Troy patients get concussion and TBI treatment at our Woodson Road clinic. It is around forty-five minutes away via I-55/70 and I-270 west. When symptoms persist beyond a month, and certainly beyond three, we test each system: vestibular, oculomotor, cervical, cognitive and autonomic. Then we treat the ones still not working.
Most concussions resolve. This page is about the minority that do not. It covers what should happen when symptoms are still there three months later.
When it stops being expected
Recovery from concussion is usually measured in weeks. Symptoms that persist beyond a month, and certainly beyond three, are no longer part of a normal course. They should not be managed by waiting longer.
At that point, the useful question changes. It is no longer whether you had a concussion. It is which systems are still not working properly and what each of them needs. Those are different answers with different treatments, and they can be identified.
Long-term effects of concussion covers what persistent symptoms actually reflect.
Why waiting was the advice
Because for most people it works, and because the alternative requires an assessment that is not widely available. Told to rest and give it time, most people do recover. That makes the advice look sound.
For the minority, it is actively harmful. Months of avoidance lead to deconditioning (loss of fitness), disrupted sleep and a narrowing life. Each of these makes the underlying dysfunction harder to treat when someone finally examines it.
Loss of consciousness happens in only about 5 to 9 percent of concussions. It also does not predict who develops persistent symptoms. A 1,507-athlete study found that recurrent injury, amnesia, concentration difficulty, insomnia and light sensitivity all predicted post-concussion syndrome. Loss of consciousness did not. Concussion without loss of consciousness sets out the evidence.
What a late assessment can still change
Vestibular and oculomotor dysfunction respond to targeted rehabilitation. That holds no matter how long they have been present. Cervicogenic and occipital headache (from the neck and the back of the head) respond to treatment aimed at the actual source. Autonomic disturbance can be identified and changed.
None of that requires the injury to have been recent. It requires that somebody tests each system, rather than treating post-concussion syndrome as a single condition with a single answer. Diagnosis and testing covers how each system is tested.
The cognitive symptoms that persist
Some symptoms people find most distressing and mention least: word-finding difficulty, losing the thread mid-sentence, and being unable to work in noise. They go unmentioned because they sound like something other than an injury.
They are common after concussion, and they are usually not a memory problem. More often they reflect processing speed and attention. Both are measurable, and both improve with targeted work rather than with time alone.
Naming them accurately matters. That is because the two beliefs lead to very different behavior. One person believes they are losing their memory. Another understands they have a treatable attention problem.
What recovery realistically looks like
Not a light switch. Improvement in persistent post-concussion symptoms is usually stepwise. There are clear gains in specific areas, not a general lifting of everything at once.
Vestibular symptoms often improve first and most clearly. Cognitive endurance takes longer. Headache depends heavily on whether a cervical (neck) source was found and treated.
We set expectations against those patterns rather than offering a timeline. And we review against what was measured at the start, not against how a given week felt.
Mood, and why it is not weakness
Low mood, irritability and a shortened fuse are common after concussion. They are partly neurological. They are not purely a reaction to being unwell. People describe not feeling like themselves. That is an accurate description of what is happening.
Naming it properly matters. That is because two people in this spot behave differently. One believes they are failing to cope. The other understands that a specific injury is producing a specific effect that improves.
How progress is actually measured
Against the findings recorded at the first visit. Not against a general sense of improvement, which is heavily colored by the past few days.
Convergence measured in centimeters, balance scored, symptom inventory totaled, cognitive screening repeated. Those numbers move or they do not. When they do not, the plan changes rather than continuing.
Driving, and when to resume
Driving needs intact reaction time, visual tracking and tolerance of a visually busy setting. All three can be impaired while someone feels reasonably well at rest.
We give specific guidance, not a blanket restriction. It is based on tested function. Where driving is restricted, it comes with a review point rather than lasting indefinitely. That is because indefinite restriction has its own substantial cost.
What to do between appointments
Follow the graded plan rather than resting completely. Keep the sleep schedule consistent. And record what provokes symptoms — not a diary of how bad each day was, but what specifically triggered a setback.
That record lets the next appointment adjust the plan precisely rather than generally. It is the single most useful thing a patient brings back.
Common questions
It has been six months. Is it too late?
No. Persistent dysfunction responds to targeted treatment well after the injury. A late assessment is worth considerably more than none: long-term effects.
Why did resting not fix it?
Rest helps in the first days and then stops helping. After that, graded activity and system-specific rehabilitation do the work: how treatment is structured.
Is post-concussion syndrome one condition?
No, and that is the practical point. It is several distinct dysfunctions, and each needs identifying separately: the assessment.
How far is the clinic from Troy?
Around forty-five minutes via I-55/70 and I-270 west, to 4477 Woodson Rd, Suite 105 with on-site parking.
Getting here from Troy
Concussion Center
4477 Woodson Rd, Suite 105, St. Louis, MO 63134
Monday–Friday, 8:00 AM – 5:00 PM
From Troy, I-55/70 west to I-270 west toward the airport — around forty-five minutes.
Related reading: concussion treatment for Collinsville, IL patients and concussion treatment for Belleville, IL patients.