What Is A Concussion and How Do We Treat It?

One of the hot topics right now in the world of brain injury is Concussion Prevention and Treatment. In order to fully be able to discuss this topic, we first have to understand and answer this question: What is a Concussion? Newer research has shown that a concussion happens from acceleration or deceleration of the brain inside of the skull. This can happen from activities such as a hit directly to the head or body as in contact sports, falls, military activity, or motor vehicle accidents. This acceleration/deceleration of the brain causes stretching of the brain tissue and creates an excitatory response that places the brain in an energy deficit resulting in any of the below symptoms. Symptoms are typically temporary and usually dissipate by 8-10 days.

What are some signs and symptoms of a concussion?

• Loss of Consciousness (only occurs in ~10% of all concussions!)
• Seizures
• Delayed verbal/motor responses
• Confusion/Disorientation/Memory deficits
• Lack of focus/Concentration
• Speech disturbances such as slurred speech
• Balance/Incoordination

Sports are one of the leading causes of concussion resulting in approximately 3.8 million concussions per year in the United States. Rugby, ice hockey, football, and soccer are the top high-risk sports for both men and women due to the amount of contact. The large number of concussions sustained from sports has led to a push for prevention measures such as advancements to helmets. Research has shown that the use of a properly fitting helmet may reduce the risk of the severity of the symptoms of a concussion; however, there is lack of evidence supporting the use actually reducing the number of concussions sustained.

Since concussions cannot be completely prevented, we now need to look at treatment! Due to the wide variation of symptoms that can present following a concussion, a comprehensive treatment plan should be utilized. The brain accounts for approximately 2% of our body weight and it takes approximately 20% of our blood supply! Why is this important? A concussion can temporarily reduce blood flow to the brain by up to 50%! This makes exercise one of the most crucial treatment options for an individual following a concussion. Treatment will be based on the presentation of symptoms and following Return-to-School and Return-to-Play guidelines and only moving to the next stage if they are symptom-free for 24 hours.

What kind of treatments should be used?

• Rest
• Nutrition
• Physical Exercise
• Visual and Vestibular Retraining
• Cervical Spine-Alignment and Musculature Issues
• Balance Retraining

What does the Return-to-School and Return-to-Play Guideline look like?

• Rest Initially 24 hours
• Light Cognitive Activity
• Half Day of School
• Full Day of School
• Clearance for Physical Activity
• Light Non-Contact Sport Specific Activity
• Higher Intensity Non-Contact Sport Specific Activity
• Full Contact Sport
• Return to Competition

An important fact to remember is that typical concussion symptoms dissipate in 8-10 days; however, the brain metabolic state (no longer being in an energy deficit) does not return to its own baseline until 22-30 days after an injury. Why is this important? Three words: Second Impact Syndrome. If there were to be another concussion prior to the brain reaching its metabolic baseline, the effects of the first concussion can now be compounded, thus placing the individual at an increased risk for permanent deficits or even death. Comprehensive Baseline Testing can assist with not only making sure all aspects of the individual's brain function, including both physical and cognitive aspects, have returned to their baseline. The testing also significantly assist clinicians in the Return-to-Play decision. Early comprehensive treatment of concussion can also decrease the time that symptoms are experienced thus reducing the likelihood of Post-Concussion Syndrome (where the concussive symptoms last greater than 2 weeks).

In summary, a concussion can and should be treated with a comprehensive approach and in a collaborative effort between the individual and their family, a trained rehabilitation professional, a physician, school administrators, and coaches. This collaborative approach will help minimize the possible long-term effects of a concussion.

References:

• Prien, Et al. “Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review” Sports Med. 2018 Apr:48(4):953-969.
• Langlois Et al. “The epidemiology and Impact of Traumatic Brain Injury: A Brief Overview” Journal of Head Trauma Rehabilitation: September-October 2006: Vol21. Issue 5. Pg 375-378.
• Patel, Et Al. “Aerobic vs anaerobic exercise training effects of the cardiovascular system” World J Cardiol. 2017 Feb 26:9(2):1324-138.
• Viano Et al. “Concussion in professional football: biomechanics of the struck player part 14” Neurosurgery. 2007 Aug:61(2):313-327.