Sports injuries, collisions, work-related accidents, and traumatic falls can all cause a blow to the head or violent shaking, resulting in a concussion. Every year, three to four million people in the United States suffer from concussions. Literally meaning to shake violently, a concussion is a traumatic brain injury (TBI) that is not normally considered life threatening. Medical assessment is important to determine the severity of the concussion and the treatment protocols.

A blow to the head can actually cause the brain to bruise and bleed. The brain is soft tissue and is housed inside the hard shell or skull.  The brain “swims” in fluid, cerebrospinal fluid, which provides cushioning for the soft brain. A bruise interrupts the function of the brain, causing disorientation, loss of balance, memory problems, and difficulty with normal thinking processes.

Symptoms of a Concussion

Acute:

• Headaches
• Slurred speech
• Loss of consciousness
• Ringing in the ears
• Fatigue
• Delayed answers to questions
• Vomiting
• Nausea
• Dizziness
• “Seeing Stars”
• Confusion and / or amnesia

Delayed Onset:

• Loss of concentration
• Irritability
• Depression
• Sleep disturbances
• Sensitivity to light and noise
• Changes to the senses of taste and smell

Not all concussions are the same.  The signs and symptoms correlate well with the severity of the injury.  The medical community has defined the severity of the concussion with a 3 level grading system.

Grade 1:  Symptoms are short lived and last for 15 minutes are less.  NO loss of consciousness.

Grade 2:  Symptoms are more severe and last longer than 15 minutes.  NO loss of consciousness.

Grade 3:  Loss of consciousness for any amount of time including just seconds.

If someone sustains a concussion, the severity of the symptoms dictates the ultimate treatment protocols.  The person should seek medical help.   A specially trained healthcare professional that will be able to do an “on the field” assessment of the person’s symptoms.  This diagnosis can take place in any setting. The same or similar diagnostic procedures/questions are used in on the field and in the clinical setting.

If an athlete suffers a concussion during a game, the process will take place immediately to help determine if the player can return to “action.” Returning to normal activity depends on the concussion evaluation.   The general rule is to keep patients out of harm’s way if there is any suspicion that they are still being affected by the symptoms of a concussion. The decision to “play” should be made by a non-partisan, healthcare professional and not a parent, coach or player.

Diagnosing a Concussion

The evaluation process includes assessing a person’s cognitive capabilities, motor skills, language skills, behavioral presentation and the ability or inability of their executive functioning (mental process of linking past experience with present actions).  The medical exam might include a CT scan or MRI to rule out bleeding and/or bruising of the brain tissue.

If a concussion is diagnosed as severe, the patient will be hospitalized. Most of the time, the patient should be able to go home and rest. Aspirin and NSAIDs are forbidden because they might cause bleeding to occur in the injury site.  Patient should rest in a quiet and dark room and decrease the stimulation to the brain (no the TV, computer, reading or playing video games). Many concussed people do not feel well enough to perform these activities and would prefer to lie down in complete darkness and try to sleep/rest.

Protecting Against a Concussion

Concussions cannot be avoided all of the time, but taking precautions can reduce the chances of having one occur.  A few simple steps should be followed:

• Drive carefully.  Auto accidents are the number one cause of concussions in most people.
• Wear protective gear.  There are numerous types of protective head gear, face guards and mouth pieces that are designed to reduce the impact of a hit /blow to the head.
• Change the rules of the game to eliminate above shoulder contact and penalize heavily if the players do not abide by the rules.
• Do not get into physical confrontations.

Long lasting symptoms of a concussion can cause motor skill dysfunction and deconditioning throughout the musculoskeletal system.  Physical Therapists are trained to rehabilitate patients that have suffered a concussion and will modify the rehabilitation program accordingly.

Concussions have been diagnosed more frequently in the past few years and have become a major concern to healthcare providers because they can cause long lasting side effects.  Unfortunately, the concussed patient can experience symptoms of a concussion for a long time after the actual injury occurs.  Anyone who suffers a blow to the head should be assessed for a concussion and the proper medical treatment should be performed to help reduce the severity of the symptoms.