Concussions: what to look for and how to react

Concussions have become a major topic in the world of health care, high school athletics, and professional sports alike. In the past, concussions were considered a “normal” part of athletics and until recently, were poorly understood and rarely treated. Recently, a new term has been coined in reference to concussion in an attempt to indicate the serious nature and possible long term effects of this injury: mTBI- mild traumatic brain injury. While researchers have a lot of work ahead of them, much has been learned about concussions in the last decade allowing healthcare providers to become more skilled in their identification, treatment, and prevention.

A concussion is defined by the American Academy of Neurology as a trauma-induced alteration in mental status that may or may not involve loss of consciousness. Often times concussions can be easy to miss given they don’t always result in unconsciousness and there isn’t always other signs of trauma such as scratches or bruises to the face. A concussion is usually a result of direct trauma to the head. However, it can also result from a hit to the body causing the soft brain tissue to be shaken against the inside of the hard skull. Common ways to get an concussion are car crash, bike accident, fight, playground injury, or sports activities.

Immediate signs and symptoms of concussion are extremely variable due to the fact that many different parts of the brain may be affected. Classic symptoms may include a vacant stare, delayed verbal expression, inability to focus, disorientation, stumbling and other in-coordination, nausea, vomiting, headache and dizziness. If any of these symptoms are present, contact your health care provider immediately. Luckily, the majority concussions are fully resolved within 1 week, and the person will have no lasting issues.

If symptoms are still present after 6 weeks, the person is considered to have post concussive syndrome. Symptoms can persist for weeks to months, or even years after the injury. Such circumstances can greatly affect a persons ability to work, go to school, play sports and cause chronic deficits in memory and concentration, headaches, poor balance, fatigue, light and sound sensitivity, mood changes, sleep disturbances, and amnesia.

The best treatment for post concussive syndrome depends on the symptoms that are persisting. Following sports concussion, up to 79% of patients report dizziness and 56% report problems with balance. Post-concussive dizziness and balance disorders may arise from injury to different parts of the brain and the inner ear. A vestibular physical therapist is specially trained in the assessment and treatment of dizziness and balance deficits, and can help in implementing specific exercises and treatments to improve dizziness and balance issues. In addition, athletes who sustain a concussion may aid from structured physical therapy to recover strength, agility and power necessary to return to sports.

In more complicated or prolonged cases, multiple providers are often involved in the full recovery from a concussion. Medications and environmental changes are sometimes needed to improve sleep quality and quantity. If the person has visual deficits or headaches during reading, specific eye exercises can be prescribed to improve eye tracking and focus. Speech therapists and occupational therapists can assist in improving memory and recall. A neuropsychologist (a doctor who specializes in the brain/ behavior relationship) or an orthopedic physician are often involved in the overall management of the concussion, can prescribe medications to address symptoms, and help determine when recovery is complete.

While not all concussions are preventable, you can reduce your chance of injury by:

• Wearing a seat belt every time you drive or ride in a car or other motor vehicle.
• Never driving when you are under the influence of drugs or alcohol.
• Wearing a helmet and safety equipment when you play sports such as football, baseball, hockey, or during other activities like biking, skateboarding, skiing, and horseriding.
• Wearing a helmet when driving or riding on a motorcycle, scooter, snowmobile, or ATV.
• Make your home safer to prevent falls.

Reduce your child’s chances of getting a concussion:

• Use child car seats and restraints correctly.
• Teach your child bicycle safety
• Teach your child how to be safe around cars and streets.
• Teach your child playground safety.

If you think you or your child may have a concussion, don’t ignore the symptoms. Returning to activity too early can exacerbate the symptoms and prolong the recovery. It is important to get evaluated by a knowledgeable doctor or physical therapist, to devise a treatment strategy to return you to your normal self!