Concussion

Overview

Concussion is a mild type of brain injury, but it should be taken seriously.
A concussion occurs when a hit or jolt to the head or body causes the brain to bounce around inside the skull. These movements can damage brain cells and cause chemical changes within the brain.

Most people recover fully from a concussion, but the process can take weeks or sometimes months. Initially, patients must rest to allow their brain to heal, then gradually return to normal activities.
Common causes of concussion include blows or falls during sports, falls at home, car crashes, and being violently shaken. Up to 3.8 million concussions occur nationally each year from sports or recreation alone, according to government estimates.

Symptoms may start immediately or up to several weeks later, and may include headache, neck pain, nausea, dizziness, tiredness, or feeling dazed. If you think you may have a concussion, or if your symptoms worsen, contact your health care provider. To learn about more severe forms of brain injury, visit our Traumatic Brain Injury webpage.

People who’ve had a concussion are more vulnerable to future concussions, and it’s especially important to avoid another head injury while recovering from one. Athletes, for instance, should be removed from play immediately if a concussion is suspected.

Prevention is the best way to reduce the likelihood of a concussion – from wearing athletic helmets and following sportsmanship rules, to removing tripping hazards in the home.

Causes

Common causes of concussion include:

  • Collisions, blows and falls during sports
  • Car accidents
  • Other falls, especially in and around the home
  • Military combat, including explosive blasts
  • Physical abuse, including shaking

Symptoms

Concussion can cause the following symptoms right away or up to several weeks after the injury.

  • Headache or neck pain
  • Ringing in the ears
  • Brief loss of consciousness
  • Dizziness or balance problems
  • Feeling dazed or confused
  • Tiredness
  • Nausea
  • Dilated eye pupil(s)
  • Blurred vision or tired eyes
  • Behavioral or mood changes, such as sadness, irritability, nervousness or anxiety
  • Sensitivity to light or sound
  • Trouble with memory, concentration or thinking
  • Bad taste in the mouth
  • Sleeping more or less than usual

For symptoms of more severe brain injury, visit our Traumatic Brain Injury webpage.

When to see a doctor

Seek medical care promptly if you notice any symptoms of concussion after a recent blow or jolt to the head or body. Thereafter, follow-up with your doctor every one to two weeks until your symptoms are gone.

Get emergency care if you have any of the following symptoms:

  • Loss of consciousness
  • Repeated vomiting or nausea
  • Convulsions or seizures
  • Confusion
  • Weakness
  • Slurred speech
  • Numbness
  • One pupil (the black circle in the middle of the eye) larger than the other
  • Decreased coordination
  • Drowsiness or inability to wake up
  • In children, crying without stopping, or not nursing/eating
  • Worsening headache

Complications

Most people with a concussion feel better within four to five weeks. In some cases, however, symptoms can continue for several months or longer. This condition, known as post-concussion syndrome, is rare after a first concussion, but more common after repeated concussions. Moreover, patients can develop emotional issues, such as anxiety or depression, that interfere with their recovery. It’s vital that patients receive proper evaluation and treatment of their symptoms and related problems.

Evaluation

Your health care provider will ask about your injury and examine you. You may also receive the following tests:

  • A neurological exam, which includes checks of your vision, coordination, reflexes and balance
  • Tests of your thinking and memory
  • Imaging tests — such as a CT scan or MRI — to check for bleeding or inflammation in the brain, skull fractures or other physical changes. X-rays may be done to check for fractures or spine problems.
  • A blood test, which can evaluate concussion in adults
  • Your doctor may also assess you for certain risk factors that can prolong recovery, such as:
  • Past concussions or other brain injuries
  • Severe symptoms immediately after the injury
  • Personal and family history, such as learning difficulties or family/social stressors.

If your symptoms continue beyond the usual recovery period of four to five weeks, you may benefit from further testing. The following evaluations can help identify problems so they may be addressed through treatment.

  • Neuropsychological evaluation, a comprehensive, non-invasive test of a person’s mental abilities and mood, including attention and concentration, learning and memory, planning and abstract thinking, language and communication, motor and sensory functions, academic skills, and other intellectual abilities. The test is done through a questionnaire and typically take four to six hours.
  • Physical-therapy evaluation, to determine problems with the neck/spine, vision or balance, which can result from a concussion.
  • Psychological evaluation, to identify any emotional or behavioral challenges, which can be caused or worsened by a concussion.
  • Independent medical examination to determine the cause, extent and medical treatment of a work-related or other concussion.
  • Functional capacity evaluation to determine a person’s ability to function in a range of circumstances, especially in employment situations, in an objective manner.
  • Driver evaluation to ensure the person demonstrates safety awareness and sound judgment while driving, and the skills needed to control a vehicle.

Treatment

In most cases, patients should stay home and rest for two or three days after a concussion, then gradually increase their activity level over the next few weeks. Certain symptoms — such as dizziness, vision problems, and headache — may require a longer rest period.

Your doctor can advise you on the right pace for your return to normal activities, including work and/or school. In fact, either too much rest or too much activity can delay your recovery, so it’s important to strike the proper balance between the two. Patients should continue seeing their physician every week or two until their symptoms subside, or until their doctor instructs them otherwise.

Physical therapy and/or psychological counseling can also help reduce or eliminate symptoms – and are especially important when a concussion’s effects linger. These treatments are even more effective when they are coordinated so they reinforce each other.

Physical therapy

Physical therapy can treat the following concussion-related issues:

  • Headache caused by neck injuries related to the concussion. PT can strengthen neck muscles, which can relieve symptoms and help prevent future concussions.
  • Visual symptoms, dizziness, and balance issues. These can also be related to the neck, or caused by eye “convergence” problems (when the two eyes don’t work together properly) that are common after concussion. Vestibular therapy – a specialty within physical therapy – also improves balance and reduces dizziness through exercise.

Psychological interventions

Psychological counselling can address continued pain, fatigue, visual symptoms and dizziness by teaching coping skills and relaxation techniques. A type of counselling called cognitive behavioral therapy is particularly effective in reducing these symptoms and their effects on patients’ lives. Counselling can also treat the emotional effects of concussion, which can include lowered self-confidence, anxiety, depression and other mood symptoms, as well as psychological trauma from the incident. And it can help patients achieve healthy levels of sleep, nutrition, and socialization – which can reduce concussion symptoms.

Medication

Certain medications can treat migraine headaches triggered by the concussion. Medication can also help treat mood symptoms, such as anxiety or depression.

Other supports

Programs are available to address other challenges that may arise, such as job loss. Vocational programs, for instance, can help people return to work and other activities.

Prevention

Everyone should take steps to avoid concussions and other brain injuries, including:

  • Always wear your seatbelt.
  • Always use the right size car seat or booster seat for your child’s age and size, and make sure it’s correctly installed.
  • Remove tripping hazards, such as throw rugs and clutter where people walk.
  • Wear the proper helmet when bicycling, skateboarding, skating, horseback riding, skiing, riding a motorcycle, and the like. Make sure the helmet fits correctly. However, know that no helmet is concussion-proof.
  • Follow rules of good sportsmanship.
  • Use gates at the top and bottom of stairs in homes with babies and toddlers.
  • Use playgrounds built over soft surfaces, such as mulch or sand — not grass or dirt.
  • Install safety guards to keep children from falling out of windows.
  • Install handrails on both sides of stairways, especially in seniors’ homes.
  • Install grab bars in the bathroom (especially for seniors), with nonslip mats in the bathtub/shower and on the floor.

The risk for a second concussion is greatest in the 10 days after an initial concussion. Therefore, it’s especially important for anyone suspected of having a concussion to immediately stop their activity – especially if they’re playing a sport.

The person may not be thinking clearly, and may therefore not be able to make this decision on their own. Furthermore, their reaction time and balance may be affected, making them more prone to further injury.

To learn how Bancroft NeuroRehab can help you or a loved one reclaim your life after a concussion, please call (844) 234-8387 or complete our contact form.