Signs and symptoms of concussionsJune 6, 2019
Concussions seem to be the hot topic these days due to all the research that has come out as to how serious they actually are. In the past, people would quickly brush off a hit to the head and would have returned to their sport immediately. With all the studies that have been published, though, we finally understand the magnitude and seriousness of concussions, and more importantly their potential long-term effects.
What is a Concussion?
Concussions occur when you hit your head on something hard enough that your brain moves within the skull and physically bumps into the side of it. Your brain sits in fluid within your head, which helps to protect it while moving around, however extreme forces will not always prevent the brain from accelerating too far forward or backward and hitting the skull. Often times, only the front or the back of the brain hits, but a fall hard enough can actually force the brain to hit the front part of the skill, and then bounce back to also hit the back part.
Concussions are actually a subcategory of a traumatic brain injury, and although 80-90% of them resolve within 7-10 days, improperly managed concussion can lead to long-term cognitive deficits and mental health problems. When someone has sustained a concussion, there is an alteration in the function of their brain rather than a structural one. The problem is that since you are unable to physically see the damage that has occurred, most people do not feel it is as serious as a broken bone or torn ligament. The presentation of a concussion can vary greatly, from significant changes in balance to less obvious changes such as increased fatigue. It is also common for neurological, behavioral, physical and/or cognitive symptoms to be present. It is important to note that symptoms can appear instantly at the time of the incident, or some minutes or hours after the event. Symptoms that typically present with a concussion include:
- Dizziness/ balance difficulties
- Noise sensitivity
- Concentration difficulties (feeling “foggy”)
- Memory difficulties
- Sleep disturbances/ fatigue
- Change in mood/ depression/ anxiety
If symptoms do last longer than 7-10 days, an individual then has Post-Concussion Syndrome. At this point, symptoms can continue to last for weeks to months, but generally resolve fully within 3 months. It is unknown exactly why symptoms last longer in some individuals compared to others, but it has been noted that severity increases with each subsequent concussion one person sustains.
Management of Concussions
As soon as an individual shows signs of a concussion, certain steps should be taken to ensure their safety. First, the individual should be evaluated by a healthcare professional to assess symptoms, cognitive (brain) function, cranial nerves, and balance. Next, an assessment tool should be used on the individual to objectively determine the patient’s status. Finally, the individual should not be left alone immediately following the injury and monitoring of any changes in symptoms should be done for the first few hours after injury.
After the immediate injury has been assessed, management of a concussion is mainly done through physical and cognitive rest. During this time of recovery, people should take time off of their sports and recreational activity and limit how much time they spend focusing on reading, computer tasks, homework, etc. As mentioned earlier, symptoms usually resolve within 7-10 days, but if they seem to be prolonged, an individual may be sent to physical therapy to help resolve some of the symptoms. A physical therapist can provide specific exercises that help to decrease symptoms of dizziness, restore function within work, school, sports, and increase exercise or activity tolerance. These exercises are usually given in a graded fashion, where they start out easy (ex: focusing on a task in a quiet, empty room) and progressively become harder (ex: focusing on a moving object, while turning head, in a crowded room). These exercises will help provide symptom relief in a controlled manner, and the physical therapist will be able to re-assess signs and symptoms on a consistent basis. Finally, a physical therapist can work with you to implement a safe return-to-sport program. After symptoms have decreased, the physical therapist will determine when you may begin performing light aerobic exercises. If no symptoms persist after this initial stage, then you will be able to progress onto sport-specific exercises, followed by non-contact training drills, full contact practice, and finally return to play. At each level of this program, the PT will be able to work with you and decide when it is safe to move onto the next step. For more information on physical therapy services go to www.totalperformancept.com.