Concussions and other forms of mild traumatic brain injuries affect brain function. These make up the majority of all brain injuries and are a growing concern in our society. Each concussion is unique and can present differently depending on the mechanism and severity of the injury, on whether the patient has a prior history of concussions, and age.

SYMPTOMS

Symptoms of concussion are diverse and complex and vary with the degree of injury. A delayed onset of symptoms following trauma can also occur. Acute symptoms can range from mild to severe, with some that may resolve immediately while others might linger for weeks, months, or years. Symptoms usually fall into four categories:

• Cognitive: difficulty concentrating, confusion, memory loss, sensitivity to light and/or sounds, feeling “foggy”
• Physical: headaches, dizziness, nausea, loss of coordination, poor vision, chronic pain, ringing in the ears
• Emotional: irritability, sadness, nervousness, lack of self-efficacy, lack of cooperation, depression
• Sleep disturbance: changes in sleep quality or pattern

It is important to note that symptoms of concussion in children and the elderly may not be as obvious as those experienced by adults.

CAUSES

A concussion or traumatic brain injury (TBI) occurs when an external force injures the brain, either through direct impact or by acceleration/deceleration. The leading causes of concussion stem from sports, falls, motor vehicle-related injuries, and assaults. Some concussions may cause loss of consciousness, but most do not.

WHY ARE CONCUSSIONS SO SERIOUS?

• A blow to the brain causes neurons to release chemicals and neurotransmitters that trigger inflammation, disrupt the transmission of electrical signals, and cause brain cell damage and death [NW3]  as well as metabolic depression.
• The effects of a concussion are not confined to the area of impact on the brain. The transfer of energy radiates throughout the brain and rarely affects only one area.
• Concussions can cause secondary complications that include alterations in cerebral blood flow, resulting in limited brain oxygenation and increased intracranial pressure.
• Individuals may appear to be fully recovered, but in fact they are still dealing with the ongoing consequences of their injury. Individuals may also experience a symptomatic recovery, only to deteriorate over time because of degenerative brain processes.
• About 80% of people who suffer from concussions deal with post-concussive syndrome symptoms such as insomnia, headaches, dizziness, fatigue, irritability, auditory or ocular aberrations, emotional and behavioral changes, and cognitive impairment.
• Repeated concussions can result in heightened degenerative processes in the brain, resulting in cerebral atrophy and long-term damage to the brainstem and corpus callosum, known as chronic traumatic encephalopathy. Repeated concussions can also lead to a nineteen-fold increase in rates of early onset Alzheimer’s disease and other memory problems, Parkinson’s disease, neurological problems, and depression.

RISK FACTORS AND PREVENTION

Activities and factors that may increase your risk of getting a concussion include falling (especially children and the elderly), high-risk sports (football, hockey, soccer, rugby, boxing), not wearing proper safety equipment, motor vehicle collisions, pedestrian or bicycle accidents, physical abuse, and a prior history of concussions. Avoiding situations where impact to the head may occur and/or wearing appropriate protective equipment can help reduce the risk of concussions but cannot stop then from happening.

DIAGNOSIS

Concussion symptoms are difficult to diagnose because directly observable clinical changes rarely occur. The same goes for CT scans and MRIs; they typically turn out normal. More often than not, concussions are diagnosed based on cognitive and neurological examinations. A variety of tools exist to assess the severity of brain injuries, such as the Glasgow Coma Scale (GCS), the Sport Concussion Assessment Tool (SCAT), and the Acute Concussion Evaluation (ACE). In sports, assessment tools such as these are often used on the field to determine whether an athlete should return to play after suffering an injury. Advancements in technology might allow us to better diagnose concussions through the examination of blood markers.

TREATMENT OPTIONS

Treatment for mild concussions generally includes activity and behaviour modification as well as an emphasis on rest to limit stress on the brain. These, along with a stepwise return to one’s daily routine, are essential in preventing symptom reaggravation. Medication and emergency surgery such as decompression may be required to treat serious concussions, while physical therapy, speech therapy and/or occupational therapy may be used in the rehabilitation process.

When a person suffers a concussion, we can assume they have also suffered some other trauma to the body, usually in the neck and spine areas. Chiropractic care can play a key role in the management of associated neuromusculoskeletal conditions that are often associated with this type of injury, including whiplash, headaches, joint dysfunctions, neck or back pain, and muscle stiffness/ spasms.

Photobiomodulation/laser therapy offers a revolutionary way to treat concussions. By directly stimulating brain tissues, cellular regeneration is enhanced, thus decreasing symptoms, and increasing overall wellbeing. It is hypothesized that laser/photobiomodulation therapy reduces oxidative damage and inflammation in the brain, in addition to increasing cerebral blood flow. A number of cases have been documented in which patients suffering from chronic mild concussions who were treated with laser/photobiomodulation therapy showed marked improvement in cognition, executive function, memory and sleep.

ANTICIPATED OUTCOME

Most people diagnosed with mild concussions can return to their previous level of day-to-day functioning within days to months. However, in moderate or severe cases, complete recovery can be prolonged. Patients who have suffered from a concussion will require patience, support, and understanding as they recover. At the Robichaud-Lévesque clinic, patients will not only be evaluated from a concussive perspective, but also from a biomechanical point of view, which can greatly enhance the recovery process.