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 symptoms that may immediately resolve, or even linger for weeks, months, or years. Symptoms of concussions usually fall into four categories:
- Cognitive- Difficulty concentrating, confusion, memory loss, sensitivity to light/sounds, feeling “foggy”, sensitivity to light and sounds
- Physical- Headaches, dizziness, nausea, loss of coordination, poor vision, chronic pain, ringing ears
- Emotional- Irritability, sadness, nervousness, lack of self efficacy, uncooperative and depression
- Sleep disturbance- Altered sleep quality/ pattern
It is important to note that symptoms of concussion in children and elderly may not be as evident as in adults.
A concussion or Traumatic brain injury (TBI) occurs when an external force injures the brain, either through direct impact or by acceleration/deceleration alone. The leading causes of concussion are falls, motor vehicle-related injury, unintentionally being struck by or against an obstacle, assaults and playing sports. Some concussions may cause you to lose consciousness, but most do not.
Why are concussions so serious?
- A blow to the brain causes the neurons to release chemicals and neuro-transmitters that lead to inflammation, disrupted transmission of electrical signals, brain-cell damage and death, and metabolic depression.
- The effects of a concussion are not confined to the point of impact of the brain. The transfer of energy radiates throughout the brain and rarely only affects only one area of the brain.
- Concussion can cause secondary complications that include alterations in cerebral blood flow limiting brain oxygenation and heightened intracranial pressure.
- Individuals may appear to be fully recovered, but in fact they are still dealing with 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 behavior 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 among other memory problems, Parkinson’s disease, neurological problems, and depression.
Risk factors and prevention
Activities and factors that may increase your risk of a concussion include, falling (especially in 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 previous history of concussion(s). Avoiding the factors above that we can control is the best way to prevent this type of injury.
Concussion symptoms are difficult to diagnose because rarely do observable clinical changes occur. The same goes for CT scans and MRIs, that are usually normal after a concussion. Concussions are often diagnosed based on cognitive and neurological examinations. A variety of tools can be used to assess the severity of a brain injury (Glasgow Coma Scale (GCS)/ Sport Concussion Assessment Tool (SCAT)/ Acute Concussion Evaluation (ACE)). Surveys such as these, are often used on the field to determine if athletes should return to play following an injury. Advancements in technology might allow us to better diagnose if a concussion has occurred through examination of blood markers.
Treatments for mild concussions generally include activity and behavioral modification and an emphasis on rest to limit stress on the brain. This accompanied by a stepwise return to activity/ school is essential to prevent re-aggravation of symptoms. For serious concussions, medications and emergency surgery (decompression) may be required, as well as physical, speech and occupational therapy may be employed in the rehabilitation process.
When one suffers a concussion we can assume that person has also suffered from other trauma to the body, commonly at the neck and spine. Chiropractic care can play a key role in the management of involved neuromusculoskeletal conditions that are often associated with this type of injury, including whiplash, headaches, joint dysfunctions, neck/back pain, and muscle stiffness/ spasms.
Laser/ photobiomodulation therapy also offers a revolutionary tool to treat concussions. By direct stimulation of the brain’s tissues, cellular regeneration is enhanced, thus decreasing symptoms and increasing overall well being It is hypothesized that laser/ photobiomodulation therapy reduces the oxidative damage and inflammation that occurs in the brain following a concussion, in addition to increasing cerebral blood flow. A number of cases have been documented in which patients with chronic mild concussions showed marked improvement in cognition, executive function, memory and sleep with the help of laser/ photobiomodulation therapy.
Most people diagnosed with mild concussions recover to their previous level to day-to-day functioning within three months. However, complete recovery is not universally achieved in moderate or severe cases.
The patient that has suffered a concussion will require patience, encouragement, and understanding as they recover.
At the RL clinic, patients will not only be evaluated from a concussive perspective, but also from a biomechanical perspective, which can greatly influence a patient’s recovery process.