Concussions are getting much more media attention. What do you need to know about these types of head injuries?
1) A concussion does not necessarily always involve a loss of consciousness or a direct blow to the head.
Concussions are the result of “impulsive” forces to the brain. Essentially, they are “whiplash” injuries, where the brain bounces around inside the bony skull. This type of injury can result from a blow to the head, but can also occur when the head jerks around because of impact to the body.
When a concussion occurs, it is likely that the injured person does NOT lose consciousness. However, they are likely to experience other symptoms, such as disorientation, unsteady balance, or poor coordination.
Many common kids’ activities can generate this type of trauma. Concussions have been documented most frequently in football, but soccer, wrestling, and basketball all have also been found to have significant risk. Cheerleading, martial arts, skate-boarding, rodeo, and completely informal activities like tree climbing or bike riding also have the potential for head injury.
It’s not just kids that are at risk for concussion. Older adults or those who have impaired balance or other health issues such as decreased sensation in the feet and legs, generalized muscle weakness, or the tendency to experience light-headedness or vertigo are all at increased risk for falling. A fall can lead to a concussion, whether it involves a blow to the head or an impact to another part of the body.
2) A concussion can be tricky to diagnose.
Because concussions can occur without a loss of consciousness, and because the incidents that may cause a concussion are often brief and difficult to observe, it can be a challenge to know whether or not a person’s brain has been injured at the time of an event. Often, initial symptoms of a concussion last for only a brief period, after which the injured person may feel essentially normal and may think that they have ‘shaken it off.’ Another factor that makes a concussion difficult to diagnose is that standard imaging of the brain (such as an MRI) does NOT reveal any abnormalities in cases of concussion.
Although it can be difficult to diagnose a concussion, these head injuries generally share several characteristics:
- ‘Impulsive’ forces to the head – either through a direct blow OR by contact to another body part that has caused the head to jerk around.
- A rapid onset of neurological impairments that may spontaneously resolve. There may or may not have been a loss of consciousness.
- A persistence of functional disturbances after the resolution of immediate acute symptoms.
- Symptoms typically follow a sequential pattern of recovery. In some cases, prolonged post-injury symptoms may persist.
- NO abnormality is observed structurally in the brain via standard imaging (e.g.: MRI)
A variety of screening tools have been developed and are in use in the medical community to attempt to identify concussions, including the Standardized Assessment of Concussion (SAT), the Standardized Concussion Assessment Tool (SCAT), and the IMPACT test. These assessments can help a medical practitioner rule IN the presence of a concussion. However, negative findings on these tools cannot conclusively rule OUT a concussion injury.
Some symptoms of a concussion occur immediately after an injury. However, further symptoms may also develop gradually – over the course of 1-2 days after the initial event. The most common symptom reported after a concussion is dizziness. Frequently, there are also complaints of headaches, mental confusion, visual disturbances, or amnesia.
Because of the challenges in diagnosing a concussion, it is good strategy to do baseline screening tests for people who are at risk for a concussion injury. Screening test results can then be compared to a person’s performance on the same screen after an injury has occurred. It is also a good idea to closely monitor a person who may have sustained a concussion for a period of time after an injury has occurred. Family members or others that are familiar with a person’s typical personality and behavior may be able to identify symptoms that may not be as apparent to others.
3) Concussions can have cumulative and long-lasting effects.
It is common for the symptoms of a concussion to recur during times of exertion or stress – even after the initial symptoms have improved. The exertion or stress that brings on post-concussion symptoms can be either physical or mental. Difficulty with concentration, sleep pattern disturbances, mood changes, and fatigue or low energy levels are commonly reported during time periods of days, weeks, or even months following a concussive injury.
It is difficult to predict the recovery time required for any one individual after a concussion. Several factors, including younger age, female gender, history of other concussions, and the presence of other health issues such as migraines or mood disorders tend to predict longer recovery times.
The risk of resuming normal activity too soon following a concussion is potentially significant. For youth athletes, there appears to be a particularly dramatic additive effect of repeated trauma – meaning that less impact force can cause more damage during subsequent injuries. This is called Second Impact Syndrome, which can be fatal. For those of any age who have had a concussion, there is a risk of developing Post-Concussion Syndrome. This risk appears to increase with each subsequent event that occurs without full recovery from a prior episode. Post-Concussion Syndrome involves prolonged symptoms such as migraines, sleep disorders, or mood disturbances such as irritability or argumentative behavior. These symptoms may persist for extended periods of time.
The risk of other musculoskeletal injury is also theoretically higher after a concussion. Visual and balance deficits that may be present after a concussion can impact coordination and movement planning – putting a person at a higher risk for falls or other sport injuries.
Longer-term health consequences of repeated head injury are also being studied. There appears to be a relationship between head injury and memory issues later in life. Studies of retired football players have demonstrated a higher incidence in this population compared to age-matched males of symptoms similar to those seen in patients with Alzheimer’s disease or progressive motor neuron diseases like Lou Gehrig’s disease. Declines in memory and mood, as well as changes in personality, have been reported in patients whose brains have later been studied after their deaths and found to show specific protein marker patterns that are different than in ‘normal’ brains.
4) Rest alone does not constitute comprehensive concussion rehabilitation.
It is very important to rest – both physically and mentally – after a concussion injury. Rest allows the brain an opportunity to begin to repair itself. Sometimes rest will necessitate the modification of typical daily activities. For example, an injured student athlete would need to temporarily reduce athletics at school, and might need to delay exams that would require intense studying. For adults, reduced hours at work and the reduction or elimination of computer use temporarily might be needed. The main goal would be to keep activity during daily activities at a level that does NOT cause any of the symptoms of a concussion – dizziness, headache, etc.
As more is learned about concussions, it is becoming apparent that total rest, or rest without any other rehabilitation intervention, is not the most effective way to recover from this type of injury. It is being found that injured persons that stay involved in activities at some level, and that also engage in prescribed light physical activity during their initial recovery stages after a concussion, tend to have better longer-term recoveries than people who either returned faster to higher levels of activity or who had more complete rest during their initial recoveries.
The physical symptoms after a concussion tend to occur across multiple body systems. The visual system and the vestibular system (which is responsible for balance) are typically involved. It is also likely that a concussion will cause mechanical problems with the neck or upper back. Each of these issues can be treated by physical therapists that have been trained to treat concussion injuries. A physical therapist might also work in conjunction with other specialists, such as audiologists and ophthalmologists, to design and implement comprehensive treatment programs that address visual, vestibular, and spinal rehabilitation in addition to monitored cardiovascular training.
As described in the most recent International Consensus Statement on Concussion in Sport, a concussion is a ‘complex pathophysiological process’. Careful assessment and treatment of this process in a manner individualized to each injured person is important.
Contact us today if you’d like to schedule baseline testing or post-injury treatment.