Concussion Chart (pdf file)
Getting the "Heads Up" On Concussion
Pretend that the following are two ‘true or false’ statements on a pop-quiz about concussions: 1) “Concussion symptoms are at their worst immediately after the occurrence of the injury.” 2) “Asking a person who was hit in the head to state his or her name or telephone number immediately after the injury is helpful information.” Do you know whether these statements are true or false? You would if you came to the educational talk hosted by Headway of Western New York titled, “Put Me In Coach” on April 17th 2007 presented by Dr. Barry Willer, co-developer of the Concussion Clinic at the University at Buffalo. These statements are common false beliefs about concussions, so you are not alone if you incorrectly answered ‘true’. We hear about concussions in sports all of the time, but the truth is that not too many people know much about them. Up until recently the common reaction to a concussion was to “shake it off and get back in the game”. While this outdated perception of concussion still remains for some, others are changing their attitudes as they become more aware of the potential dangers of concussion.
Headway, a support and advocacy agency for people with brain injuries in Western New York, is dedicated to providing information to the public about injuries that result in trauma to the brain. They know that concussions are often overlooked and are a major concern, especially for dedicated young athletes who would do anything to stay in the game. Tim Connelly’s recent concussion and the unfortunate suicide of Andre Waters, who played defensive back for the Eagles and Cardinals, spurred a lot of questions about concussion. Are concussions something to worry about? Can there be long-term or cumulative effects from a concussion? Some parents, coaches, and athletes were part of the audience who attended the “Put Me In Coach” talk hosted by Headway. These people took the initiative to empower themselves by choosing to learn more about this fairly common, yet somewhat elusive and misunderstood sports injury.
Those who attended the talk were completely engaged as Dr. Willer shared his knowledge about concussions with the audience. Many recognized Dr. Willer’s name from the media, as he was instrumental in the design of the promising new treatment program for post-concussion syndrome that appeared to be helpful in returning Sabres’ Tim Connelly back to the ice. Needless to say, everyone wanted to hear what Dr. Willer had to say about concussion.
Dr. Willer began his talk by saying that most concussions occur as a result of the head crashing into something stationary, rather than a moving object hitting into a person’s head. In other words, an athlete is more likely to get a concussion from a fall that caused the player to hit his or her head on the ground, rather than being concussed from an elbow to the head. Basic physics tells us that an object in motion stays in motion. The same concept applies to our brain. The brain is encased in fluid inside our skulls, creating some space between the brain and the skull. So when the moving head comes to an abrupt halt, the brain continues to move until it hits the inside of the skull. The brain will then bounce from one side of the skull to the other, causing some kind of bruising to multiple areas of the brain. The significance of this is that concussions can still occur even when a helmet is worn. This should not diminish the importance of a helmet, as it minimizes the blow and protects the skull from actual fractures.
Dr. Willer defined a concussion as an alteration in awareness or consciousness as a result of a blow to the head. He explained that when your head has been hit, the impact alters the chemistry of your brain and triggers metabolic changes that affect the entire body. These chemical and metabolic changes set in gradually over time, possibly resulting in the delay of some symptoms. This is important for several reasons. One reason is that it can create a false sense of security. If an athlete is assessed immediately after an injury, they may appear to be alright and allowed to return to the game. This is a problem since symptoms might not actually start to set in until minutes after the accidents. Now the person is back in the game, not performing up to par, and at risk for further injury. Dr. Willer stressed the importance of checking the concussed person 15 minutes after the injury, not just immediately afterwards. Symptoms often include confusion, poor concentration, headaches, dizziness, nausea, balance and coordination problems, and almost always some type of memory loss. The best way to identify if someone has a concussion is by asking them a series of questions about what the person remembers. A concussed person has difficulty with new or recent memories, not old memories like their name or telephone numbers. Therefore they should be asked where they are, what the score of the game is, what the last play was, or how the injury happened. Their ability to form new memories can be tested by giving them a few unrelated words to remember, distracting them, and later asking them to recall the three words. The other reason metabolic changes are significant is the way that the body will metabolize medications. If the person wants to take something for a headache, the use of medicine like ibuprofen should be used cautiously since the rate of metabolism will be unpredictable due to the concussion. Furthermore, aspirin which thins the blood should never be taken after a concussion.
A person who experiences a concussion should be monitored closely over the next several days for symptoms that might get worse. Dr. Willer reported that contrary to popular belief, do not wake the person with the concussion up several times a night or prevent them from going to sleep. However, if the person is more difficult to wake up than usual, then further medical attention should be sought. The good news is that 95% of concussions resolve themselves. To date, the immediate treatment for concussions is REST. With rest, most symptoms will disappear over the course of a few days. However, this does not mean that the athlete should just go full steam ahead and jump right back into the game. The resolution of symptoms can be deceiving since the brain has still not recovered from the chemical changes that have occurred. This is why when a concussed person returns to exercise they often find that their symptoms re-appear. The brain has not yet healed and the person is not ready for rigorous activity. If a person gets back in the game too soon the player will be at risk for further injury. Any blow to the head that is significant enough can cause a concussion, even if the person does not lose consciousness. While one concussion alone is usually benign to an athlete’s health, multiple concussions have cumulative cognitive, psychological and emotional consequences that can become more permanent.
Although most concussions are transient, some are severe enough to cause lingering symptoms, or more permanent changes. When symptoms last for several weeks or months it is classified as post-concussion syndrome. People who cannot get relief from the symptoms, especially athletes who aren’t able to train without consequence, often become depressed. Common practice by most physicians is to tell the concussed person not to exercise until their symptoms are completely gone. Meanwhile the athlete is becoming de-conditioned and feelings of depression are compounded. Eventually the person begins to withdraw from their normal activities and may feel as if things will never return to normal for them. Dr. Willer and his colleagues go against the grain and do not share the opinion that athletes with post-concussion syndrome shouldn’t exercise at all. Once symptoms linger long enough to be considered post-concussion syndrome, it becomes less likely that those symptoms will resolve on their own. The body and the brain need to be re-trained how to exercise without consequences of headache, nauseau or other physiological symptoms. Dr. Willer and colleagues believe this could be done by determining the athlete’s threshold, or how much exercise it takes to bring on symptoms, and then having the athlete train just below this threshold. Over time, the body gets used to the exercise, and is gradually able to tolerate more activity. The next time the individual is assessed, they usually find that their threshold has increased, and they are able to exercise a little harder and a little longer. This continues until the athlete can exercise at their full capacity symptom-free.
Dr. Willer wrapped up the evening’s talk by saying that most concussions are not problematic if managed properly. The biggest concerns are proper assessments, recognition that symptoms may be delayed, rest and monitoring of symptoms, gradual return to play, and avoiding multiple concussions. New information is being learned all of the time about concussion. If you have had a concussion or know someone who has and would like more information, please contact Headway of Western New York at (716) 629-3636 or the Concussion Clinic at UB at (716) 829-2070.