It can happen when least expected. You’re driving down the street obeying all the rules when all the sudden another vehicle comes out of nowhere. Bam!
Moments later you waken, surrounded by flashing emergency vehicle lights. Still in the driver’s seat, the EMT tells you to stay put while she does her assessment. Other than the brief flash of the car speeding toward when you entered the intersection, you remember nothing until hearing the sound of the EMT’s voice.
Fortunately, you don’t suffer any broken bones or external injuries. You’re pretty shaken and a little sore, but “Other than that,” you tell the EMT, “I’m fine.”
And yet, in the days to come, you find, something is different—maybe you’re not so fine. You begin to be more confused, your vision seems to blur, you find yourself too nauseous to eat, the headaches never go away, and you can’t seem to get to sleep.
What you’ve likely suffered is a concussion.
What is a concussion?
A concussion is a traumatic brain injury. But, it’s a milder one, and so it can be harder to diagnose. According to a recent survey by NPR-Truven Health Analytics, one-fourth of all Americans have had a concussion.
Even though you may not have had an injury to your head in the crash, you could still have suffered a concussion. The brain can be injured from shaking inside the skull when your body is jolted or when your car is moving and suddenly decelerates or comes to an unexpected stop. Even if your head doesn’t hit the steering wheel, you can still have a brain injury. And interestingly enough, helmets provide limited protection for these inertial effects—unfortunate news for athletes in football and other high-impact sports.
Even more interesting is that a concussion affects people differently because of anatomical differences for different age groups and genders. For instance, the youngest brains (up to age 5) have less protection because the skull is softer, while elderly brains are more vulnerable if there has been shrinkage of the brain due to aging. Although to date, there isn’t strong scientific research to substantiate the differences in vulnerability of the brain due to gender differences, girls and women may be more likely to report symptoms or even have different vulnerabilities due to anatomy or other biological factors.
Causes of brain injuries also vary; with young people, they are more likely to have injuries due to sports and recreational activities while very young and older individuals are more likely to have a concussion or other injury due to a fall.
Dr. Elizabeth Sandel has specialized in caring for patients with brain injuries for more than 30 years and is board-certified in physical medicine and rehabilitation and brain injury medicine (BIM). She has worked with patients of all ages as well as athletes, veterans, injured workers, and victims of violent crimes. She is currently a medical director for Paradigm Management Services, which provides case management to those with concussions and severe brain injuries.
Here are four things you should do if you experience a head injury:
- Stop doing the activity you were doing. Your brain and your body need rest immediately following the injury. Stop the activity immediately. In the case of sports or recreational activities, sidelining or taking a break isn’t enough. You need to stop the activity for at least that day.
- Call for help. In some situations, you might be by yourself when you have a concussion. If there is no one else around, reach out to a family member, friend, or neighbor to watch over you. You need someone to be with you in case your condition deteriorates. If your symptoms intensify (i.e., you fall into a deep sleep and are difficult to arouse, you have severe headaches and confusion, your balance worsens or you become weak, or you have severe vomiting or abnormal movements), your caregivers must call 911.
- Get a same-day assessment. You should be seen by a physician who has training in the evaluation of concussions. If your initial symptoms are relatively mild, try to schedule an appointment with your primary care physician. If your symptoms are severe, get immediate transport to an emergency room or urgent care facility. The physician should ask you about your history, conduct a thorough physical examination, and use validated tests to diagnose your condition. Cognitive testing, or testing of your mental processes of attention, memory and perception, judgment, and reasoning, are important.
- Get follow-up care. A second evaluation with the same physician or with another qualified medical professional may be necessary if your symptoms do not resolve after 7-10 days. As with the initial visit, the provider should be someone who has training in concussion evaluation and management. The follow-up care plan should include:
- Using a symptom checklist to following your symptoms until you are fully recovered
- Examining you carefully with a cognitive and physical examination specifically designed for people with concussions
- Ordering additional tests or more extensive evaluations, such as a neuropsychological evaluation, if needed
- Treating you with medications and, if needed, ordering physical or cognitive therapy
- Determining when you can return to activities, including sports, recreation, school, or work
A key concern with concussions is that symptoms may initially appear mild, but can become worse, and chronic or new symptoms can emerge over time. You may begin to have recurring headaches or neck and shoulder pain. You may find yourself having trouble remembering things. Your concentration may wane and you may begin to have trouble processing information. You may find yourself fatigued and yet unable to fall asleep or stay asleep. Or you may want to sleep all the time. Some people develop sensitivity to light and sound and have mental and physical fatigue. And many become more irritable, which is one of the ways people close to you will know something is really amiss.
If you continue to have symptoms over the weeks and months following a concussion, a condition known as post-concussive syndrome, there are some specific measures you should take:
- Minimize the amount of time you spend reading, watching television, or using electronic devices (computer work, texting, etc.)
- Talk with your physician about taking additional time off from work or school
- Take time off from exercise or physically stressful activities if your symptoms worsen
- Watch your balance and use an assistive device, if needed
- Avoid caffeine, especially after the morning hours
- Eat well and stay hydrated
- Avoid alcohol and any drugs not prescribed by your physician
A concussion clinic or center with a team of providers—physicians such as physical medicine and rehabilitation physicians, speech/language pathologists and occupational therapists (cognitive therapists), physical therapists, optometrists, and neuropsychologists—provide an ideal treatment venue for people who have post-concussive syndrome.
A team of specialists such as these can determine if your symptoms are related to other issues including depression or other mental health conditions, or post-traumatic stress disorder (PTSD). With PTSD, symptoms can be different than or similar to a concussion which makes the diagnoses difficult. PTSD symptoms may include recurrent nightmares about the incident, withdrawal or isolation, feelings of sadness or hopelessness, frequent thoughts about death or dying, or even serious thoughts about inflicting harm on yourself or others. If you have any of the symptoms of PTSD, contact your physician immediately.
Getting back to normal activities
When returning to mental or physical activity, the key is to start slow. Get advice from your doctor and other providers about when to resume activities, especially those that put you at risk for another concussion. Stay in touch with your provider on your progress. If symptoms return or worsen, stop your activity and give yourself more time to recover with help from your providers until it’s safe for you to get back on the road again.