Concussion: The Signs and Symptoms
June 27, 2019
The American Academy of Neurology has clarified that concussions are, in fact, a relatively common consequence of trauma to the head in contact sports. In the position statement on sports concussions in 2010, they report data from the Centers for Disease Control indicating that for individuals aged 15 to 24, sports concussions are the second reason for a traumatic brain injury, after motor vehicle accidents. There has been some debate in the literature trying to qualify what a concussive event is, with a majority of professional agencies at this point recognizing a concussion is a brain injury. This can be caused by any significant bump, blow, or sudden jolt to the head that causes the brain to experience some type of acceleration and deceleration force. This force ultimately results in the brain moving, which can contribute to diffuse axonal injury, shearing forces, or neuronal strain that can cause a variety of symptoms. Just like a rubber band that stretches too far, the neurons can be stretched or twisted out of shape.
Some of the more common symptoms experienced include:
Feeling sick or nauseous
Being sensitive to light or noise
Feeling sluggish or groggy
Poor attention and concentration
Being more easily confused
Decision-making becomes problematic
Headaches and migraines
The symptoms will not always be immediately evident following the blow. In fact, some individuals may believe that they had not been injured due to delayed onset of symptoms and immediately want to return to the athletic event or whatever other activity they were doing, but is very important to continue to monitor these individuals closely and to be vigilant. Parents and coaches might notice irritability (they can be quick to snap) and might also recognize other personality changes. They may forget how to do simple things like adding or subtracting for a period of time, but more importantly, they often seem fatigued. During these times, it is important not to push these individuals to shake it off and get back to the tasks immediately. This may only exacerbate the symptoms and prolong recovery.
It has generally been assumed that most mild traumatic brain injuries will resolve without any support. This is generally consistent with a majority of the information that has been published within mTBI (mild traumatic brain injury) cases. Yet, Willer and Leddy (2006) suggest that as many as 10% of mTBI individuals will experience persistent signs and symptoms, leading to a diagnosis of the post-concussive syndrome (PCS). Rather than recovering within days to weeks, these individuals may not feel “back to normal” for months or longer. These individuals may require medications to assist with attention, concentration, or mood, since there is a higher risk for anxiety and/or depression in PCS.
Most athletic programs now have “return to play guidelines.” It is Michigan law for coaches to know about concussions and High School Athletics have additional protocols. It can be challenging to determine if a concussion has occurred and to know how to respond. Many times the athlete wants to return to play before they may be neurologically ready. They might feel they are letting the team down, may fear losing their starting status or position on the team, may feel pressured by others and they themselves want to feel normal again. They may underestimate symptoms and try to fake it, in attempts to get back into the swing of life like nothing happened. Although I appreciate many of these somewhat overly zealous qualities, they may only be prolonging their recovery and would be significantly increasing the risk for things like “second impact syndrome.”
Unfortunately, we have too commonly seen children who are reported to have experienced five to six significant blows prior to their teenage years. Many of these experiences were in close proximity to the original blow. This is where a pre-concussion evaluation is encouraged for any athlete participating in a sport that has a higher likelihood of physical contact or head injury. Broglio et al. (2007) acknowledged that the test-retest results are not the best, but the general conclusion is that baseline histories and clinical data are useful as part of any concussion program. The most recognized pre-concussion screening at this point is the ImPACT. Several clinics in Grand Rapids have adopted this and BRAINS is working with teams and individual athletes to provide pre-concussion screening and postconcussion follow-up. The screenings are very low cost, but can be invaluable in determining care if a concussion occurs.
If there has been a serious event, a loss of consciousness, repeated vomiting or epileptic-like activity, severe migraine, inability to walk, and/or severe sedation to the point that they cannot be aroused, this is an emergency situation that requires Emergency Room care. Fortunately, this is relatively few of the concussions that occur. Most concussive events are, in fact, mild and are not easily evident. In these situations, outpatient physicians are commonly asked to render an opinion. Many times I have heard physicians indicate that they are uncomfortable making these decisions because they do not have a baseline for comparison, nor the time to track recovery or provide the documentation for the school, team, and organizations in order to returning point. BRAINS is able to work with these physicians, schools, the team and others for pre and post-concussion care.
About the Author: Dr. Michael Wolff, Psy.D., ABPDN is a neuropsychologist and co-owner of BRAINS. Dr. Wolff specializes in autism spectrum disorders, ADHD, forensic evaluations, medically complex cases, and other neurodevelopmental and genetic disorders. He has awards for his contributions to the field of psychology and has a history of committee participation through the National Academy of Neuropsychology, the American Psychological Association as a graduate student, and is a Professional Advisor for the Epilepsy Association of Michigan and on the Board of Directors for the Down Syndrome Association of West Michigan.
For more information regarding concussions: www.cdc.gov/concussion/sports/
Broglio, S., et al., (2007). Test-Retest Reliability of Computerized Concussion Assessment Programs. Journal of Athletic Training, 42, 509-514.
Willer, B. & Leddy, J. (2006). Management of Concussion and PostConcussion Syndrome. Current Treatment Options in Neurology, 8. 415-426.