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UNDERSTANDING CONCUSSION

 

Concussions are often seen as a sports-related injury, they can occur in other places such as work, home or in a car. Something as simple as knocking your head against the corner of the kitchen cabinet can result in a concussion.

As further research around concussion is produced, the definition of a concussion is being further changed and refined. For example, the traditional definition of a concussion was when a person had a loss of consciousness from an external force (Hanson et al., 2014). However, research has found that only 1 in 10 concussions have a loss of consciousness.

The most recent definition of concussion is:

“A brain injury characterised by a complex pathophysiological process affecting the brain and caused by a direct blow to the head or an indirect blow elsewhere on the body, transmitting an impulsive force to the head." (McCrory et al., 2017).

WHAT HAPPENS TO THE BRAIN?

The brain sits in a sack of cerebrospinal fluid which acts as a cushion between the brain and the skull. However, it can only stop so much. During a concussion, the brain bounces within the cavity, causing blood vessels to tear. Blood accumulates between the brain and the dura mater, forming a clot. Swelling occurs, affecting such functions as eye movement. The functions occur dependent upon which area of the brain is affected (Hanson et al., 2014). 

SIGNS AND SYMPTOMS 

  • Symptoms: somatic (e.g., headache), cognitive (e.g., feeling like in a fog) and/or emotional symptoms
  • Physical signs (e.g., loss of consciousness, amnesia)
  • Balance impairment
  • Behavioural changes (e.g., irritability)
  • Cognitive impairment (e.g., slowed reaction times)
  • Sleep/wake disturbance (e.g., drowsiness)

Within each of these categories, there is a set of specific symptoms (e.g., a change in irritability, sadness, more or less emotional or nervousness in the behaviour category). These symptoms can vary from person to person.

SO, WHAT DO WE DO IF WE SUSPECT A CONCUSSION?

If you suspect someone or yourself has a concussion, monitor the symptoms. If the suspected person with a concussion has severe symptoms, either call an ambulance or if you can, take them to a hospital for monitoring.

It is important to note that, concussions can be delayed, with symptoms arising hours after the injury. This is why monitoring is crucial post-concussion.

If you are finding the concussion is affecting your work, make an appointment with your GP to have a concussion test completed. In some cases, you may need time off work to assist with a full recovery. 

MANAGING CONCUSSION

When a person is recovering from a concussion, there are protocols to follow to ensure that the brain heals well. It is important to note that each concussion is different, and everyone heals at different rates. But we can use the protocols as guidelines for rehabilitation.

The most recent concussion protocols identify that the first 24 - 48 hours post-injury should be rest and allow the brain to settle. This means total physical and mental rest and minimal screen time. The next phase is to start to introduce light aerobic activity. This is symptoms guided by low-moderate level of exercise, such as stationary cycling or walking. A Physiotherapist will guide this rehabilitation and will identify when it is appropriate to increase the difficulty of the task such as weight training, screen time and return to sport or work (McCrory et al., 2017).

If symptoms persist for example longer than 10-14 days for adults or four weeks for children. Please ensure that the person has regular meetings with their GP or physiotherapist as the may require more in-depth interventions (McCrory et al., 2017).

As I stated earlier, concussions can show some variability in symptoms from person to person. If you do suspect a concussion please either go to hospital, see your GP or come into Habit to see a Physiotherapist. 

Chris Marshall is Lead Physiotherapist at Habit Upper Hutt.


REFERENCES

Abrahams, S., Mc Fie, S., Patricios, J., Posthumus, M., & September, A. V. (2014). Riskfactors for sports concussion: an evidence-based systematic review. British journal of sports medicine48(2), 91-97.

Benson, B. W., McIntosh, A. S., Maddocks, D., Herring, S. A., Raftery, M., & Dvořák, J. (2013). What are the most effective risk-reduction strategies in sport concussion?. British journal of sports medicine47(5), 321-326. 

Hanson, E., Stracciolini, A., Mannix, R., & Meehan, W. P. (2014). Management and Prevention of Sport-Related Concussion. Clinical pediatrics, 0009922813518429.

McCrory, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., ... & Davis, G. A. (2017). Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med, bjsports-2017.