- - Tuesday, October 18, 2016

Head injuries and concussions continue to ignite a fire storm among the public — and for good reason. High school athletes sustain an estimated 300,000 concussions per year and, recently, National Football League Commissioner, Roger Goodell announced an initiative intended to increase the safety of the game, specifically by preventing, diagnosing and treating concussions and head injuries.

And, today, the numbers of head injuries and concussions have been increasing — a trend that underscores a need for better safety education. We need to develop a watchful eye and keen understanding about how they happen, how they can be prevented and treated, and what is known about their long-term impact – and multiple impact. It is a fact that concussions can have significant consequences in terms of cognitive function and brain development.

There is a much needed call to arms over concussions with the goal of public awareness of what a concussion is — and to encourage the prompt, proper assessment and care from a specialist (research shows that half who sustain a concussion are never seen by a clinician). We all need to gain a greater awareness about concussions and their potential risks – and proper care actions.

Dr. Nina’s What You Need To Know: About Concussions, Awareness, and Treatment

What is a concussion? A type of traumatic brain injury—or TBI—where the brain gets shaken, jarred, bounced, or twisted against a hard skull. This can result in damage to brain cells and connective tissue, as well as metabolic changes (shifts in electrolytes, blood flow, and neurotransmitters, and an increase in toxins).

Concussions can occur when there is a direct blow to the head or body, a fall, or other injury that results in the brain being moved rapidly back and forth.

Do you have to pass out for it to be a concussion?

No. While many associate a temporary loss of consciousness, most people who have a concussion do not pass out. For some, the only sign may be dizziness.

Should I get medical care?

Because a concussion affects the brain, an injured person may lack the clear judgment to make an informed decision regarding whether or not to go to the hospital. Family and friends can be instrumental in urging them to seek medical attention. Remember, when in doubt, check it out! Depending on your symptoms, your age, and the severity of the injury, the emergency room physician may order some tests. The sooner someone is diagnosed, the better the chances for a good recovery.

How is a concussion treated?

Too often people (of all ages) may try to power through but research shows it is important to seek professional help to access and “watch”

Rest allows the brain the opportunity to heal. This includes limiting school or work schedules, and getting the proper quantity and good quality of sleep

Limiting technology—emails, texting, and watching television

Avoid contact sports and other risk activities that can result in another concussion— biking, climbing, horseback riding, and skateboarding (to mention a few) until the signs of the concussion have resolved.

Avoid alcohol

Starting light activity and resuming intellectual and social activities are an important part of healing and should be reintroduced gradually.

What is post-concussive syndrome (PCS)?

The majority of people recover from symptoms experienced at the time of the injury. These typically involve confusion, headache, and a loss of memory of the event that caused the concussion. However, some develop symptoms that last for several days, weeks, and months, and possibly even longer. This is known as post-concussive syndrome (PCS).

There is still a lot that is unknown about PCS. Even the diagnostic criteria vary regarding the specifics. However, what experts do agree on is that post-concussive syndrome (PCS) is the onset of neuropsychological symptoms typically within 7 to 10 days after a head trauma. According to the Centers for Disease Control and Prevention (CDC), symptoms typically include:

• Emotional: anxiety, irritability, labile mood, depression

• Physical or Somatic: headaches, visual problems, dizziness, noise/light sensitivity, nausea

• Sleep disturbances

• Thinking or Cognitive: difficulty with concentration, memory issues, decreased processing speed, fatigue

The severity of symptoms varies greatly—mild, moderate, severe—and recognizing them may be difficult and even missed. And, research suggests that the risk of developing PCS does not appear to be related to the severity of the head injury. However, there does appear to be a greater risk with increasing age, a history of prior concussion, and in women. Of note, the gender discrepancy may be because women are more likely than men to attain medical care.

Research shows that most cases of PCS resolve within 3 months but there are some where symptoms last longer, known as persistent post-concussive symptoms (PPCS).

How is post-concussive syndrome diagnosed?

With a thorough neuropsychological examination, often performed by a neurologist, a doctor specializing in the brain and nervous system. In addition to attaining a history of the injury, your doctor will also get a thorough history of any illnesses, medications, family and social history, and will perform a physical examination with a focused neurological exam.

Depending on the findings, he or she may order further testing such as an MRI of the brain, or neuropsychological testing which can pick up subtle signs or symptoms that are not immediately obvious. This sort of testing also allows for a baseline to then determine if there is improvement with treatment and time.

How is post-concussive syndrome treated?

Research shows that psychological support can help to minimize depression, anxiety, and demoralization. And when appropriate, behavioral modification (e.g., improving sleep hygiene), cognitive rehabilitation (e.g., techniques to improve concentration), and social services may be needed.

Many people ignore their symptoms – and especially young athletes who sustain a concussion (because they do not want to risk losing “playing” or a “starting” position). It is important that we don’t “just try to power through.” We all need to realize that doing this puts us at an increased risk for developing chronic traumatic encephalopathy (commonly referred to as CTE) or second impact syndrome, two degenerative diseases of the brain.

Continuing to play a sport despite a concussion doubles recovery time for athletes and leads to worse short-term mental function than in those immediately removed from action, a study found. This calls for players to heed the warning to avoid “return-to-play.” More than ever before, we know how important safety is for ensuring children and teens reach their highest potential, on and off the field.

Also, concussions in older adults can be dangerous—because they are often missed. If you are caring for an older adult who has had a fall, check them for symptoms of a concussion.

All of us—parents, coaches, athletes, teammates, spectators, families and friends —play a role in creating a culture of concussion safety (and getting the professional help needed) for ourselves and for those we cherish



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