What we should all know about concussions.

Written by Cindy Hovington Ph.D. Founder of www.curiousneuron.com

Montreal, Canada

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I had the pleasure of studying concussions for the first 2 years of my doctoral degree. After working at the Montreal NEURO, I learned that concussions can potentially be quite devastating. A hit to the head can either have no effect or can take months and even years to recover from. I have gathered some info that is important for all of us to know. Most importantly, when can we go back to work, school or a sport we play?

What happens to the brain when you get a concussion?

Concussions, or mild traumatic brain injuries, are caused by a direct or indirect blow to the head. When you sustain a hit to the head, the brain jolts inside your skull. The brain is soft and floats in a liquid (called cerebral spinal fluid) the surrounds it. This liquid protects your brain and stops it from smashing into your skull every time you move or fall. However, if the hit is hard enough, the brain pushes through this liquid and hits the skull. The same way that you can bruise your arm or leg, you can "bruise" your brain. The only problem is that when this happens to your brain, certain brain functions can be impaired. You can lose your memory, have diminished concentration, get dizzy spells, have poor balance and much more. 

What are the signs and symptoms of a concussion?

A person can have many concussion symptoms. These symptoms are called Postconcussive Symptoms. They can experience a headache, fatigue, nausea, sensitivity to light, and cognitive symptoms such as problems with memory, concentration, planning and organizing. Most people are not aware that after a concussion they can also develop psychiatric complications such as anxiety, depression, and irritability. 

More signs and symptoms:

  • Difficulty remembering new information

  • Nausea or vomiting

  • Feeling dizzy

  • Balance problems

  • Sleeping more or less than usual

  • Feeling tired and having no energy

  • Feeling down or sad

Symptoms can show up immediately after the concussion or even a few hours or days later. It is important to monitor the symptoms. Make note of when a symptom begins and when it ends. You will need this information for your doctor. As mentioned, they could last for a few hours or as long as weeks/months. 

Is there a test that confirms you got a concussion?

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Unfortunately, doctors and researchers need to rely mostly on a person's description of their symptoms to confirm if it is indeed a concussion. Technically, you can't "see" a concussion or its severity with any brain scanner (unless the hit to the head caused internal bleeding in the brain), but concussion research is starting to show us that even if someone does well on cognitive tests (attention, memory, and planning seems ok) when you have them do  (fMRI), they are able to see less activation in the concussed brain. fMRI is when you have to perform tasks in an MRI. Rather than just looking at pictures of the brain, with fMRI you can see which parts are being activated during a task such as a memory activity). 

Doctors will use the Postconcussion Symptom Scale to assess the presence of your symptoms and determine the severity of the concussion. 

How does one recover from a concussion?

Recovery is VERY important. Recovery from a concussion means DOING NOTHING. Let me repeat that...DOING ABSOLUTELY NOTHING!! The brain needs to rest, the only way it can heal is by doing nothing. Pop quiz...is watching TV doing nothing? Nope. Is going to work or school doing nothing? No. Is reading a book doing nothing? Nope, sorry! All these activities require the brain to work and function and are therefore not considered rest. You don't want it to function, you need your brain to relax. This is the most difficult part of recovery. Especially for children, but I can not emphasize enough how important it is. How long should you do this? The general rule of thumb is that you rest until the moment all of your symptoms are COMPLETELY GONE. Then you can slowly return to work or school. However, let your symptoms guide you. If you sit in front of a computer or sit in the classroom and your nausea/headache/or any other symptom returns, you need to go back to resting again. 

If you play sports, you need to wait longer and the process for return to play is much slower. Once your symptoms have all stopped, you slowly start your sport again but one step at a time (click on the link "return to play" above to get details). If any symptoms return when simply running, you go back to the start line.  I understand that this can be difficult for athletes, but the consequence of sustaining a second blow to the head when the first concussion has not healed can be devastating. A second concussion that occurs when the first was not healed yet is called Second Impact Syndrome

Recovery can be longer in older adults, children, and teens. Moreover, if this is not your first concussion, recovery may also be slower. (See info below on repeated concussions). 

Is it the same in adults and children?

Researchers are starting to look into concussions that occur in children. Most symptoms are similar in children and adults, however, the extent of consequences in children remains largely unknown. Although you might think that a child's brain heals faster given their age, it is actually not the case in concussions. Since their brain is developing, it is very vulnerable to injury and the brain can take much longer to heal. An interesting study from Montreal showed that fMRI could also be a valuable tool when assessing concussions in children. Also, although concussion symptoms might be gone, studies have shown that a child's cognitive symptoms could still be present and could cause difficulties in school. 

What happens to professional athletes who get repeated concussions?

 

Multiple concussions could cause symptoms to stay much longer and can cause cognitive deficits (memory, attention or planning difficulties). However, researchers are still trying to understand the true impact of repeated concussions. They are studying various sports that have high risks of concussions such as boxing, football, hockey etc. For instance, several medical groups have asked for the discontinuation of boxing. Why? Its primary goal is to hit the opponents head and this can result in the Punch-Drunk Syndrome. The more you get punched in the head, the higher the release of certain chemicals in the brain. These chemicals have been linked to Parkinson's-like symptoms. 

Hope you learned a thing or two about concussions! Feel free to ask a question in the comment boxes below (you need to click on the title of the newsletter to see the comment boxes). 

 

Resources: 

http://www.concussionmtl.com/resources.html

http://www.cdc.gov/headsup/providers/return_to_activities.html