What is a concussion?
A concussion is a form of mild brain injury that results when the brain is exposed to trauma, i.e., collision, crash, sport injury of head to head, head to ball, head to helmut, helmut or stick to helmut, fall, assault or whiplash injury.
Regardless of the type of force sustained, the type of mechanism of brain injury is thought to be the same; .i.e., alteration of brain neurons and their connecting fibers thru strain, stretch, cellular swelling and “molecular cascade“ of cellular ionic imbalance over days to weeks.
The good news is that the majority of concussions, 85-90%, resolve fully within a short period of time - one to six weeks.
The symptoms of concussion may be apparent immediately or delayed for 24-48 hours. The symptoms fall into three main categories; somatic, cognitive, behavior-mood - PCS form
Somatic symptoms may include: headache, neck pain, fatigue, nausea, dizziness, light- headedness, sensitivity to light and sound, unsteadiness of balance and insomnia or hypersomnia- inability to fall asleep or sleeping too much.
Cognitive symptoms may include: lapse of attention, sense of forgetfulness when completing a task, sense of immediate disorientation or confusion, slowness with processing information such as when listening, reading, writing, texting, playing electronic games, sense of information overload and exhaustion with very little “ cognitive load “, delay or loss of immediate memory.
Behavior and mood symptoms may include: a sense of irritability, anger, sadness, worry without provocation, impulsive display of emotions such as yelling, shouting, aggression, acting out of character and personality.
Concussion is determined by history and clinical examination.
The history must include the report of one’s exposure to an external force either from a sport contact, motor vehicle collision or rapid maneuver, fall, direct assault or even blast injury. One’s self report is often incomplete, delayed and initially inaccurate. A history provided by a witness, teammate, athletic trainer, coach, friend, family member is very supportive and helpful. A photo or video of the event may also be helpful to view.
The examination takes place in stages; at the event, following the event or in a medical office or emergency room.
At an athletic event, a coach or athletic trainer may evaluate you with a standard exam and question protocol (SCAT-3). Additional testing may include tests of balance (BESS,SWAY) and vision (KING- DEVICK, EYE-SYNC), and computerized attention, processing speed, working memory tests (AXON SPORTs COGSTATE, IMPACT, CNS VS), etc.
The physician examination includes the following; taking a full history and reading any reports from above, examining the head and neck for spine injury, general physical exam of heart, lungs, abdomen and extremities and a thorough NEUROLOGICAL EXAMINATION.
Observing eye movements ( pursuit and saccade ) while tracking a moving object or head turning motion while reading or identifying the point of convergence- fixation difference as a pattern is brought from far to near one’s eyes.
Observing eye movements while performing a graded attention task such as following a moving target while reciting alternating letters and numbers of the alphabet going forward.
Palpating the skull for a decreased balance-symmetry of “Cranial “ motion pattern - CRANIAL-SACRAL.
Treatment of concussion-mild brain injury involves three stages;
Physical and Cognitive rest for several days followed by graded exercise that stays below the threshold of increasing symptoms of concussion- see Buffalo Concussion Tredmill Test- BCTT.
Managing somatic symptoms with analgesic OTC meds including optimizing rest and sleep and headache. Managing transition to work or school with a GRADED RETURN TO PLAY/LEARN PROTOCOL.
Actively treating remaining symptoms with physical therapy, occupational and vestibular therapy, vision therapy, psychotherapy.