Concussion, post-concussive syndrome, Traumatic Brain Injury (TBI), Chronic Traumatic Encephalopathy (CTE): All these terms have a place in the neurologist’s nomenclature describing the pathophysiology resulting from a blow to the head.
Arguments about which applies where and the desire to find a definitive diagnostic is a hot topic of discussion.
This article intends to inform and advocate for the role all providers have in protecting patients from the cognitive damage associated with concussion.
The confusion surrounding concussion should not deter primary care providers from doing what they do best: Provide evidence-based, common sense health advice.
Concussion in brief
Simply put, a concussion involves damage done to structures of and surrounding the brain as a result of a mechanical injury. Determining severity can be done with a variety of diagnostic tools, including the mild, moderate and severe scale used for TBI.1
Half a million children are treated for concussion each year in US emergency rooms. Half of these are due to falls. The CDC expects that the actual number of concussions is much higher, with a large number going unreported.2
Symptoms of concussion are as basic as they are vague, hence important for patients and parents to understand.
Headache, light sensitivity, dizziness, labile mood and inability to maintain focus, anywhere from immediately to several days post-injury are important to note in recognizing a concussion.3
Treatment is unique to the patient, but nearly all will include rest. Both body and brain are included, patients are counseled to avoid screens, cognitive work and physical exertion.
Concussion and cognitive damage
In the past decades, football has earned the most headlines when it comes to concern over head injuries. However, other sports common in high school and college have similar profiles for injury.
For example, soccer has a similar risk as football with many players at the college level sustaining a concussion during the season.
Evidence is growing that supports several theories showing variables that create a higher risk for long term impacts of concussion.
If injury occurs in a younger, growing brain, risk is elevated across the lifespan for sequelae such as headaches, mood disorders, issues with concentration and risk for additional injury to the brain.
Also, the commonsense notion that multiple mild injuries to the brain create a cumulatively profound symptomology.
The lack of recovery time between injuries also compounds damage, with year-round sports contributing to greater harm. Cognitive capacity is lessened by each additional injury.4
Advice for parents and players
The annual checkup is prime opportunity for providers to educate parents and adolescent patients on facts about concussion and opportunities to prevent damage.
- Some sports are higher risk than others, but common sense deems that any sport requiring a helmet is high likelihood for head injury. Sports that require head contact with balls (soccer), mats (wrestling), sticks (lacrosse), also carry risk.
- Developing brains are more vulnerable to long-term negative cognitive effects from even mild concussions.
- A series of concussions, no matter how mild, has the potential to diminish the brain’s ability to achieve optimum performance.
- Year-round sports engagement exposes children to greater risks and deprives the brain of rest and recovery time between seasons.
- For those aspiring to professions requiring peak cognitive performance, chancing lost ability to focus and process caused by concussions might either warrant a strategy to mitigate or be too great a risk.
A conversation covering awareness of risk and informed choices about engaging in sports is worth having with all patients of sports-playing age. The decisions made by patient and family will be individual to their beliefs, aspirations and values.
Despite the complexity of concussion and TBI pathophysiology and its sequelae and the science still in development, primary care providers are in a unique position to give life-altering advice to their patients.
We can inform and advise and hopefully save young patient’s brains from the damage that may impact the rest of their lives.
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- O'Neil ME, Carlson K, Storzbach D, et al. Complications of Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review [Internet]. Washington (DC): Department of Veterans Affairs (US); 2013 Jan. Table A-1, Classification of TBI Severity. Available from: https://www.ncbi.nlm.nih.gov/books/NBK189784/table/appc.t1/
- Heads Up. Centers for Disease Control and Prevention. https://www.cdc.gov/headsup/resources/graphics.html. Published February 16, 2015. Accessed December 2, 2019.
- Fidan E, Lewis J, Kline AE, et al. Repetitive Mild Traumatic Brain Injury in the Developing Brain: Effects on Long-Term Functional Outcome and Neuropathology. Journal of Neurotrauma. 2016;33(7):641-651. doi:10.1089/neu.2015.3958.
This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of Optum Care. The views and opinions expressed may change without notice.