Posted tagged ‘TBI’

Concussions are brain injuries

February 19, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

Many parents (and even some teenagers) realize that kids are going to be using their brains at some point in their lives. I’m getting more and more questions about the effects of concussions—are they going to lead to trouble, down the road? How can they be prevented and treated?

First: let’s abandon the term “concussion.” It’s a weird word that waters down a much simpler term: traumatic brain injury. A concussion is a mild brain injury caused by trauma. So let’s just call it that, “mild traumatic brain injury.” Wordy, but those words say a lot more to parents and children than “concussion.”

How do you know a brain has been injured? Simply enough, it stops working right. A person who’s had a blow to the head followed by a period of brain-not-working has had a brain injury, a “concussion”. The symptoms could include, after the injury, a period of confusion or dizziness or a feeling that you’re “not all there.” Sometimes, but not usually, there’s a brief loss of consciousness. That worth saying again: people who’ve had a mild traumatic brain injury usually do not get knocked out. They just feel knocked around. Later, there are continued symptoms like headache, dizziness, a “fuzzy brain” feeling; sometimes there are also problems with moodiness or irritability, or trouble with sleep cycles. Again, remember, these are all symptoms of an injured brain.

People understand the concept of injuries. You injure your ankle, you expect to need to rest it. Everyone knows rest is the best way to prevent an injury from getting worse, and rest is the best way to prevent an even-worse re-injury. We instinctively know that during rehabilitation for an injured ankle, you’ll kind of walk and run funny—which puts you at risk for other injuries, too.

All of these concepts are exactly the same for concussion, and that’s easy to explain if you remember to think of a concussion as a “traumatic brain injury”. Rest is the key, to allow the brain to heal, to prevent worsening damage from continued trauma, to prevent re-injury of the brain, and to prevent injury of other body parts because you’re not performing well with an injured brain. See? Easy as an ankle to explain.

Of course, resting a brain isn’t exactly as simple as resting an ankle. We can’t use a sling or an ACE wrap (well, you can, but you’ll look weird and it won’t help.) Resting a brain means, well, brain rest: no intellectual work, no school, no physical exercise. Just like you’d rest an ankle until it felt better, resting a brain after it’s injured should continue until there are no symptoms of injury. No headaches, no sleep problems, no fuzzy brain, no dizziness, no trouble focusing. When all of these symptoms have abated, people with mild traumatic brain injuries should gradually advance to more-intense schooling and activities, step by step, until the patient is back up to full activity. If there’s a step backwards—if brain symptoms begin—do exactly what you’d do if your ankle starts to hurt again. Back off the activity and allow more time to heal.

There’s good evidence that allowing a period of time to rest and heal after a mild traumatic brain injury can help prevent re-injury and longstanding symptoms—but we don’t know exactly how long the rest should be. One recent study showed that to a point, too much rest for too long can actually worsen and extend symptoms. Once symptoms improve, it’s a good idea to start back on activities (start slow and advance step by step) rather than continue through a fixed number of days of rest. We have some work to do to fine tune and individualize the best concussion care advice.

While a single concussion, especially with appropriate treatment, is unlikely to lead to long term problems, there are some sobering concerns about people who’ve had multiple concussions. There’s an increased risk of long term cognitive decline, movement disorders, and depression. And we know many athletes under-report concussions. In one study, 30% of high school football players reported a history of concussion, but only half of those had reported the injury. There may be far more concussions injuring far more high school brains than we appreciate.

As I said, many of those brains are going to be used later. Maybe we ought to try to do a better job keeping them in good shape.

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Football and your child’s brain

May 20, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Eat your vegetables. Be good to your momma. Change your underwear.

Good, solid advice. Maybe we need to add: “Don’t damage your brain. You’re going to need it someday.”

More and more evidence is accumulating that football, or at least football as it’s currently being played in high schools and colleges, is causing irreversible brain damage. The latest study was published in JAMA this week. Researchers looked at 25 collegiate football players (who had played in high school), and compared both brain imaging and cognitive performance with students who hadn’t played college. They correlated their findings with the number of years of football experience, and the number of recalled concussions.

Bottom line: concussions correlate with a loss of brain volume in the hippocampus, an area of the brain involved with memory recall and the regulation of emotions. Not only were concussions correlated, but  the number of years playing football also correlated with this change in MRI scans and with deficits in cognitive testing, including tests of reaction time and impulsivity.

The study itself wasn’t large, and relied only on the students’ recall of concussions. And it does not establish causality—maybe people with smaller hippocampi are more attracted to football, or tend to have more concussions (though no other research suggests this). Still, studies like this add to the considerable evidence that the kind of high-impact head trauma that occurs during football is causing real damage to real brains.

What can we do about it? There are steps individual families can make to protect their own children, especially by recognizing and treating concussions when they occur. Beyond that, we’ll have to see if coaches, athletes, and families are willing to risk brain damage to continue traditional football programs. Are the benefits worth the risk? It’s time to talk about it.