For concussions, proper treatment is critical to recovery
- Appears dazed or stunned
- Confused about assignment or position
- Forgets an instruction
- Is unsure of game, score or appointment
- Moves clumsily
- Answers questions slowly
- Loses consciousness (even briefly)
- Exhibits mood, behavior or personality changes
- Can't recall events prior to hit or fall
- Headache or pressure in head
- Nausea or vomiting
- Balance problems or dizziness
- Double or blurry vision
- Sensitivity to light
- Sensitivity to noise
- Feeling sluggish, hazy, foggy or groggy
- Concentration or memory problems
- Just does not "feel right"
Returning to normal activities too soon can have serious consequences
By Lauren Glendenning
Brought to you by Kaiser Permanente
Traumatic brain injuries aren’t exclusive to the NFL or Hollywood cinema — Americans of all ages experience concussions, with children and seniors most at risk for serious complications.
Traumatic brain injuries — typically the result of concussions or head trauma — disrupt the normal function of the brain and contribute to about 30 percent of all injury deaths in the United States, according to the Centers for Disease Control and Prevention. Symptoms can be mild, moderate or severe, and no two brain injuries are ever the same.
“In both children and adults, the neuropsychological effects of concussion include impaired emotional and cognitive abilities,” said Dr. Shannon Garton, Family Medicine Physician at Kaiser Permanente’s Edwards Medical Offices. “Adults, however, tend to have physical symptoms such as headache, balance problems, and fatigue. Children are more likely to display behavioral symptoms such as irritability, drowsiness, and insomnia.”
These symptoms can appear instantly or they can take days or weeks to develop, but it’s important to recognize them and follow the appropriate treatment as directed by a physician.
A concussion and its aftermath
With concussions, an event causes the brain to strike the inside of the skull, and then it strikes again on the opposite side as it rebounds away, Garton said. This sudden, rapid movement of the head and brain can lead to chemical changes in the brain or damaged brain cells, according to the CDC.
Helmets are effective in reducing skull fractures, scalp lacerations and brain contusions, but helmets do not protect the brain from moving inside of the skull during impact. Garton said that while helmets don’t offer protection from concussions, using a helmet is very important for the prevention of more severe head injuries.
Concussions are usually not life-threatening, therefore are often considered mild, but the symptoms can be extremely disruptive to a person’s life.
“If there is any concern of a concussion the person should not continue the activity which caused the concussion until they have been evaluated. Increased rest and limited exertion are important to facilitate the patient’s recovery,” Garton said. “Getting adequate sleep at night and taking daytime naps or rest breaks is advisable when significant fatigue is experienced. Symptoms typically worsen or re-emerge with exertion.”
This can also include cognitive strain, such as reading, being on a computer, being in a classroom or at work. The amount of cognitive rest a patient requires is based on their symptoms, Garton said.
Treatment and prevention
Symptoms from a concussion might start immediately, or they could take days or weeks to develop after the initial injury, said Dr. Patricia Dietzgen, Family Medicine Physician at Kaiser Permanente’s Frisco Medical Offices.
A person might rely on the help of others to notice changes such as attention or memory problems, mood swings, foggy thinking and irritability, among other symptoms. This is especially important for parents to remember as they evaluate their children following a concussion.
“Children who sustain one concussion are also at higher risk for a second concussion from an injury sustained soon after the first one, so it is very important to not prematurely return a child to play,” Garton said. “This can be complicated because children may have their own motivations for under- or overstating the symptoms of concussion, which can complicate the injury’s aftermath.”
Because symptoms can last for a month or longer, it’s important to recognize the symptoms and take the proper precautions before returning to normal activities.
“It is critical to make sure that a person who has suffered a concussion does not participate in an activity which could cause a second concussion. Second-impact syndrome (SIS) occurs when the brain swells rapidly, and catastrophically, after a person suffers a second concussion before symptoms from an earlier one have subsided,” Garton said. “This second blow may occur minutes, days or weeks after an initial concussion, and even the mildest grade of concussion can lead to SIS.”
Some competitive young athletes are so eager to get back on the playing field that they deny having any symptoms, or they downplay their symptoms, in order to get back in the game, she said. Others may exaggerate their symptoms to avoid returning to school.
“Athletes should only progress to the next level of exertion if they are not experiencing symptoms at the current level,” she said. “It is important to work with a provider to help evaluate how the patient is doing, and if progression of activity is advised.”
Garton recommends that any youth involved in sports that have an increased risk of head injury should get baseline concussion testing, which improves the accuracy of evaluation and management of a concussion if one should occur.
Long-term effects of concussions are rare, but most concussions and other mild traumatic brain injuries resolve in one to six weeks, Garton said. Post-concussion syndrome can last longer, with symptoms including physical, cognitive and emotional problems. Anyone experiencing any of these symptoms should see their doctor to develop a treatment plan.