It's almost football season again, especially now that the NFL is back to work. I'm sure most of you are aware of the increased interest in concussions that has been brought on, in part, from injuries to NFL football players. Of course, many people are at risk of having a concussion, and not only people involved in sports. Let's review some information regarding the diagnosis and treatment of concussions, as well as the risks of not addressing them appropriately.
A concussion is a traumatic brain injury, and it results in a change in how your brain functions. Therefore, there must be an event (for example a fall, blow to the head or collision) that causes the injury to the brain. Typically, this is temporary, but symptoms may last for a long time. You do not have to lose consciousness to have a concussion; in fact most people do not. Concussions may be hard to diagnose. There is no specific blood test or radiology study that "proves" that someone has had a concussion. Signs and symptoms of a concussion include: headache, dizziness, nausea, feeling tired or "in a fog", balance problems, and irritability. Some people find that they are not doing as well at work or at school, or perhaps note that they are having difficulty getting along with others. This may be due to memory problems, visual deficits, tiredness, anxiety or other symptoms that may be due to a concussion.
The most important thing to do after a concussion is to rest. If the injury happens during an athletic activity, you should not return to play until you have been evaluated by a health care professional who is experienced with treating concussions. This person can assess you and determine when you may be able to return to light activity and carefully increase activity (a graduated return to play protocol). For a concussion of any cause, rest means not only refraining from physical activity, but also cognitive rest. Students may need to minimize school work and workers may need to reduce work to "rest their brains". We remind people to minimize cognitive activities such as computer use, texting and video games as well. People can start to increase activity when their symptoms have gone away, but like athletes, return to activity should be gradual and not increased if symptoms return.
The best way to determine if you have recovered from a concussion is by determining whether you are symptom-free, first at rest, and then with an increase in activity. Athletes who are at risk for concussions often get baseline (pre-injury) testing of memory, reaction time, attention, balance and other measures of performance. Then, if they have an injury, a comparison can be made between performance before and after the injury. When performance returns to pre-injury levels and the athlete remains symptom-free, he/she is likely ready to return to play. For any individual, if recovery is slow, the injured person may need to be seen by a brain injury specialist for further evaluation and treatment.
Returning to activity too soon may slow your recovery time and worsen symptoms. Additionally, if you sustain another concussion when you have not yet recovered from your first one, the injury and subsequent complications may be much more severe than they would have been had the brain been fully healed when the second concussion occurred. The most dramatic, but thankfully rare, complication is known as "second impact syndrome", a situation in which two rather mild concussions that occur close in time may lead to catastrophic results. There is also concern regarding the long-term impact of multiple concussions, and we will address this topic in a future post.
