The ability to concentrate is a crucial skill that we often take for granted. Concentration allows us to stay present and accomplish tasks, whether it’s for school, work, sports, or everyday life. However, after a concussion, you may notice that your perceived ability to focus isn’t quite the same as before the injury, making it frustrating to complete even basic daily activities.

So, what exactly impacts our concentration, and how can we improve mental performance? In this article, we’ll explore the fundamentals of concentration, how it can be affected after a concussion, and strategies to help you regain your focus.


Understanding The 3 Brain Networks.

To understand your ability to concentrate, it’s essential first to know how your brain operates. Your mind’s ability to focus can be divided into three critical networks, each responsible for mental focus and self-awareness.

The Default Mode Network (DMN)

The Default Mode Network (DMN) controls your internally directed state. This network governs your thoughts about yourself—your ego—shaped by past experiences, future plans, and internal reflections. Essentially, this network handles your auto-pilot, daydreams, and mental self-talk.

Executive Network (EN)

In contrast, the Executive Network (EN) is activated when your brain focuses on external tasks. Memory, attention, decision-making, planning, and problem-solving occur here. 

Salience Network (SN)

The third network, the Salience Network, acts as a switchboard, shifting your brain’s focus between the DMN and the Executive Network. Its job is to help your brain prioritize where to direct its energy. When the Salience Network isn’t functioning correctly, both networks may be active simultaneously, leading to wasted energy, mental fatigue, and difficulty concentrating.

Studies have shown that simultaneous activation of the Default Mode Network and Executive Network results in significant loss of brain activation, mental fatigue, lapse in attention, and poor cognitive performance. (1)   

An additional study using functional magnetic resonance imaging (fMRI), which tracks brain activity, has shown that when the Default Mode Network is active during mental tasks, it increases mental fatigue and worsens cognitive performance. (1)


How Is My Concentration Affected?

Mental Health and Psychological Component

Concentration is primarily a subjective experience, meaning it’s based on how you perceive your ability to focus on a given task.  In contrast, memory is more objective and can be measured through various tests, providing more explicit results than concentration.

Because concentration is so subjective, it often has a significant psychological component. Your internal dialogue doesn’t necessarily create a memory problem but rather an attentiveness problem.

Your ability to remember and focus may be functioning just fine, but when internal thoughts are clouded by anxiety, depression, or fear, your attention and presence suffer. This can lead to the perception that you’re unable to concentrate, even though the issue lies more in attentiveness than memory.

A study performed by Covassin et al. found that collegiate and high school athletes experienced increased depression scores up to 14 days after concussion that coincided with neurocognitive decrements in reaction time and visual memory.(2)  

Additionally, researchers found that psychological interventions, specifically cognitive behavioral therapy (CBT), were more effective at improving cognitive performance than cognitive rehabilitation.(3)

Misattribution of Symptoms 

Good Old Days Bias

Another factor that can make you feel like you’ve lost your ability to concentrate is a phenomenon called the “Good Old Days Bias.” 

The “Good Old Days Bias” occurs when a patient views their pre-injury health as perfect or flawless, even though it was far from it (“Ahhh, the good ol’ days”). For example, you may claim that you could focus on work tasks for hours without issue, but after a concussion, you can only concentrate for 30 minutes. In reality, you likely experienced some sort of average lapse in focus within the hours of work pre-injury but never paid much attention to it.

This bias can distort your perception of your past abilities, making you believe the concussion is the sole cause of your decreased cognitive performance when, in reality, these lapses were common before the injury and are a normal part of everyday life.  

Visual System and Neck Function

Concentration is a complex process that involves various systems working together. Surprisingly, how your eyes track and how your neck muscles function can indirectly affect your ability to concentrate. 

If your visual system isn’t working correctly, it can send mixed signals to your brain. When your eyes work harder to make sense of your surroundings, it requires more energy, leading to mental fatigue and reduced focus on the task at hand.

For example, this study used anti-saccade tasks to show that individuals with depressive symptoms, similar to those experiencing post-concussion syndrome, have difficulty disengaging from negative stimuli, which could contribute to subjective feelings of poor concentration. – https://pubmed.ncbi.nlm.nih.gov/37463539/ 

The same is valid for neck function. Pain, especially headaches, has been shown to reduce cognitive performance. After a concussion, neck pain or headaches during mental or physical tasks can distract you, making it harder to concentrate. Improving neck function and reducing pain, such as headaches, can help you regain focus and concentration. (4)

Inflammation and Your Gut 

Shortly after a concussion, changes can occur in the gut lining. The connection between your brain (i.e., concussion) and your gut lining is known as the “gut-brain axis.” This connection may contribute to symptoms like mental fatigue, brain fog, and difficulty concentrating.

After a concussion, gut inflammation can lead to immune patches in the gut (e.g., M-cells of Peyer’s patches) bringing in more bacteria and inflammatory endotoxins into the bloodstream. The body reacts to these bacterial products (e.g., LPS), triggering an inflammatory response to eliminate them. Additionally, some of these molecules make their way to the brain to trigger further inflammation in the nervous system, creating a “positive feedback loop of inflammation.” It is through this chronic process of inflammation that can disrupt our ability to concentrate and focus. 


Increase Your Ability To Concentrate.

Directing Attention 

Calming your internal dialogue (i.e., Default Mode Network) can significantly improve your concentration and focus.

By quieting these internal thoughts, you free up your brain to focus entirely on the task at hand. While this takes practice, techniques like meditation, mindfulness training, and cognitive behavioral therapy have effectively regulated the Default Mode Network and boosted concentration.

Visual Tracking and Neck Therapy 

A trained concussion specialist can assess your visual system to determine if rehabilitation is needed. This is often done through a Visual Oculomotor Screening (VOMS) test, which involves guiding you through simple visual tasks to check if any critical aspects of your eye-tracking system are off. If issues are identified, the specialist can provide targeted rehabilitation exercises to help correct them.

When it comes to the cervical spine, a concussion specialist can also offer manual therapy for the muscles and joints in your neck. This has been shown to reduce neck pain and improve symptoms affecting your concentration.

Fixing Your Gut 

Enhancing your gut health can significantly improve your cognitive performance and mental clarity. 

You can begin with simple, proven strategies such as incorporating a variety of anti-inflammatory foods such as colorful fruits and vegetables, organic meats and fish, along with fermented foods like sauerkraut and kimchi. It’s equally important to avoid processed foods, alcohol, and tobacco. 

Following these straightforward guidelines can effectively reduce gut inflammation and boost your overall mental health.


Conclusion.

Concentration is highly subjective and multifactorial, making pinpointing a single treatment solution challenging. However, a comprehensive approach can yield the best results. 

Concentration has a vital psychological component, so regulating your internal dialogue or the default mode network through mindfulness meditation, positive self-talk, and proper education on concussion care can rapidly improve focus and cognitive performance. 

Additionally, supporting your concentration with anti-inflammatory diets, manual therapy, and visual tracking exercises can further enhance your ability to concentrate.


Citations 
  1. van der Horn HJ, Liemburg EJ, Scheenen ME, de Koning ME, Spikman JM, van der Naalt J. Post-concussive complaints after mild traumatic brain injury associated with altered brain networks during working memory performance. Brain Imaging Behav. 2016;10(4):1243-1253. doi:10.1007/s11682-015-9489-y
  2. Kontos AP, Covassin T, Elbin RJ, Parker T. Depression and neurocognitive performance after concussion among male and female high school and collegiate athletes. Arch Phys Med Rehabil. 2012;93(10):1751-1756. doi:10.1016/j.apmr.2012.03.032
  3. Silverberg ND, Iverson GL, Panenka W. Cogniphobia in Mild Traumatic Brain Injury. J Neurotrauma. 2017;34(13):2141-2146. doi:10.1089/neu.2016.4719
  4. Nadar MS, Jasem Z, Manee FS. The Cognitive Functions in Adults with Chronic Pain: A Comparative Study. Pain Res Manag. 2016;2016:5719380. doi:10.1155/2016/5719380