What is a Concussion?

Written by Dr. Christopher LaRocque

We are all aware of the term concussion and its relationship to head trauma. Whether the trauma occurs from an accident around the home, in the work place, during recreational or competitive sport, or a car accident it is important to be able to recognize signs and symptoms of a concussion.

A concussion is…

“A complex pathophysiological process affecting the brain, induced by biomechanical forces”.  (Zurich 2012)

“A traumatically induced disturbance of brain function and involves a complex pathophysiological process. Concussion is a subset of mild traumatic brain injury which is generally self-limited and at the less-severe end of the brain injury spectrum”.  (American Medical Society for Sports Medicine)

A common misconception about concussions is that you have to experience loss of consciousness: this is of course false, as is relying solely on conventional neuro-imaging techniques such as MRI and CT scans that often don’t show detectable injuries suggesting a more functional than structural disturbance.

If we can’t identify a concussion with the presence or absence of consciousness nor rely on special imaging techniques what are the indicative signs and symptoms we can expect?

Unfortunately, there are numerous signs and symptoms associated with concussions and mild traumatic brain injuries. A suspected concussion may include a combination of the following symptoms:

Cognitive	Emotional	Somatic	Sleep Disturbance
Confusion	Depression	Headache	Insomnia
Difficulty remembering	Anxiety	Fatigue	Hypersomnia
Slurred Speech	Nervousness	Nausea and vomiting
Loss of Consciousness	Irritability	Dizziness
Difficulty thinking		Balance difficulties
Difficulty concentrating		Paresthesia
		Light/noise sensitivity
		Seizures
		Blurred Vision

Concussion Management:

When an individual presents with signs of a concussion they should be evaluated by a physician as soon as possible. A SCAT3, Impact, Axon, or other concussion assessment/outcome measurement tool should be administered and the individual should not be left alone following immediate head trauma as monitoring for deterioration is critical.

Concussion injuries result in the rapid onset of short-lived neurological impairment that usually resolves spontaneously within 7 to 10 days. Individuals with migraine type symptoms during post concussion exhibit a longer recovery time than with individuals with headache only.

Initially the patient will require physical and cognitive rest until the acute symptoms resolve. Next, they should be put through a progressive exertion program until they are able to return to their pre-concussive state of activity without symptoms. Each step requires an asymptomatic period of 24 hours post exertion.

The program takes approximately one week if no symptoms arise. If symptoms become present the patient should regress to the previous level of asymptomatic exertion and start the program again after a 24 hour rest period.

An example of an exertion program for a return to”play” status for a sports related concussion:

1. No Activity

2. Light aerobic activity

3. Sport – specific exercise

4. Non-contact training drills (more complex drills involving increased coordination & cognitive load)

5. Full-contact practice

6. Return to play

** can be related to work/daily activities

Anyone that has experienced a head injury followed by any combination of the signs and symptoms listed above should consult their medical provider and seek interdisciplinary care from any of the following: General practitioner, Psychologist, Optometrist, Neurologist-Headache specialist, Neuropsychologist, Chiropractor, Physiotherapist.

Take Home Message:

– Concussions are complex

– Multiple signs and symptoms will present (be aware of them)

– Direct patient to immediate medical attention.

– Monitor individual for several hours for any signs of deterioration.

– A suspected concussion should not return to work or play on day of injury

– Physical and cognitive rest is recommended until symptoms resolve

References:

McCrory et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. (2013).

Baker JG et al. “Return to full functioning after graded exercise assessment and progressive exercise treatment of post concussive syndrome.” Rehabilitation Research and Practice (2012); 705309

Signoretti et al. The pathophysiology of concussion. American Academy of Physical Medicine and Rehabilitation. (2011).

J J, Leddy, H. Sandhu, V. Vikram, J. G. Baker, B. Willer. (2012) Rehabilitation of Concussion and Post-concussion Syndrome. Sports Health. 4 (2). 147.

Cantu, R. C. (2001). Classification and clinical management of concussion. Neurological Sports Medicine: A Guide for Physicians and Athletic Trainers. Park Ridge, AANS, 25-33.