploring for a while yet!)

All of this is done only as long as and if it remains comfortable for them. You can improvise smaller steps, other props or just stay with breath and awareness. I’m working with people who are relatively healthy and stable in their healing process. It’s important to screen out people with severe and dynamic symptoms, especially neurological signs/symptoms.

Here are some ideas strategies that have been working well:

Initial set up:
Zoom rules apply: if they can have a quiet space without a lot of ambient noise or commotion, that’s best. I like them to stay ‘unmuted,’ so I can hear any quiet murmurings and responses from them as we proceed.

What I’ve found is that we start with a little chatting – a usual intake time. Then I invite them to lay down in a comfortable position. I like them to be propped to their own comfort, as close to neutral spinal position as possible. They can use folded blankets or towels rather than big, thick pillows for neck or knee support.

It helps me if I can see their body, so I ask them to adjust the angle of their laptop/phone. They don’t need to see me — just hear my voice.

Passive positioning and restfulness:
The first phase is letting the body settle, letting the ANS begin its shift from a ‘social engagement’ or mobilized state (ventral vagal/sympathetic) to a more safely-immobilized state (dorsal vagal in safety/deep parasympathetic). Guiding their awareness of breath, through several cycles, can assist this process.

For a blended Core Link/Cups and Domes, I invite them to use their hands as props. First place their hands under their sacrum, palm to the resting surface (forearms pronated). Become aware of how the lumbar spine falls away from the sacrum/pelvis, since it is lifted a bit. The breath can do the work for several cycles.

Next, they can put their hands under their occiput, cupped. I don’t have an opinion about whether or not they interlace or overlap their fingers. Again, let the breath bring small movements into the upper neck, allowing the upper cervicals to gentle settle, heavy, to the table.

Next, they can bring their hands to any (all?) of the torso diaphragms: low belly/pelvic floor, respiratory diaphragm, and upper chest/thoracic inlet. Feel the weight of the hand as it settles, emphasizing the exhale (parasympathetic). Let the breath come in waves, maybe invite a sigh or yawn (don’t stifle them!).

You can stay with them as they notice body changes and/or emotional content rising. If they become aware of areas of particular tension, you can invite them to bring their awareness, energy, breath, vibration, colors — whatever feels available and evocative to them — to the area. Allow several breaths, time and attention to begin to change the area.

Self Massage:
Small circles or combing with finger tips, gentle pressure or squeezes with palm of their hand or using a roller or pad can help people address stiffness in their soft tissue. Good areas: sub-occipitals, temporalis/masseter, hands/forearms, neck, feet. Caution: their hands will get tired well before ours might — they haven’t had the practice! Under treat rather than over treat.

For the spine, people can lay on a rolled towel or foam roller and gently shift their weight side to side. Bent knees with feet on the resting surface provides good stabilization. One client decided to change to Child’s pose for this — we were able to direct her breath to the various stiff places she felt.

Vagal Nerve Release:
Taken from Stanley Rosenberg’s “Accessing the Healing Power of the Vagus Nerve” (read it if you haven’t yet!), the vagal release technique is simple and remarkably effective. It’s short and you can find lots of versions on line. Here’s one that I like.

This usually takes us most of the way there. You can build off this in lots of ways depending on their particular symptoms:
• self ear-pull for vertigo/tinnitus
• self Sutherland’s grip for migraines
• self frontal decompression for headaches
• warm compress or warmed hands over the eyes for eye strain

Slowly transition to sitting and help them orient to the room. Simple closer and coordinating payment (I’ve been charging a bit less than my in person sessions) and you’re done!

Have fun!