Concussions
Concussions occur in both the young and old due to sports related injuries and falls, respectively. Between 1997 and 2007, ER visits for 14 to 19 year olds relating to concussion TRIPLED. (Bakhos et al., 2010) This is in part due to better detection with the implementation of mandatory concussion guidelines that now exist for high school sports. Falls in the elderly is a well-recognized problem but often without good follow up concussion management/treatment.
There are several types of concussions. One in which the brain moves forwards and then backwards in the skull in a linear motion at a rapid rate of speed as occurs during a tackle or a fall. The front of the brain strikes the front of the skull and then rebounds, forcing the back of the brain to hit the back of the skull. The head does not have to contact the ground for a concussion to occur. In addition to the contusions created at the front and back of the brain, stretching and tearing of neurons in the brain and brain stem may occur. A second type of concussion is due to a rotational injury, for example, in a boxing injury. In this case, the brain rotates causing stretching and tearing of brain stem and brain structures in addition to the brain hitting the inside of the skull.
No two concussions are alike which makes it more important to recognize any potential symptoms. Grading scales, which are based on whether there was loss of consciousness (LOC), are no longer used as LOC occurs in less than 10% of concussions and is not a reliable predictor of severity or recovery. (Guskiewicz et al, 2003). Headache is the most common symptom, occurring in approximately 75% of concussions (Kontos et al., 2013). Problems with memory loss and cognitive function are a means to predicting severity of the concussion (Collins et al, 2003). Those with vestibular symptoms, dizziness in particular, are 6 times more likely to require a longer recovery time (Kontos et al, AJSM, 2011).
Initial symptoms of concussion, within the first week, commonly include impaired cognitive function (difficulty concentrating and remembering, fatigue, drowsiness), migraine related symptoms (headache, sensitivity to light and noise, nausea) and vestibular issues (dizziness, foggy feeling). Symptoms change over time. Patients may notice being more emotional, increased irritability or nervousness, changes in cognitive function, sleep disturbances and ongoing migraines (Kontos et al; AJSM, 2012)
For athletes, it is imperative to recognize even subtle changes in physical and cognitive performance as many athletes, in their desire to return to play, will often indicate that they feel fine. Schools have implemented pre-season physical and cognitive testing to use as baseline measurements in the event of a suspected concussion. Trainers, coaches and medical personnel have greatly improved on-field assessments. Athletes must also match their post-concussion testing scores and should be symptom free both at rest and with exertion before returning to play. Within the last 5 years, vestibular and ocular screening has gained attention to further help in determining whether an athlete is fit for play. These screenings include identifying dizziness, balance and ocular-motor (movement of the eyes) deficits.
Adults that experience concussion following a fall do not have the advantage of comparing pre and post testing. Assessing all clinical signs and comparing them to age related norms (when available) is imperative. Screening should include vestibular, ocular, cognitive, migraine, anxiety/mood and cervical assessment.
High school age athletes take on average 1 to 3 weeks longer to recover than an older athlete; therefore conservative management of the younger athlete is imperative. Additionally, the brain remains vulnerable until the athlete is able to achieve baseline measurements. In both young and old, a second concussion can sharply increase symptoms and significantly extend recovery time. Not all concussions result in vestibular symptoms, but when they do, the role of a certified and experienced vestibular therapist is essential to managing and improving recovery in both the athlete and older adult, whether from a sports related injury or a fall.
There are several types of concussions. One in which the brain moves forwards and then backwards in the skull in a linear motion at a rapid rate of speed as occurs during a tackle or a fall. The front of the brain strikes the front of the skull and then rebounds, forcing the back of the brain to hit the back of the skull. The head does not have to contact the ground for a concussion to occur. In addition to the contusions created at the front and back of the brain, stretching and tearing of neurons in the brain and brain stem may occur. A second type of concussion is due to a rotational injury, for example, in a boxing injury. In this case, the brain rotates causing stretching and tearing of brain stem and brain structures in addition to the brain hitting the inside of the skull.
No two concussions are alike which makes it more important to recognize any potential symptoms. Grading scales, which are based on whether there was loss of consciousness (LOC), are no longer used as LOC occurs in less than 10% of concussions and is not a reliable predictor of severity or recovery. (Guskiewicz et al, 2003). Headache is the most common symptom, occurring in approximately 75% of concussions (Kontos et al., 2013). Problems with memory loss and cognitive function are a means to predicting severity of the concussion (Collins et al, 2003). Those with vestibular symptoms, dizziness in particular, are 6 times more likely to require a longer recovery time (Kontos et al, AJSM, 2011).
Initial symptoms of concussion, within the first week, commonly include impaired cognitive function (difficulty concentrating and remembering, fatigue, drowsiness), migraine related symptoms (headache, sensitivity to light and noise, nausea) and vestibular issues (dizziness, foggy feeling). Symptoms change over time. Patients may notice being more emotional, increased irritability or nervousness, changes in cognitive function, sleep disturbances and ongoing migraines (Kontos et al; AJSM, 2012)
For athletes, it is imperative to recognize even subtle changes in physical and cognitive performance as many athletes, in their desire to return to play, will often indicate that they feel fine. Schools have implemented pre-season physical and cognitive testing to use as baseline measurements in the event of a suspected concussion. Trainers, coaches and medical personnel have greatly improved on-field assessments. Athletes must also match their post-concussion testing scores and should be symptom free both at rest and with exertion before returning to play. Within the last 5 years, vestibular and ocular screening has gained attention to further help in determining whether an athlete is fit for play. These screenings include identifying dizziness, balance and ocular-motor (movement of the eyes) deficits.
Adults that experience concussion following a fall do not have the advantage of comparing pre and post testing. Assessing all clinical signs and comparing them to age related norms (when available) is imperative. Screening should include vestibular, ocular, cognitive, migraine, anxiety/mood and cervical assessment.
High school age athletes take on average 1 to 3 weeks longer to recover than an older athlete; therefore conservative management of the younger athlete is imperative. Additionally, the brain remains vulnerable until the athlete is able to achieve baseline measurements. In both young and old, a second concussion can sharply increase symptoms and significantly extend recovery time. Not all concussions result in vestibular symptoms, but when they do, the role of a certified and experienced vestibular therapist is essential to managing and improving recovery in both the athlete and older adult, whether from a sports related injury or a fall.
Have You Heard About GyroStim?
For those with mild concussion to severe Traumatic Brain Injuries (TBI), PTSD, and other neurological conditions, GyroStim provides a controlled means to incrementally challenge and safely recondition balance, reaction skills, and other cognitive functions while addressing symptoms such as headache, dizziness, nausea, anxiety, and fogginess. See more on our GyroStim page.