Concussions

 Concussion refers to a traumatic brain injury caused by intensive shaking of the head and upper body or a blow to the head. Concussion occurs as a result of gentle blow to the head, either with or without loss of sense of awareness. This sometimes can lead to temporary cognitive symptoms such as confusion, headache, memory loss, lack of coordination, ringing in the ears, vomiting, nausea, sleepiness, excessive fatigue and dizziness. The most common cause of concussion are falls but also they are common if one plays a contact sport, such as soccer or football. But the good news is, most people usually recover fully after a concussion. Since there is no exact cure for concussion, rest and restriction of activities allow the brain to recover (Schneider 5) This implies that one should temporarily reduce time spent on video games, television, sports, or extreme socializing. Ondansetron, medication for headache pain or other anti-nausea medication can be used for symptoms.

How Can One Detect if She/he Has Concussion?

The signs and symptoms of a concussion at times may not be easily understood and may not show up instantly. Therefore, concussion symptoms can last for days, weeks and even longer. People who have concussion always report a short period of amnesia or loss of remembrance, whereby they cannot remember what happened right before or after the injury. At times, they may act puzzled, in a state of shock or portray “seeing stars.” If athletic trainers and individuals trained to medically stabilize victims of trauma suppose a person is suffering from a concussion, they may ask the victim if they know their name, what month or year it is and where they are. Brain injury professionals and neurosurgeons usually stress that although some concussions may seem to be less serious than others, there should be no such thing of minor concussion. Therefore, in most situations, minor concussion should not cause permanent damage. It is advisable that, a second concussion soon after the first one should not be very strong since its impacts are permanently disabling.

Physical Symptoms of Concussion

Physical symptoms of concussion are: headache, memory loss, dizziness/imbalance, ringing ears, nausea/vomiting, confusion, vision disturbances i.e. blurred vision, difficulty in concentrating, loss of smell or test, trouble falling asleep and sensitivity to light.

An individual can identify these signs and symptoms in the person with concussion:

• Slurred speech
• Delayed response to questions
• Temporary loss of awareness (though this doesn’t often occur)
• The quality of being forgetful i.e. keeping asking the same question

Signs and Symptoms in Children

Head injury is mutual in young children although concussions can be very hard to detect in infants and toddlers since they can’t be able to explain how they feel. Concussion indicators can be: lack of interest in favorite toys, excessive crying, dazed appearance, loss of balance and unsteady walking, change in sleeping and eating patterns, vomiting or upset stomach, irritability and crankiness, sensitivity to light or noise, listlessness and tiring easily, and problems with memory, concentration and focus.

Types of Concussions

Brain injury experts rank or grade seriousness of concussions based on loss of consciousness, loss of balance and loss of memory (amnesia). Therefore, there are only three grades and they include:

• Grade 1: Gentle, with symptoms that last less than 15 minutes and involve no loss of consciousness
• Grade 2: Moderate, with symptoms that last more than 15 minutes and involve no loss of consciousness
• Grade 3: Intense, in which the individual loses consciousness, sometimes for just a few seconds

Causes of Concussion

Human brain has a uniformity of gelatin which is protected against any shock by cerebrospinal fluid situated inside human skull. Any violent blow to someone’s head or upper body, can lead to the sliding of the brain back and forth forcefully against the inner walls of the skull. Abrupt acceleration or deceleration of the head, caused by activities such as a car crash or being violently shaken, also cause concussion. These kind of injuries affect the function of the brain, generally for a short period, resulting in signs and symptoms of concussion. Sometimes, these brain injuries may cause bleeding in or around human brain, leading to symptoms such as prolonged drowsiness and disarray which may develop later or immediately. Such breeding in human brain may be fatal hence, an individual who experiences a brain injury needs monitoring afterwards and emergency care if symptoms become severe.

Risk Factors

This refers to activities and factors that may increase the risk of concussion and they include:

• Involvement in a motor vehicle collision
• Involvement in a pedestrian or bicycle accident
• A soldier involved a combat
• Having had a previous concussion
• Falling, especially in older adults and young children
• Participation in high-risk sports, such as football, hockey, boxing, rugby or other contact sport
• Being a victim of physical abuse

Complications

Following a concussion, some individuals may suffer continued symptoms, such as mood swings, memory and concentration, personality changes, dizziness, fatigue, headache, insomnia and excessive drowsiness for many weeks to months. This is referred to as post-concussive syndrome. Individuals with post-concussive syndrome should limit activities that expose them to risk of repeated concussion (Polinder 7-10). Athletes should not go back to play while experiencing these symptoms and those who suffer continued concussions, should consider ending participation in the sport. Second-impact syndrome results from acute and frequent fatal brain swelling that occurs when a second concussion is held before complete recovery from a previous concussion. This effect at times may cause vascular congestion and increased intracranial pressure which can occur intensively and may be impossible to control (Ellis 45-49). The risk of second-impact syndrome is more in sports like football, boxing, ice or roller hockey, baseball, soccer, skiing and basketball. According to reports, an average of 1.5 deaths per year from sports concussions occur.  

 

Concussion Diagnosis

Most patients with concussions fully recover when put under appropriate treatment. But since a concussion can be serious, protecting oneself is very crucial. Here are a steps to follow:

Seek medical attention. A health care expert can determine how serious the concussion is and whether one has to undergo treatment.

If an individual has grade 1 or grade 2 concussion, wait until symptoms are gone before resuming to normal activities. It can take several minutes, hours, days, or even a week.

If an individual has lost consciousness, which is grade 3 concussion, it needs a doctor’s instant evaluation and care. Doctors will always ask the patient how the head injury happened and then discuss the symptoms. The doctor may also ask an individual simple questions such as “What is your name?”, “Where do you live?”, or “What is the name of your father?”. The doctor usually asks these questions to examine memory and concentration skills.

The doctor may examine coordination and reflexes, which are the functions of the central nervous system. The doctor may also order a CT scan or an MRI to make decision on breeding or other serious brain injury.

Concussion Treatment and Home Remedy

Concussion symptoms can affect individuals in many ways, involving balance, vision and even mood. In the past, the quality treatment for concussion was to have plenty of rest, but the recent approaches involve therapy to target specific symptoms. Existence of clinics help to determine the most affected brain system and appropriate therapy for a given symptomology. If one doesn’t need hospitalization, he/she has to be given instructions to follow by the doctor. Professionals recommend a follow-up for medical attention within 24 to 72 hours if symptoms become severe. In order to recover from home, one should: 

• Have a break: If one’s concussion was held during an athletic activity, he/she should stop to play and rest. Brain always needs time to properly recover, so rest is important. It is advisable to monitor closely athletes and children through coaches upon resuming to play. If one resumes to play before recovering fully, it is very risk to have a second concussion which can later cause damage. The American Academy of Neurology has given guidelines about resuming activities after concussion.
• Protection against repeat concussions: Repeat concussions lead to cumulative impacts on the brain. Successive concussions can have severe consequences which include brain swelling, long-term disabilities, permanent brain damage and even death. One should not return to normal activities if the symptoms persist.
• Treat concussion with aspirin-free medication: A doctor will prescribe a medication to ease the pain or suggest an over-the-counter option.

 Concussion Prevention

A concussion is something unexpected, so it is sometimes difficult to control. But there are several common measures one can take to lessen the probability of violent brain injury.

• Wearing protective gears: Participation in high-risk sports like rugby, football, hockey, and boxing can increase the possibility of a concussion. Hoarse-back riding, skateboarding, snowboarding, and rollerblading are also a threat to the health of the brain. Wearing eye and mouth guards, headgear and padding can help to protect an individual against violent head injuries (Rowson, Bethany, and Stefan 1,2). Also wearing a bike helmet can lower the chances of having violent head injuries by approximately 85%. There is also introduction of a C-shaped collar like device known as Q-collar which can be worn by athletes. It applies compressive pressure to the neck and increases blood capacity to help reduce movement of the brain, which may occur as a result of hits to the head. It is advisory to wear an equipment that fits you correctly and which is well-maintained.
• Never fight: Many concussions are always sustained during assault, and statistics show that more men compared to women report traumatic brain injury.
• Buckle your sit belt: Wearing a sit belt at times prevent serious injury, involving head injury, during a traffic accident.
• Protect your children: To lessen the risk of head injuries to your children, block off the stair ways, install window guards and make sure the home is well-lighted.
• Do exercise often: This gives an individual stronger leg muscles and better balance, which limits stave off falls.
• Educate others about concussions: Educating parents, coaches, athletes and other individuals about concussions, can assist in the spread of awareness. Parents and coaches can also assist in encouraging good sportsmanship.

Impact of Concussion on Football Players and Young Players

In recent, we know more about what happens in the brain during a concussion and as well, we know that an athlete who sustains one concussion is 4-6 times more likely to sustain another. Many players return to play before recovering or don’t display their concussion symptoms at all (Ellis 2-5). In the process of doing this, they put themselves into risk for more severe injuries in which its impact is possibly deadly second impact syndrome (SIS). Returning to play before recovering also increases the risk of developing symptoms that do not fade away quickly or do not fade away at all without treatment and this condition is referred to as post-concussion syndrome. Players should learn about the signs of post-concussion syndrome and seek treatment as soon as possible if their concussion symptoms continue.

Common Causes of Football Concussions

The most common source of football concussions that we usually observe in our clinics are from helmet-to-helmet contact in blocking and tackling and from head-to-ground impacts. It is very crucial to remember, however, that an individual can suffer a concussion from being hit very hard.

NFL and College Football

During the period of 2012-2019, the National Football League (NFL) Injury Data displayed that an average of 242 NFL players sustained concussions annually. Some statistics declare that about 10% of all college players experience brain injury every playing season. A recent research of brains gotten from former deceased football players found CTE in 99% of the brains of NFL players, in 88% of Canadian Football League players, and in 91% of college football players. Athletes who manage to reach this level of the game, have been playing football and sustaining impacts for several years and are thus at high risk of developing CTE.

High School Football

Statistics display that about 20% of all high school football players experience brain injury every football season and that football is accountable for more than 60% of the concussions in high school sports (Kerr 28,29). The players that sustain the highest percentage of concussions in defensive positions are line backers, and in offensive positions, running backs.

Youth Football

There have been very few studies about youth football player concussions. However, many parents and medical experts question the safety of tackle football in this age group. One small research got that children as young as 7 and 8 years old can experience high impact collision during the game. Researchers measured impacts of more than 40 times the force of gravity on these players by the use of sensors whereby majority of these impacts occurred during practice. These players experienced more impacts to the sides of their helmets, usually from hitting the ground after being tackled. It is crucial to note that children usually have weaker neck muscles compared to teens and adults hence, these put them at risk for concussions caused by rotational force.

Managing Concussions: The NFL Protocol

Since each player and each concussion is unique in away, there is no set timeframe for healing and return to play under the NFL’s current procedures. But if a player is diagnosed with a concussion, the protocol advocates for a minimum of daily monitoring (Ellenbogen 2). The player’s previous concussion exposure, medical and family history are reflected on hence creating a clear picture of his health. The protocol moves forward through a series of steps and only if all activities in the current step are dealt with fully limiting recurrence of symptoms. Communication between the medical officer and the player is very important. The first protocol step is rest. In the course of this period, the main aim is to avoid physical exertion whereby the player has to avoid social media, electronics and even team meetings until he has fully recovered.

The next step introduces light aerobic exercise, which takes place under direct monitoring of the team’s medical staff. If aerobics work efficiently, the team physician will reintroduce strength training (Leddy 9). The fourth step involves some non-contact football-specific activities, and the fifth step involves clearance to resume into participation. The fifth step only comes after neurocognitive testing remain at baseline and there is no recurrence of signs and symptoms of concussion. The player has a final examination by the INC assigned to his team after he is fully been given a final clearance by the team physician. As part of this examination, the INC will review all reports and tests documented along the period of the player’s recovery. Once the INC comes into agreement with the conclusion of the team’s physician, the player is cleared and is fit to return to full participation. NFL protocol allows players to recover at their individual rate, involve the experts of both the team physicians and a neurological consultant.  Lastly, the protocol involves an assessment of not only the most recent concussion, but also takes into account the medical background of the player.

 

 

Works Cited

“Neurocognitive and Psychiatric Symptoms Following Mild Traumatic Brain Injury.” Translational Research in Traumatic Brain Injury, 2016, pp. 402–417., doi:10.1201/b18959-24.

Dacosta, A, et al. “A - 48Baseline Symptoms from the Sports Concussion Assessment Tool (SCAT) Predict Concussion Recovery Time in Collegiate Athletes.” Archives of Clinical Neuropsychology, vol. 33, no. 6, 2018, pp. 703–794., doi:10.1093/arclin/acy061.48.

Ellenbogen, Richard G, et al. “National Football League Head, Neck and Spine Committee’s Concussion Diagnosis and Management Protocol: 2017-18 Season.” British Journal of Sports Medicine, vol. 52, no. 14, 2018, pp. 894–902., doi:10.1136/bjsports-2018-099203.

Ellis, Michael J., et al. “A Physiological Approach to Assessment and Rehabilitation of Acute Concussion in Collegiate and Professional Athletes.” Frontiers in Neurology, vol. 9, 2018, doi:10.3389/fneur.2018.01115.

Kerr, Zachary Y., et al. “Concussion Incidence and Trends in 20 High School Sports.” Pediatrics, vol. 144, no. 5, 2019, doi:10.1542/peds.2019-2180.

Leddy, John J., et al. “A Preliminary Study of the Effect of Early Aerobic Exercise Treatment for Sport-Related Concussion in Males.” Clinical Journal of Sport Medicine, vol. 29, no. 5, 2019, pp. 353–360., doi:10.1097/jsm.0000000000000663.

Polinder, Suzanne, et al. “A Multidimensional Approach to Post-Concussion Symptoms in Mild Traumatic Brain Injury.” Frontiers in Neurology, vol. 9, 2018, doi:10.3389/fneur.2018.01113.

Rowson, Bethany, and Stefan M. Duma. “A Review of On-Field Investigations into the Biomechanics of Concussion in Football and Translation to Head Injury Mitigation Strategies.” Annals of Biomedical Engineering, vol. 48, no. 12, 2020, pp. 2734–2750., doi:10.1007/s10439-020-02684-w.

Schneider, Kathryn J, et al. “Rest and Treatment/Rehabilitation Following Sport-Related Concussion: a Systematic Review.” British Journal of Sports Medicine, vol. 51, no. 12, 2017, pp. 930–934., doi:10.1136/bjsports-2016-097475.

Thomas, Elizabeth, et al. “Post-Concussion States: How Do We Improve Our Patients’ Outcomes? An Australian Perspective.” Journal of Concussion, vol. 4, 2020, p. 205970022096031., doi:10.1177/2059700220960313.