What is a concussion?
A concussion is a mild traumatic brain injury, resulting from a direct impact to the head or a whiplash movement that suddenly causes the brain to shift in the skull. A concussion may be associated with an altered mental state or loss of consciousness.
The ACRM (American Congress of Rehab Medicine) provide the following diagnostic criteria:
A patient with mild traumatic brain injury is a person who has had a traumatically induced physiological disruption of brain function, as manifested by at least one of the following:
- Any period of loss of consciousness
- Any loss of memory for events immediately before or after the accident
- Any alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused)
- Focal neurological deficit(s) that may or may not be transient; but where the severity of the injury does not exceed the following
- Loss of consciousness of approximately 30 minutes or less;
- After 30 minutes, an initial Glasgow Coma Scale(GCS) of 13-15; and
- Post traumatic amnesia (PTA) not greater than 24 hours.
Symptoms may be physical, behavioral/emotional, or cognitive. Commonly reported symptoms of a concussion include:
- Balance Disturbance
- Blurred or Double Vision
- Memory Problems
- Sensitivity to Light
- Sensitivity to Noise
- “Feeling Foggy”
- “Feeling Dazed”
- Poor Concentration
Concussion symptoms are non-specific and may overlap with many other conditions such as ADHD, Depression, Anxiety, insomnia, Vestibular injury, and Neck Injury.
Concussion Recovery Time
These symptoms may present themselves immediately or up to 3 days after the injury. When properly managed, the recovery time is usually within 10-14 days. Symptoms typically begin to improve after 3 days.
The neurometabolic cascade including higher levels of potassium and calcium with reduced cerebral blood flow will resolve in 7-10 days.
Some factors that may result in delayed recovery include:
- Previous history of brain trauma
- Post-traumatic amnesia
- High number of symptoms reported early after injury
- Skull fracture
- Early onset of pain and in particular headache within 24 hours after injury
- Presence of life stressors at the time of the injury
- Lack of social supports
It is important for parents, teachers, coaches, and medical practitioners to understand and recognize the signs and symptoms of a concussion to help with early identification and proper management.
General Advice Post Concussion
- Rest: It is important to get adequate amounts of sleep to allow the brain to heal
- Driving: Do not drive until you feel much better and are able to concentrate properly (check with your doctor)
- Alcohol: Do not drink alcohol until you are fully recovered
- School/Work: You may need to take a couple of days off but will likely be back full-time within 2 weeks.
- Use Acetaminophen instead of Aspirin or Anti Inflammatory Pain Relievers (e.g. Ibuprofen or Naproxen) as they may increase risk of complications (check with your doctor).
- Avoid re-injury. It may be necessary to avoid slippery surfaces or working at heights.
Given the complicated nature of a concussion and the multitude of external factors that may impact recovery, an interdisciplinary team approach may be necessary to successfully manage complex cases.
Concussion rehabilitation may include:
- Education / Advice
- Activity Modification
- Sleep Advice
- Energy Conservation
- Guidance With Return To Work/Sport/School
- Balance Exercises
- Joint Position Error
- Visual/Eye Exercises
- Brock String / Convergence
- Tracking Exercises
- Vestibular / Habituation Exercises
- Cognitive Exercises
- Memory Exercises
- Assistive devices
- Binasal occlusion glasses
- Computer screen filter
- Manual Therapy
- For associated neck pain and tension
- And More…
If you suffer from signs and symptoms of a concussion, you should consult with your family doctor/hospital, and your local CBI Health Centre for Concussion Management and Rehabilitation.
Please share with anyone who needs to know how to treat signs and symptoms of a concussion.
CBI Health Centre Concussion Management Seminar – London, Ontario – September/October 2017