concussion

16 February 2017

Concussion: What Kind of Rest is Needed?

A large study is questioning some of the common wisdom regarding treatment of concussion in children.

We’ve talked a lot in the past about concussion (which is a brain injury), especially related to sports injuries. Concussion needs to be taken seriously – it could result in ongoing symptoms. Recent recommendations include being very cautious of activities that could result in another concussion, and getting sufficient rest after the injury.

In particular, cognitive rest. That is, avoiding (for example) reading, homework, and video games. (For more, see the 2014 study Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms)

But while getting rest and avoiding activity with a risk of concussion seems to be the best, does that mean that the child or teen should lie in bed all day? Apparently not.

A study involving 3063 children and teens (up to the age of 18) compared patients who returned to physical activity (within 7 days) with those who were restricted to more “conservative” rest. The question – which group was experiencing more postconcussive symptoms at 28 days?

Postconcussive Symptoms in Children and Youth As you can see from the chart, those who went back to physical activity within 7 days were significantly less likely to have the unwanted symptoms.

Depending on who you talk to, there seem to be two dangers. First, keeping your child away from any physical activity seems to be a danger. Activity is all the more critical to growing children and teens – it can play an important part in their recovery. But the other danger remains – not taking the concussion seriously, and putting the child right back into the sport that caused the injury in the first place.

A slow and cautious return to low-risk physical activity, with limited brain-work for a while, seems to be the best advice.

For more on the study, see the abstract: Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. Also see Early return to physical activity after concussion may reduce post-concussive symptoms at the New York Headache Clinic.

11 July 2016

What causes the symptoms of a concussion?

James Discoveries & Stats, Information 2

Confusion, sensitivity to noise, drowsiness, headache – these are some of the symptoms that may occur minutes, or even days, after a concussion. But exactly what causes concussion symptoms?

Concussion is a type of brain injury usually caused by a blow to the head, although it can be caused by any whiplash-type motion, even if the head is never touched. This is another way to see that helmets protect the skull, but can never give 100% protection against concussion.

A concussion is not structural damage that can be seen in a typical CT or MRI scan. The damage actually goes down to the cellular level.

Brain tissue is very soft – think soft butter. When the brain tissue is pushed against the skull, or suddenly twisted, the brain cells themselves can twist and tear.

Cells are like little factories, with highly developed communication systems tying them together. When the little factory is damaged, a number of things can happen.

For example, important materials may “leak” out of the cell, no longer properly contained. Communication between cells may break down. Normal balance is lost. And those little factories go into high gear to try to get everything working again. They may start to produce more of certain things that your brain may have trouble dealing with, such as free radicals or inflammation.

Clean up Think of a city after a war, or riot. Bricks are lying everywhere. Normal communication is broken down. There may be looting. But hopefully most citizens are trying to get things back to normal. Meanwhile, nothing is normal. Buildings may not be recognized. Family members may not know where other family members are. There are gas leaks, fires, and broken pipes.

Sometimes things that should be helping can cause other problems – a fire hose causing flooding in a nearby room, police cars blocking roads.

Remember that this is all happening on a cellular level. It’s incredibly complex, and it’s not easy to see what’s going on from the outside, which is why it’s taking researchers so long to understand the details.

Usually, the brain regains its normal function within a couple of weeks. However, there may be parts of the injury that do not resolve. This can lead to long term problems, such as post concussion syndrome, or chronic traumatic encephalopathy (CTE), a condition occurring late in life in people who have had repeated brain trauma (such as people who played contact sports).

Though we still have a lot to learn about concussion, we’ve come a long way in the past few years. Understanding what is going on in the brain after a concussion is helping with the development of new treatments.

For example, if there are too many free radicals in the brain, could we use antioxidants (as a patch or oral supplement) to clean things up faster, and maybe avoid long term issues?

Meanwhile, if you get a concussion, see a doctor. Be sure to rest and stay away from computer screens and heavy mental activity for three days. Let your doctor know if new symptoms appear, or if some don’t go away.

More tips here: What Should You Do If You Think You Have Had a Concussion?

22 February 2016

A Better Way To Evaluate Concussions?

James Discoveries & Stats, News 0

A concussion is a form of brain damage. And the brain, as we all know, is a very complex piece of equipment. It’s not easy to tell how bad the damage is.

Some patients may seem fine to start with, but within weeks they may develop serious symptoms that could be with them for years to come.

Sometimes migraine symptoms will develop. But sometimes they won’t. Sometimes recovery will be fairly quick, sometimes not.

Typically, your doctor will give you a neurological examination, checking for vision problems, hearing problems, changed in your coordination or balance. If your doctor is concerned about some serious symptoms, either from the exam or from diagnosis of headaches or nausea, he may request some type of scan, such as a CT or MRI.

The MRI can assess white matter injury in the brain. A mean fractional anisotropy (FA) is one way to assess how much damage has been done. But because everyone’s brain is different to start with, the FA measure doesn’t always give reliable results.

Dr. Joseph Delic at the University of Pittsburgh Medical Center and his team investigated the value of another technique, known as Shannon entropy (SE) analysis, to see if it would give more accurate results. And in the opinion of the study authors, it does.

In fact, someone with a SE below a certain level were 16 times more likely to develop migraine from concussion. Also, the lower the SE the longer the recovery.

If doctors have access to a better way to assess patients with concussion, they will be better able to provide treatment over the long term, and avoid treatment that isn’t needed.

For more, read the information on the study from the Radiological Society of North America: Technique Helps Predict Likelihood of Migraines in Concussion Patients, and this article in ScienceDaily: Technique helps predict likelihood of migraines in concussion patients.

Also see: Is it Concussion or Migraine? and Concussion: Tests and diagnosis

29 October 2015

My Child was hit in the head – What should my doctor do?

James Information, Resources 0

After a blow to the head, it’s certainly wise to see the doctor. The blow could be from falling, from a sporting event, from a fight, from an accident – but whatever it was, it can result in brain damage and needs to be taken seriously.

Many organizations have a specific process that they want doctors to go through when seeing a patient who may have a concussion. An excellent example of this is the Concussion Algorithm from Hamilton Public Health Services in Hamilton, Canada.

You can download the one-page document for yourself using the link at the bottom of this article. But here are some highlights.

If there are certain red flags after or even before an examination, the patient is advised to go to the emergency department immediately. Red flags include loss of consciousness, slurred speech, or ongoing vomiting.

If the red flags aren’t present, but there are other symptoms (such as headache, dizziness, irritability, or sleeplessness), doctors need to check for factors which may predetermine the patient to more serious problems. These issues will help doctors decide how much rest/recovery time the patient needs.

If no symptoms are present, patient may return to normal activities (with caution, I would add. Symptoms may show up later, or another blow to the head may make matters worse.).

It’s worth your time to have a document like this handy, particularly if your child is heavily involved in sports, so that you and your child will know what to expect.

Concussions can be very serious, and can lead to lifelong problems. Taking them seriously right from the start is vital to your child’s health.

To pick up the document, see Concussion Algorithm [Important: Original link no longer available. This is an archives link.]. If you’re actually in the Hamilton area, you’ll notice that there is a second page with emergency numbers and addresses.

12 September 2014

Football Helmets and Sports Concussion

James Information, News, Resources, Tips 0

The debate about concussion in sports continues to heat up. Recently FIFA’s medical committee chairman, Michel Dâ€™Hooghe, recommended that games be stopped for three minutes so that players could be properly assessed for brain injury (that is, concussion). Meanwhile, Will Smith and Gugu Mbatha-Raw are set to star in a new movie about concussion in the NFL.

The controversy about football helmets isn’t over either. On the one hand, some studies seem to show that helmets can protect players from concussion to some extent, while some experts claim that the protection is minimal to none.

Virginia Tech has come up with a five star rating system for helmets, based on testing both on the field and in the lab. Certain helmets, such as the Schutt AiR XP Pro VTD and Riddell 360, for example, far out-performed the Schutt Air XP Ultralite and Riddell Revolution IQ.

To see the ratings, visit Adult Football Helmet Ratings – May 2014.

Although ratings are helpful, players need to know one thing above all the controversy and hype. If you’re playing a contact sport, especially sports like American football, hockey or rugby but including sports like football/soccer and basketball, you’re in danger of brain injury. Even if you buy the best protection, it won’t protect you anywhere close to 100% from concussion.

Does that mean don’t play the sport? Not necessarily, but it does mean that you can’t keep your brain from banging against the side of your skull using a helmet. That’s why there is a call for proper assessment of injuries, the need to visit a doctor or specialist, the need to get out of the game when there is an injury, and to think carefully before you put yourself in danger again.

There are also movements for better training on how to tackle, and better rules to protect players. (See the ideas from one specialist here)

The bottom line? Get the best helmet you can, but don’t trust it to protect you from concussion, a brain injury which can have consequences for years ahead.

For more thoughts, see this recent news report (video and article): High school football helmets tested for concussion risk See also this article on Head sports trauma