BRINGING SCIENCE TO TREATMENT

Getting ahead with a concussion

Concussion injuries remain in the news, particularly concerning those that result from American football. Reason being, many players suffer seemingly traumatic injuries, such as that experienced recently by Josh Allen of the Buffalo Bills who’s head bounced dramatically off the turf in a Sunday game. As if the injury itself wasn’t startling enough, Allen was cleared to return to play later that same week.

Such exposure and awareness means the field of concussion medicine devotes more resources to research, injury prevention, and rehabilitation. As a result, we’ve learned more in the last several years on the lingering effects of a concussion. Physiotherapist Kay Robinson explains the reality of living with the long term effects of a concussion, known as post conclusive disorder, in today’s feature article.

A study led by Harvard University examined over 7000 research papers concerning concussion and selected only 101 as meeting criteria of examining athletes with concussion from sport (1). The research showed that most who suffer a sports concussion will recover in about a month’s time. However, younger athletes and those with a history of a prior concussion may continue to have symptoms for more than a month. Between the genders, females exhibited symptoms of concussion longer than males, usually taking more than a month for a full recovery.

The literature review debunked the age old myth that a loss of consciousness results in a more severe concussion. In truth, there’s no relation between consciousness and severity of injury or recovery rate. Most concussions do not actually involve a loss of consciousness. Yet, coaches continue to make return to play decisions based on the fact that a player never passed out, and therefore send them back into the game.

The researchers from Harvard found that rather than the clinical picture at time of injury, the acute and subacute symptoms more accurately predicted an athlete’s recovery. Mild symptoms for the first couple of days seemed to predict a more rapid return to health. However, headaches and depression that persisted into the second or third week likely forecast a longer road (see table 1). In today’s article, Robinson highlights appropriate rehabilitation for each subset of post concussive syndrome and explains the progression toward recovery. Understand that while an athlete may demonstrate clinical recovery, some of these post concussive symptoms may persist, especially in young athletes, females, those with history of prior concussion or who had more severe acute symptoms.

Table 1: Concussive subgroups and their characteristics

Cognitive


Decreased concentration

Increased distractibility

Difficulty learning/retaining new information

Decreased multitasking abilities

Increased fatigue
Vestibular







Balance impairments

Difficulty interpreting motion

Difficulty co-ordinating head/eye movements

Poor stabilization of vision on head movements
Ocular
Difficulties brining eyes together/using eyes in tandem

Difficulty tracking motion
Post-Traumatic Migraine

Headaches

Nausea

Light sensitivity
Cervical


Headaches

Neck pain/dysfunction

Dizziness
Anxiety/Mood
Excessive worry

Difficulty turning thoughts off

Personality changes
Physiological Symptoms exacerbated by exercise/increased cognitive function (headache, dizziness, nausea, fatigue, difficulty concentrating)
Adapted from:http://rethinkconcussions.upmc.com/2016/10/concussion-clinical-trajectories/)

Reference:

  1. . 2017 Jun; 51(12): 941–948.
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