CONCUSSION
FACTS

 
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What is a concussion?

A concussion is a brain injury that results in disruption in neurological functioning following a significant impact to the head or elsewhere on the body. This can affect the function and communication of key neural areas in the brain causing a biochemical imbalance within brain cells as well as decreased blood flow and temporary energy deficits within the brain. The resulting dysfunction may not show up on traditional neuro-imaging such as CT scan or MRI.

A concussion does not always result from direct contact to the head and/or loss of consciousness.

If you suspect that you or someone else has sustained a concussion, removal from the activity/sport and referral to a physician or nurse practitioner should always be considered. Ideally the individual should be placed on complete rest in order to recover from the energy deficit. This is particularly true for children and adolescents and in recreational sports where on-site trained medical care is usually absent. For non-sport concussions, stopping all activities and starting complete rest is also necessary. Assessment by a trained and knowledgeable health care professional is recommended within the next 24-48 hours to confirm whether or not a concussion has occurred. Best practice is rest without screens. 

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What’s changed in concussion rehab and management?

It was previously recommended that concussed individuals rest until all symptoms were gone. However, for many, symptoms changed over time and often patients felt worse and experienced more distress. Researchers have shown that continued rest after 5-7 days may not be as helpful as once thought.

Current international consensus states that too much rest may promote prolonged symptoms. After 24-48 hours of rest, patients are encouraged to gradually begin activities that do not worsen their symptoms. Activities can include light exercise and cognitive tasks.

There is NO need to wake a concussion patient every 2 hours. 

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What type of symptoms should one look out for?

  • Headache, dizziness, nausea and/or vomiting

  • Difficulties with vision, balance, and/or coordination

  • Tolerating light and/or noise

  • Changes in mood (foggy, frustration, rapid changes in emotions, feeling anxious, and/or sad)

  • Difficulties with decision-making, memory, attention, and/or concentration

  • Changes in sleep quality (too much or too little, not falling asleep and/or staying asleep)

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What are “red flag” concussion symptoms?

A “red flag” is meant to indicate danger, or high alert. They are helpful to ensure there are no serious injuries present, like bleeding into the brain or brain swelling. If “red flags” are present, immediate medical care should be sought.

 

Danger sign and symptoms for adults

  • Headache that gets worse and does not go away.

  • Weakness, numbness or decreased coordination.

  • Repeated vomiting or nausea.

  • Slurred speech.

The people checking on you should take you to an emergency department right away if you:

  • Look very drowsy or cannot be awakened.

  • Have one pupil (the black part in the middle of the eye) larger than the other.

  • Have convulsions or seizures.

  • Cannot recognize people or places.

  • Are getting more and more confused, restless, or agitated.

  • Have unusual behaviour.

  • Lose consciousness (a brief loss of consciousness should be taken seriously, and the person should be carefully monitored)

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Danger signs symptoms for children with concussion

Take your child to the emergency department right away if they received a bump, blow, or jolt to the head or body, and:

  • Have any of the danger signs for adults listed above.

  • Will not stop crying and cannot be consoled.

  • Will not nurse or eat.

If there are no red flags then rest at home is the best medicine in the first day or two. Then it’s time to have the concussion assessed. 

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How long can it take for me to recover?

Just because you may no longer be feeling any symptoms, it still may take time for your brain to recover fully from a concussion. To know when the brain has fully recovered and is out of the “vulnerable period” you must undergo some testing for different aspects of current brain function. This post injury assessment is multi-modal. It evaluates symptoms along with memory, concentration, balance and proprioception, eye movements, reaction time and strength, all shown to possibly be impaired following a concussion. For individuals in high-risk sports (e.g. football, hockey or rugby), computer based neurocognitive testing may also be performed.

Fortunately, the concussion recovery time for about 80-90% of people is less than a month. Many recover in about two weeks. Younger athletes generally take longer. Each concussion is different, so a person’s concussion recovery time may take a little less or a little more time.

Patients who are not recovering in this time frame require re-evaluation, and adjusting rehab to address any persisting symptoms.