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What do you know about Concussion?

Concussion study-Gaetz-GW Graham 22A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head that changes the way the brain normally works. It can be caused by a direct or indirect force.   According to the CDC (2011) 1.6 to 3,800,000 sports and recreational related traumatic brain injuries (TBI) occur in the US annually. The likelihood of suffering a concussion in a contact sport is 19% per year of play. Activities with the greatest number of TBIs include bicycling, football, playground activities, basketball, and soccer. 70.5% of sports/recreational TBI injury visits were among people 10-19 years of age. Females have a higher incidence than males with sports related concussion with worse outcomes. Headache is the primary complaint for both male and females. Males report amnesia, confusion, and disorientation while females report drowsiness and photophobia or sensitivity to bright lights.

There are several myths surrounding concussion. Here are a few: loss of consciousness is necessary for a diagnosis of concussion. A CT/MRI is needed to diagnose a concussion. Treating a concussion related headache with medication is contraindicated. You should not let your child sleep after a head injury. Myth: Children heal from concussion faster than adults. In fact on the contrary, due to their immature and still developing neural tissue especially the frontal lobe, it actually takes longer.

So how long does it take to recover? Everyone is different and there are many factors, but symptoms often resolve in 7-10 days. The average return to play for high school athletes is 3-6 days. 10% of individuals continue with symptoms greater than 10 days. Symptom duration tends to be longer in children with prior concussion.

So what actually happens during a concussion? The injury is dependent upon many factors, but includes the amount of force and if the impact is linear or rotational. A metabolic cascade occurs within the brain that can last minutes to hours. This is why it is critical that once you identify there may be a concussion, not to continue riding your bike, playing soccer, football etc. on that same day. The cascade of chemical changes that occur in the brain create a situation where the cerebral blood flow decreases resulting in the brain needing more energy than it is getting. This leaves the brain vulnerable to a 2nd ischemic injury.

The vestibular system which is the main organ that provides orientation information assisting with eye movement and stability as well as postural stability is often affected. Physical Therapy may be helpful for those people not recovering within the first week. Physical Therapists will evaluate and treat any neck pain first. They will evaluate the oculomotor system, vestibular system, balance/gait as well as cardiovascular. Although some patients have been instructed to take the “cave man” approach: no TV, computer, texting etc, new research suggest that the brain needs some physical activity increase the energy to the brain required for healing. A critical step that may be overlooked if not under the proper care is the gradual return to activities. It is important to increase your heart rate incrementally over one week, 20% per day without symptom production prior to returning fully to your prior activities.

So how do we prevent concussion? Did you know that helmets are meant to prevent skull fracture and do not prevent concussion? The guru of concussion research has some guidelines that the teens may not like: no tackle football or heading in soccer until age 14. Parents, err on the side of caution!!

Mary Boyd, MS, PT is the owner of Mountain View PT and can be reached at 290-5575

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