• Glenn Charbonneau, P.T.

Concussions Part I - Mild

Concussions, also known as mild traumatic brain injuries (mTBI), can be defined as an elaborate pathophysiologic process that affects the brain as a result of direct or indirect trauma, may or may not involve the loss of consciousness, and leads to temporary disturbances in brain function. Mild concussions can also lead to further complications such as post concussion syndrome. For a dive into post concussion syndrome, check back soon for part II.


** part II on concussions coming soon**

Background

Motor vehicle collisions are a leading cause of concussion, but may also be recognized through sports, falls, domestic violence and military services. Research has shown that some vehicle crashes can cause damage to the brain similar to that of impacts through the rear of a football helmet.

Of those who experience a concussion, 87% will be classified as mild. A mild concussion typically resolves within 7 to 10 days from the date of injury. Concussions that continue beyond the expected recovery time occurs for up to 30% of patients.


Signs and Symptoms


Concussions can adversely affect one or more aspects of our daily function, which may vary between physical, emotional, cognitive or sleep disturbances.


Physical: nausea, vomiting, fatigue, light sensitivity, balance problems

Cognitive: difficulty concentrating, forgetfulness, confusion, repeating questions

Emotional: sadness, irritability, anxiety

Sleep: difficulty falling asleep, sleeping less or more than usual, drowsiness



Management


The simple expression, “if in doubt, sit them out” is recommended for sports-related concussions, and should be recognized for motor vehicle collisions as well. Immediately following a suspected concussion, one should be accompanied by others for the first 2 hours after injury, avoid driving home and abstain from alcohol and recreational drugs.

Physical and cognitive rest is recommended for the first 24 to 48 hours following injury, before being gradually exposed to activity such as school, work and sports. Too much rest however has been associated with prolonged recovery. Rest may include the avoidance of work, school, driving, computers, video games, text messaging, television and social activities outside.


Return to play or activity is typically a symptom guided and graded process that involves 6 steps. Each step must be successfully completed by demonstrating absent symptoms for 24 hours before advancing onto the next, more challenging step.


1 - Rest   

2 - Light exercise

3 - Sport-related training

4 - Non-contact training and exercise

5 - Full contact permitted

6 - Return to play / activity


If you either suspect or have experienced a recent concussion, then following up with your medical doctor is important for the evaluation and management that is appropriate for you.




Sources


Craton, N. & Leslie, O. (2014). Is Rest the Best Intervention for Concussion? Lessons Learned from the Whiplash Model. American College of Sports Medicine, 13 (4), 201-204. DOI: 10.1249/JSR.0000000000000072


Dennis, J., Yengo-Kahn, A.M., Kirby, P., Solomon, G.S., Cox, N.J. & Zuckerman, S.L.(2019). Diagnostic Algorithms to Study Post-Concussion Syndrome using Electronic Health Records: Validating a Method to Capture an Important Patient Population. Journal of Neurotrauma. https://doi-org.ezproxy.library.ubc.ca/10.1089/neu.2018.5916


Elkin, B.S., Elliott, J.M. & Siegmund, G.P. (2016). Whiplash Injury or Concussion? A Possible Biomechanical Explanation for Concussion Symptoms in Some Individuals Following a Rear-End Collision. Journal of Orthopaedic & Sports Physical Therapy, 46 (10), 874–885 DOI: 10.2519/jospt.2016.7049


Kane, A.W., Diaz, D.S. & Moore, C. (2019). Physical Therapy Management of Adults with Mild Traumatic Brain Injury. Semin Speech Language, 40(1), 36-47. DOI: 10.1055/s-0038-1676652


Marklund, N., Bellander, B., Godbolt, A., Levin, H., McCrory, P. & Thelin, E.P. (2019). Treatments and rehabilitation in the acute and chronic state of traumatic brain injury. Journal of Internal Medicine. https://doi-org.ezproxy.library.ubc.ca/10.1111/joim.12900


Origenes, A.K., Alleva J.T. & Hudgins, H. (2019). Concussion rehabilitation/post concussion syndrome. Disease-a-Month, S0011-5029(19), 30034-3.

https://doi.org/10.1016/j.disamonth.2019.02.007Get rights and content


Schneider, K.J. (2019). Concussion part II: Rehabilitation – The need for a multifaceted approach. Musculoskeletal Science and Practice, S2468-7812(19), 30017-7.

https://doi.org/10.1016/j.msksp.2019.01.006


Quinn, D.K., Mayer, A.R., Master, C.L. & Fann, J.R. (2018). Prolonged Postconcussive Symptoms. The American Journal of Psychiatry, 75(2),103-111.

https://doi-org.ezproxy.library.ubc.ca/10.1176/appi.ajp.2017.17020235

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