Concussions | TBI

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A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include loss of consciousness; memory loss; headaches; difficulty with thinking, concentration, or balance; nausea; blurred vision; dizziness; sleep disturbances, and mood changes. Any of these symptoms may begin immediately or appear days after the injury. Concussion should be suspected if a person indirectly or directly hits their head and experiences any of the symptoms of concussion. Symptoms of a concussion may be delayed by 1–2 days after the incident/accident. It is not unusual for symptoms to last 2 weeks in adults and 4 weeks in children. Fewer than 10% of sports-related concussions among children are associated with loss of consciousness.

The mechanism of injury involves either a direct blow to the head or forces elsewhere on the body that are transmitted to the head. This is believed to result in neuron dysfunction, as there are increased glucose requirements, but not enough blood supply. A thorough evaluation by a qualified medical provider working in their scope of practice (such as a physician or nurse practitioner) is required to rule out life-threatening head injuries, injuries to the cervical spine, and neurological conditions and to use information obtained from the medical evaluation to diagnose a concussion. Glasgow coma scale score 13 to 15, loss of consciousness for less than 30 minutes, and memory loss for less than 24 hours may be used to rule out moderate or severe traumatic brain injuries.

Worldwide, concussions are estimated to affect more than 3.5 per 1,000 people a year. Concussions are classified as mild traumatic brain injuries and are the most common type of TBIs. 

Concussion symptoms vary between people and include physical, cognitive, and emotional symptoms.  Symptoms may appear immediately or be delayed by 1–2 days.  Delayed onset of symptoms may still be serious and require a medical assessment.  Up to one-third of people with concussion experience longer or persisting concussion symptoms, also known as post-concussion syndrome or persisting symptoms after concussion, which is defined as concussion symptoms lasting for 4 weeks or longer in children and adolescents, and symptoms lasting for more than 14 days in an adult.  The severity of the initial symptoms is the strongest predictor of recovery time in adults.

Physical Symptoms

Headaches are the most common mTBI symptom. Others include dizziness, vomiting, nausea, lack of motor coordination, difficulty balancing, or other problems with movement or sensation. Visual symptoms include light sensitivity, seeing bright lights, blurred vision, and double vision. Tinnitus, or a ringing in the ears, is also commonly reported. 

In one in about seventy concussions, concussive convulsions occur, but seizures that take place during or immediately after a concussion are not "post-traumatic seizures", and, unlike post-traumatic seizures, are not predictive of post-traumatic epilepsy, which requires some form of structural brain damage, not just a momentary disruption in normal brain functioning.

Cognitive and Emotional Symptoms

Cognitive symptoms include confusion, disorientation, and difficulty focusing attention. Loss of consciousness may occur but is not necessarily correlated with the severity of the concussion if it is brief.  Post-traumatic amnesia, in which events following the injury cannot be recalled, is a hallmark of concussions.  Confusion may be present immediately or may develop over several minutes.  A person may repeat the same questions, be slow to respond to questions or directions, have a vacant stare, or have slurred or incoherent speech.  Other concussion symptoms include changes in sleeping patterns and difficulty with reasoning, concentrating, and performing everyday activities.

A concussion can result in changes in mood including crankiness, loss of interest in favorite activities or items, tearfulness, and displays of emotion that are inappropriate to the situation.  Common symptoms in concussed children include restlessness, lethargy, and irritability.

For unknown reasons, having had one concussion significantly increases a person's risk of having another.  Having previously sustained a sports concussion has been found to be a strong factor increasing the likelihood of a concussion in the future. People who have had a concussion seem more susceptible to another one, particularly if the new injury occurs before symptoms from the previous concussion have completely gone away. It is also a negative process if smaller impacts cause the same symptom severity.  

In post-concussion syndrome, symptoms do not resolve for weeks, months, or years after a concussion, and may occasionally be permanent.  About 10% to 20% of people have persisting concussion symptoms for more than a month.  Symptoms may include headaches, dizziness, fatigue, anxiety, memory and attention problems, sleep problems, and irritability.  Rest, a previously recommended recovery technique, has limited effectiveness.  A recommended treatment in both children and adults with symptoms beyond 4 weeks involves an active rehabilitation program with reintroduction of non-contact aerobic activity.  Progressive physical exercise has been shown to reduce long-term post-concussive symptoms.  Symptoms usually go away on their own within months but may last for years. The question of whether the syndrome is due to structural damage or other factors such as psychological ones, or a combination of these, has long been the subject of debate.

 Traditional Concussion Treatment(s) include: 

• Resting and monitoring symptoms
• Taking over-the-counter pain relievers, such as paracetamol, but avoiding NSAIDs, alcohol, and recreational drugs.
• Drinking plenty of water to prevent dehydration.
• Applying a cold compress to the injury to reduce swelling.
• Taking a break from sports and other strenuous activities.
• Doing exercise therapy to improve blood flow to the brain.
• Doing manual therapy and neck rehab to address the whiplash element of the injury.