If I’m going to host a week on the subject of concussions, it would only make sense to give at least a little bit of background information on concussions and post concussion syndrome. Which is exactly what this post is about; it’s all about the science behind it. I am no medical expert, let’s get that straight. The information I am presenting below is largely from what I learned as a patient receiving treatment. The rest of the information is from my own personal research that I did in my undergrad on projects where we could choose a subject of our own. Again, I repeat I am not a medical expert. I am just regurgitating information that I have received, looked into and personally experienced.
In our modern society, the majority of us can say that in general, we know what concussions are. I mean, I’m sure most of you have seen Will Smith’s killer performance in the 2015 film Concussion. But for the majority of us, do we really know what concussions are? Or are we just familiar with accepting the general term concussion in our society? For example, if someone were to ask you what a concussion was right now, what would you say? I’m guessing a lot of us would say something along the lines of : “when you hit your head hard and you get headaches”. That answer, for the record would be right. At least partially, however, that answer would only apply to the very tip of an enormously large underwater iceberg.
So, if that answer doesn’t reply to the whole question, then what does? Well, medically speaking, concussions are defined as a mild-traumatic brain injury (MTBI) in which trauma to the brain or spinal cord leads to a variety of different symptoms. These symptoms can range from confusion, dizziness, headaches and loss of consciousness. Typically, these concussion related symptoms will either rebound with a complete, immediate recovery or the recovery period will roughly last between 7-10 days. Sounds about right, right? I would still consider this information to be apart of the upper-most, exposed part of the iceberg. It’s only when we start talking about Post-Concussion Syndrome (PCS), that we begin to drop below the waterline to the rest of the iceberg.
Post-Concussion Syndrome is the progression of concussion like symptoms. PCS is becoming more commonly known but to date, it’s still not on many people’s radar. Heck, I probably wouldn’t even know what PCS was if I didn’t have it for a year. Overall I would say that people who know about PCS are a) people in the medical field b) people who have/had PCS and c) people who know people with PCS. Statistically speaking, PCS is fairly rare. This is because 85%-90% of all concussion injuries become asymptomatic within 7-10 days. It’s only the other 10-15% of individuals that sustain their symptoms to then be identified as Post-Concussion Syndrome. Simply speaking, PCS is known as the persistence of concussion like symptoms. This means the continuation of physical symptoms, sleep related symptoms, thinking/memory impairments and mood disruption. These symptoms can last anytime between weeks, months and years and can affect independent home management, academics, work performance and as an athlete, you are unable to return to play until you are completely symptom free.
All of this raises the question, why does this happen? What is causing Post Concussion Syndrome? Although there is current research being conducted, there is still very little known to date. PCS was previously believed to be associated with sustained swelling in the brain following the initial injury. Currently, medical researchers suggest that PCS is related to continued blood flow abnormalities in the brain after the initial injury. After damage to the head, neurons in the brain get stretched and pulled out of their normal orientation as a result of the bouncing and twisting motion of the brain in the skull due to harsh movements. For those of you that aren’t familiar with the term neurons, I’ll give you a quick explanation. Neurons are cells in the brain that transmit nerve impulses to communicate with different areas of the body. Think of neurons as the highways of the brain; they allow passageway of signals to different areas of the brain to achieve the goal of the signal they are trying to transmit. When these neurons get pulled out of their original orientation, they aren’t able to work as effectively or efficiently. This leads to a cascade of implications which denies the brain’s ability to properly regulate and function normally and inevitably results in a range of symptoms.
PCS symptoms and the severity of PCS symptoms all vary depending on the individual. This is simply because there are no two brains that are exactly identical. However, typical symptoms induced by this syndrome will result in physical symptoms, sleep issues, mental processing delays and mood disruption. Physical symptoms will often present with headaches, nausea, vomiting, balance problems, slowed reaction time, dizziness, sensitivity to light and sound and blurred vision. Sleep wise, individuals will sleep more or less than normal, may have difficulties falling asleep and typically have persistent feelings of fatigue or drowsiness. As a result of PCS, mental processing is often delayed, there is increased difficulty with concentration and memory, along with confusion, feeling foggy and slowed down. Increased sadness, irritability, nervousness, depression and having elevated emotions compared to normal is also related to PCS. Once again, all of these symptoms or only a few of these symptoms can be present in individuals with PCS.
How do we get rid of these symptoms and get back to leading a normal life? Well treatment first starts with a diagnosis. Diagnosis can be received from primary health care providers, where they will ask about your symptoms, perform cognitive memory tests, use physical examinations to test the nervous system as well as balance tests. Currently, there are no brain scans that can be used to diagnose PCS. However, CT or MRI scans can be used to ensure there is no bleeding in the brain following the injury.
After the initial trauma to the head, it is important to rest the brain by staying in quiet environments, avoiding the use of electronics and limiting the amount of tasks that require mental effort. If symptoms persist after 7-10 days, the diagnosis of a concussion then becomes post-concussion syndrome. PCS is currently treated with the use of a progressive treatment approach. Progressive treatment is exactly what it sounds like. It means to slowly start reintroducing normal life activities into your schedule little by little, one by one and taking breaks during these progressions before symptoms spike. Incorporating supplements, maintaining reduced stress levels and sticking to a nutritious diet that reduces inflammation has also been found helpful. If symptoms continue to persist, participating in cognitive rehabilitation, vision therapy, vestibular therapy, speech therapy or psychological support can assist in identifying and strengthening areas in the brain that may require extra assistance to function as they previously did.
And there it is! Now that you have a little bit of background information on the subject of concussions and post-concussion syndrome, you’ll have a greater understanding on what the writers may be referring to in their personal stories over the next few days. Although there is much more research that needs to be done to better understand the causes and treatments of concussions and post-concussion syndrome, the expression “knowledge is power” accurately references the impact that current remedies can have on individuals struggling with this syndrome if they are treated early enough.
Bigler, E. D. (2008). Neuropsychology and clinical neuroscience of persistent post-concussive syndrome. Journal of the International Neuropsychological Society : JINS, 14(1), 1-22. Retrieved from http://search.proquest.com.ezproxy.rit.edu/docview/218865006?accountid=108
Iverson, G. L., Zasler, N. D., & Lange, R. T. (2007). Post-concussive disorder. Brain injury medicine: Principles and practice, 373-405. https://books.google.com/books?hl=en&lr=&id=yplFkKimNcYC&oi=fnd&pg=PA373&dq=post-concussive+syndrome&ots=9ZwIcr9V0E&sig=5sP266k4gJiy-d9YoCnvnBrD-9g#v=onepage&q=post-concussive%20syndrome&f=false
Lubit, R. H. (2015, September 23). Postconcussive Syndrome Psychiatric Care Treatment & Management. Retrieved April 29, 2016, from http://emedicine.medscape.com/article/292326-treatment