Saturday 21 October 2017

15 facts about concussion

Concussion. Getty Images
Concussion. Getty Images

The signs of a concussion aren’t always obvious, with the symptoms often not appearing for several hours after the injury.  So what are the warning signs and treatment? We talk to Dr Niamh Lynch, consultant paediatrician who gives a comprehensive guide to everything you need to know.

1 Concussion is a mild, traumatic brain injury

It is important that all concussions are taken seriously and treated appropriately. After a concussion the energy levels of the brain are depleted, and blood flow to the brain is decreased. Signalling between brain cells is disrupted. This leads to the common symptoms of concussion and is also referred to as ‘the sprained brain’.

However, because no symptoms are visible on the outside, it can be missed, and so concussion awareness is very important. Most sporting organisations are pro-active in managing the issue of concussion. However, the more members of the public who are ‘concussion aware’ the better. You may end up being a big help to someone.

2 Not all cases of concussion cause loss of consciousness

Dizziness, headache, nausea and confusion are the early symptoms of concussion. Anyone complaining of these symptoms should be removed from play. If someone is showing signs of neck pain, increasing confusion, repeated vomiting, seizures, weakness in the arms or legs, decreasing consciousness, severe or increasing headache, unusual behaviour change or double vision, then medical attention should be sought IMMEDIATELY. These are red flags and may be a sign of a more serious brain injury. Anyone who exhibits these symptoms should see a doctor, and may require hospitalisation and further investigations.

3 It is very common

Approximately one in every three people will sustain a concussion before they reach the age of 21. Males are more likely than females to sustain a concussion over the course of their lifetime, but females are more vulnerable to the effects of concussion. It is not clear why this is the case, but the good news is that females usually recover from concussion more quickly than males, as they are more likely to seek medical help early.

The risk of concussion should not deter people from sport. The long-term benefits of sport outweigh the risks, and remember, concussion is a treatable condition, as long as it is recognised and treated with respect.

4 Most cases recover within one month

With appropriate management and following of return to play protocols, most people with concussion make a complete recovery. The chances of quick recovery are increased by immediately coming off the field of play after suffering a concussion, or even a suspected concussion. Remember, ‘if in doubt, sit it out’. Never be shy about speaking out if you think someone is concussed.

5 it can happen anywhere, at any age

Slips, trips and falls, as well as road traffic accidents, account for most cases of concussion. It is increasingly being recognised that elderly people who fracture a bone because of a fall have also sustained a concussion, which may exacerbate symptoms of tiredness and confusion. Concussion is most common amongst children however. They have a large head relative to the size of their body, and are more liable to fall over, and hit the ground head first.

6 The symptoms may not appear for several hours after the injury

It may take 24 hours for the symptoms of concussion to become evident after the initial impact. It is possible for a child to get a concussion without the parent or carer realising, so it is important to ask about any knocks or bumps if someone is complaining of dizziness, nausea or headache.

7 It can cause difficulty with sleep and concentration

School children with concussion may find homework and study difficult. It is always useful to inform the teacher if a concussion has occurred. Sometimes children need to be given less school work whilst they are recovering from concussion.

8 It can lead to symptoms of anxiety and irritability

These symptoms usually resolve along with the other symptoms of concussion, but they can be very debilitating, and sometimes input from a psychologist is required. It is important that people with concussion remain socially engaged and as active as they can be. This helps with their recovery.

9 Complete rest is not usually the appropriate treatment for

 The traditional advice was to abstain from all activity until all symptoms had resolved. However, a gradual, supervised return to activities is now advised. Exercise is increased in a stepwise fashion. Each exercise step must be completed to the point where symptoms of concussion are no longer provoked, and the person must be free of all symptoms of concussion before returning to contact sports.

10 Helmets do not prevent concussion

Concussion occurs because the head is brought to an abrupt stop, but the brain keeps travelling in the direction the body was going and hits off the inside of the skull. The brain is ‘rattled around’ in the skull, causing microscopic injury to brain cells. A helmet protects the head from fractures, cuts and bruises however, and should always be worn in high risk sports.

11 You don’t need to bang your head to get concussion

Anything that causes a rapid back and forth movement of the head can cause concussion, for example a clash of shoulders, or a whiplash.

12 When symptoms last for more than a month, it is called post-concussion syndrome

The symptoms of post-concussion syndrome can go on for months, or even years. It can be very debilitating, leading to people falling behind at work and at school, becoming isolated from their friends, and causing low mood. Post-concussion syndrome usually needs specialised rehabilitation, but with appropriate help most people can recover fully from post concussion syndrome.

13 Early intervention is important

Athletes who continue to play, even for a few minutes after sustaining a concussion, take twice as long to recover as those who come off the field of play immediately. Similarly, those who return to contact sport before they are fully recovered are more likely to have a prolonged recovery.

14 There are six different types of concussion

If the main symptoms are dizziness and poor balance, it is vestibular concussion. If the main symptoms are with difficulty focussing the eyes it is ocular concussion. If the main symptom is neck pain, it is cervical concussion. If the main symptom is headache, it is migraine predominant concussion. If the main symptom is difficulty concentrating and learning, it is cognitive concussion, and if the main symptoms are anxiety and low mood it is emotional predominant concussion.

Knowing what type of concussion a person has directs the nature of the treatment they receive. Every treatment programme is then tailor -made for the individual.

15 Concussion can be treated

The mainstay of treatment is restoration of normal function through physiotherapy. Sometimes medications can help, particularly if there is chronic pain, or severe anxiety. There is a specialised concussion clinic for children aged 10 to16 in the Bon Secours Hospital in Cork, which can be accessed via GP referral.

* Dr Niamh Lynch is a Paediatrician working in the Bon Secours Hospital in Cork. She has a special interest in neurology, and in 2016 established Ireland’s first Concussion Clinic for children. She has travelled to Pittsburgh to observe the management of a concussion clinic treating elite athletes such as NFL footballers, and worked with University of Pittsburgh Medical Center to help develop and enhance the Bon Secours concussion treatment program.

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