Instructions for Concussion and Traumatic Brain Injury Patients

Medical Journal Article


Designs for Strong Minds: Cognitive Rehabilitation for Mild or Moderate Post-Traumatic Head Injuries
Physical Medicine and Rehabilitation Clinics of North America, February 2007, Volume 18, Issue 1, pages 109-131
D. Markus

Download the Article


Steps to Follow Post-Concussion:

  • See your primary care physician first and if needed meet with a doctor trained in treating concussions if you find that your symptoms do not resolve within 4-6 weeks (see symptoms list)

  • Limit visual input. Wear sunglasses outside and indoors (Solar Shields or FL41 sunglasses to block sunlight, LED and fluorescent lights); Darkness is your friend.

  • Avoid TV and limit cell phone screen time.

  • Rest! Limit all physical activity. Some head injury patients need to sleep every few hours and this is okay.

  • Wear a baseball cap outside and in stores, at school, and in offices. Fluorescent lighting taxes your nervous system.

  • Wear musician’s earplugs (Earasers, found online or at Guitar Center, work well for many people).

  • Avoid loud environments like auditoriums and sports events. Know your limits to being exposed to noise.

  • Ask for accommodations at work or school. 


My Story 

By Cathy Grochowski, May 2019

Brain injury can lead to a real roller coaster of emotions. As one of Dr. Markus’ many clients who sought out her expertise following having read The Ghost in My Brain book by Dr. Clark Elliott, I was asked to share my story, some thoughts, and potential steps that might come in handy for you or your loved one moving forward.

My mild traumatic brain injury/concussion took the better part of two years to resolve. It was indeed a long journey, and I commend you and your loved ones for seeking as much knowledge as you can to do your best to beat TBI. TBI survivors are a strong bunch, and they need to be their own best advocates.

NEVER GIVE UP, you have the neuroplasticity of the brain on your side! According to, neuroplasticity is “the brain's ability to reorganize itself by forming new neural connections throughout life. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment.” If one provider fails to encourage healing, whatever the techniques and tools used, move on to other alternatives. During the first year of my journey, I learned it took a village to heal my hurting brain. 

A concussion, even a mild one, is a traumatic brain injury. I wince every time I hear someone state “Oh, it’s just a concussion, she’ll be fine. I had many concussions and they are no big deal.” Argh! Here’s a little-known stat to ponder. Approximately 80% of concussions will resolve within the usual suggested timeframe of 4-8+ weeks. That’s great news! However, that leaves 20% of us (a whopping 500,000 people annually in the U.S. alone) whose symptoms may not fully resolve so quickly or easily. For these individuals, quite often things get worse in the weeks following the initial insult to the head. 

The following is a list of head injury symptoms I endured either immediately or soon after sustaining my injury. Yes, it’s a lengthy list, and no, not every symptom was present from day one. That’s a key understanding that all should be aware of, symptoms come and go and quite often they arrive well beyond the initial date of injury. I think in my own case, part of my not noticing certain symptoms immediately was that I had other stronger symptoms that took my complete undivided attention. In hindsight, I’d say I was “putting out fires” symptom by symptom as I sought relief. 

While the symptom list below is lengthy, you won’t necessarily experience all of the same symptoms. Use the list as a starting point to enable you to identify some of your own concerns/struggles. Know that you can get your life back. Be patient and kind to yourself. Thanks to doctors like Dr. Markus and others, I experienced a full recovery and you can too!

Head Injury Symptoms:

  • Nausea

  • Vertigo or dizziness; loss of balance

  • Sound sensitivity (hyperacusis) 

  • Light sensitivity, especially to fluorescent lighting

  • Feeling overloaded/overwhelmed

  • Difficulty with emergency vehicle lights and sound

  • Problems walking in wide open areas; on shiny floors; on “busy” rugs/carpeting; in crowds

  • Blurred vision/Double vision

  • Constant fatigue, long naps, sleep difficulties at night

  • Failure to initiate movement

  • Depression; mood swings; low motivation

  • Anxiety, frustration, anger

  • Hypervigilance, exaggerated startle response

  • Limited attention or concentration

  • Inability to follow directions

  • Poor reading comprehension (rereading the same paragraphs); memory loss; short attention span

  • Poor spatial judgement

  • Impaired depth perception

  • Visual midline shift (sensation of pulling to the left or right)

  • “super market syndrome” (difficulty walking down the isles in a supermarket or other store)

  • “Unsteady-non-specific spatial disorientation”

  • Feeling of “walking in my own silent movie” (a phrase often used to describe the disconnect between the individual and the environment)

  • Inability to watch TV – any fast movement leads to head pain

  • Cannot watch commercials (scenes are switched quickly)

  • Word-finding difficulties

  • Inability to multi-task or work in transition

  • A feeling of “Electrical storms” in the brain

  • Poor adaptation to visually complex environments (patterns on the floor, high ceilings)

  • Post-injury amnesia (no recollection of specific events/activities not connected to original injury)


It is difficult to estimate how many appointments a patient might need for cognitive restructuring.

The first appointment consists of an interview, review of records and formulation of a treatment plan: 1.5hrs
Please bring copies of pertinent medical reports and a neuropsychologic evaluation (if available).

3 to 4 additional appointments (1 appointment is 2/50 Minute Sessions) with Dr. Markus are recommended.
Many patients elect to return for additional treatment after several weeks.


Interview, review of records and formulation of a treatment plan: $950.00  
50% deposit required to confirm your appointment time, balance is due upon completion of appointments. 

Cancellation Policy for initial consultations and multiple appointments fully refunded 2 weeks prior to appointment. 

If an appointment is canceled less than two weeks prior, there will be a $750.00 charge. 

Private Cognitive Restructuring Sessions including take-home materials and two 50 minute individualized cognitive restructuring sessions, as well as customized cognitive materials for at-home rehearsal.
Session rate: $750 per 2/50 Minute private sessions
7 Days is required to change or cancel an appointment without charge. There will be a $375 cancellation charge. 

FORM OF PAYMENTS ACCEPTED: credit card, check or cash 


Dr. Markus offers phone consultations, which are particularly useful for out-of-town patients. 

If you want Dr. Markus to review any neuropsychological testing or other reports prior to your phone consultation, please send this material via email or snail mail. Review of these materials usually takes an additional hour. 

Phone consultations and advance review of material cost $375.00 per 50 minute session. 
Payment is required when the appointment is scheduled. 
7 Days is required to change or cancel a phone consultation appointment without charge. There will be a $375 cancellation charge. 
Appointments are scheduled with Margit Nikitas / Office Coordinator 847-433-7878



Don K. - Traumatic Brain Injury
I was on the job for SBC one Saturday morning four years ago, parked in my truck, when I was hit head-on by a reckless driver. I recovered quickly from a concussion, but was subsequently plagued with post-concussion syndrome: I was hypersensitive to noise, my field of vision was broken down to pixels rather than a whole integrated picture – in fact, all my systems were hyperactive.

Doctors wrongly told me I'd be good as new in a year; what did make all the difference was working with Donalee, who said, “Life's going to be different from now on, so let's make good use of it.” It took me less than four years to retrain my brain with Donalee Markus, and I'm back with SBC, splicing cable – thanks to Donalee, I'm able to lead a normal life.

Janette Gerber

Brain Plasticity refers to the ability of the brain to change itself, to rewire.

This work is an expression of my gratitude for the professionals of the many healing paths I have taken to get my “Self” back, post injury and concussion. The umbrella, made of constructed cloth, is a loose representation of the synapses made by our magnificent brains. From the head spring many of the symptoms which occur simultaneously. Think of the inside of a telephone cable, with multiple colored wires, bare in spot and shorting out as they touch.

Each of the eight sections of the umbrella is devoted to a phase of healing with dangling visual representations of some of the healing steps, a process that is ongoing. 

This is a very brief summary of a long and difficult internal invisible injury and journey. Integrating Traditional Medicine and Alternative Therapies, I build a dancelike interweaving of complimentary approaches, each working toward the common goal of brain plasticity.

Dr. Deborah Zelinsky O.D. referred me to Cognitive Therapist Donalee Markus Ph. D. who said that her exercises would result in the return of the “pictures in my head.” It is a frightful loss for an artist to the pictures. Mine had gone, along with my creativity, in the moment of the crash nearly three years ago. Cognitive exercises brought the pictures back.

Traumatic Brain Injury Rehabilitation
Responses to the workshops ranged from participants who could document personal behavior change to others who perceived change in their thinking styles. Participants related improvements in their communication and decision making skills, particularly with managers, and an increased appreciation for others cognitive processing methods. Your approach is extremely valuable to a large number of audiences.

DSM puzzles and the DSM mediation technique are vital tools in helping adolescents and adults with mild or moderate post-traumatic head injuries. DSM treatment focuses on the difference between how a patient dealt with the world cognitively prior to injury and how they deal with it post-injury, helping them bridge the gap and working with them to repair and rewire their cognitive processes so that they can again function at what they consider to be an acceptable level.