Concussions

         Every year in Ontario an estimated 80,000 people suffer a concussion, or mild traumatic brain injury. Of those, as many as 16,000 can experience lingering, troublesome symptoms for more than three months. Nearly a decade later, this incidence rate is widely thought to be considerably higher.

       Concussion is commonly thought of as a sports injury but the reality is that many concussions, or mild traumatic brain injuries, come from mishaps of daily living, such as slipping on the ice while walking the dog, falling down the stairs at home, or being in a car crash.

Important Points about Mild Brain Injury

•   You had a mild brain injury or what is sometimes called a concussion. Most people recover quickly

following a mild brain injury. A few people may experience symptoms over a longer period.

•   There is a small risk of you developing serious complications so you should be watched closely by

another adult for 24 hours after the accident.

•    Please read the following. It outlines what signs to look for after a brain injury and what you need to do

if you have problems.

Warning Signs

If you show any of these symptoms or signs after your brain injury, or you get worse, go to the nearest hospital, doctor or call 911 immediately.

• Fainting or blacking out, drowsiness, or can’t be woken up

• A constant severe headache or a headache that gets worse

• Vomiting or throwing up more than twice

• Cannot remember new events, recognise people or places (increased confusion)

• Acting strange, saying things that do not make sense (change in behaviour)

• Having a seizure (any jerking of the body or limbs)

• Inability to move parts of your body, weakness in arms or legs, or clumsiness

• Blurred vision or slurred speech

• Being unsteady on your feet or loss of balance

• Continual fluid or bleeding from the ear or nose

 

The First 24-48 Hours After Injury

• Warning Signs: You should be observed and return to hospital if you develop any of the above warning signs.

Rest/Sleeping: Rest (both physical and mental) and avoid strenuous activity for at least 24 hours. It is

alright for you to sleep tonight but you should be checked every four hours by someone to make sure

you are alright.

Driving: Do not drive for at least 24 hours. You should not drive until you feel much better and can

concentrate properly. Talk to your chiropractor or doctor.

Drinking/Drugs: Do not drink alcohol or take sleeping pills or recreational drugs in the next 48 hours. All

of these can make you feel worse. They also make it hard for other people to tell whether the injury is

affecting you or not.

Pain Relief: Use acetaminophen or acetaminophen/codeine for headaches (e.g., Tylenol).

• Sports: Do not return to sports until you have received medical clearance from your health care provider.

See your local chiropractor or doctor if you are not starting to feel better

within a few days of your injury.

 

The First 4 Weeks After Injury

You may have some common effects from the brain injury which usually resolve in several weeks to three months. These are called post concussion symptoms (see below). Tiredness can exaggerate the symptoms. Return to your normal activities gradually (not all at once) during the first weeks or months. You can help yourself get better by:

Rest/Sleeping: Your brain needs time to recover. It is important to get adequate amounts of sleep as

you may feel more tired than normal and you need to get adequate amounts of both physical and

mental rest.

Driving: Do not drive or operate machinery until you feel much better and can concentrate properly. Talk

to your chiropractor or doctor.

Drinking/Drugs: Do not drink alcohol or use recreational drugs until you are fully recovered. They will

make you feel much worse. Do not take medication unless advised by your doctor.

Work/Study: You may need to take time off work or study until you can concentrate better. Most people

need a day or two off work but are back full time in less than 2 weeks. How much time you need off work

or study will depend on the type of job you do. See your chiropractor or doctor and let your employer or

teachers know if you are having problems at work or with study. You may need to return to study or work

gradually.

Sport/Lifestyle: It is dangerous for the brain to be injured again if it has not recovered from the first

injury.Talk to your chiropractor or doctor about the steps you need to take to gradually increase sports

activity and return to play. If in doubt, sit out.

Relationships: Sometimes your symptoms will affect your relationship with family and friends. You may

suffer irritability and mood swings. See your doctor if you or your family are worried.

 

Recovery

• You should start to feel better within a few days and be ‘back to normal’ within about 4 weeks. See your chiropractor or doctor if you are not starting to feel better.

• Your chiropractor or doctor will monitor these symptoms and may refer you to a specialist if you do not improve over 4 weeks up to 3 months.

Post Concussion Symptoms

There are common symptoms after a mild brain injury. They usually go away within a few days or weeks. Sometimes you may not be aware of them until sometime after your injury like when you return to work.

 » Mild headaches (that won’t go away)

Headaches are a common problem after a mild brain injury. They can be made worse by fatigue and stress. Sleeping, resting or taking a break from activities requiring concentration or effort will usually relieve headaches. Pain relievers may help to break a cycle of headaches – use acetaminophen or acetaminophen/codeine, limited to <15 days per month. If your headache gets worse, or cannot be relieved, see your chiropractor or doctor.

 » Having more trouble than usual with attention & concentration

No one can concentrate well when they are tired, so it is not surprising that many people have trouble concentrating for a while after they have had a mild brain injury. Maybe you cannot even concentrate well enough to read the newspaper. If you really need to, just read for a short time, and then come back to it when you have had a break. The same thing applies to other areas where concentration is needed. Leave things that need your complete concentration until you are feeling better. If you need to concentrate on something important, do it when you are feeling fresh.

» Having more trouble than usual with remembering things (memory difficulties/forgetfulness)

You cannot expect your brain to be as good at remembering things as it usually is. Don’t worry if you can’t think of a name or a phone number that you ought to know, or if you go to get something, and then can’t remember what it is. Your memory is only going to be a problem until you recover. In the meantime, get your family and friends to remind you of important dates and appointments, or write things down.

» Feeling dizzy or sick without vomiting (nausea)

Occasionally, people find that they get a sick or uncomfortable feeling if they move or change their position quickly. Usually it is only a problem for a few days. If you find that things seem to spin round if you sit up suddenly after lying down, or if you turn your head sharply, it is best to avoid such sudden movements or changes in position until it clears. If the dizziness persists for more than a week or two, see your chiropractor or doctor.

» Balance problems

You may find that you are a bit more clumsy than usual. Don’t worry if you do find that you are a bit unsteady on your feet, or bump into furniture, or maybe drop things. Just take everything you do a little more slowly. Your brain is the control centre for your whole body. It has to make sense out of all the messages coming in from your eyes and ears and other senses, and to send the right signals to the right muscles for you to be able to do anything. So give yourself more time to do things.

» More difficulty than usual with making decisions and solving problems, getting things done or being organized

You may find you are less able to plan ahead or follow through the steps that are required in carrying out an activity. These kinds of difficulties may cause particular problems during the first few days after a mild brain injury but they are usually temporary in nature. When facing situations that present problems or opportunities to plan, it may help to think things through in a more structured and objective way. For example, you may want to ask yourself a series of questions like:

1. What do I want to achieve?

2. What are the available options?

3. What is the best option?

4. What steps will I need to take to achieve this?

After these questions have been considered and answered, you can then carry out your plan. Writing down a goal, plan or problem also helps to give structure to your thinking and helps to make things clearer. Using a daily and weekly time table, planner, or keeping a diary can provide structure and ensure that plans are made routinely and on an ongoing basis.

» Feeling vague, slowed or ‘foggy’ thinking

Some people who have sustained a mild brain injury find their thinking is a bit slower. This means they might have some difficulty keeping up with conversations or following directions, and things take longer to get done. Encourage others to slow down by asking questions and having them repeat what they have said. Allow yourself extra time to complete tasks and avoid situations where you are under pressure to do things quickly.

» Balance problems

At first, even a little effort may make you feel very tired. Your brain has less energy to spare than it normally does.If you feel sleepy, go to bed. You will probably find that you need several hours more sleep than you usually do. Let your brain tell you when it needs to sleep, even if it is the middle of the day.

» Tinnitus. Ringing in the ears.

Tinnitus is due to damage to the inner ear after brain injury. It is usually described as a whistling, ringing or roaring sound and may be accompanied by some hearing loss. It usually settles on its own within a few weeks after injury. If the ringing in your ears gets worse or does not go away, see your doctor. Reduce your normal intake until you feel fully recovered.

» Irritability/mood swings. Losing your temper and getting annoyed easily

Some people who have had a mild brain injury find that they get annoyed easily by things that normally would not upset them. This does not last very long, but it can be difficult for you and for your family. It happens because the brain controls your emotional system as well as the rest of your body. After a mild brain injury your emotions may not be as well controlled as they usually are. There are several ways to deal with this. Some people find that going out of a room, or away from a situation as soon as it begins to get annoying is enough. Others use relaxation techniques (controlled breathing, progressive muscle relaxation) to help them get back on an even keel. You may find that you can stop the irritability from developing by doing an activity that uses up some physical energy like riding an exercise bicycle, if tiredness permits. Irritability will be worse when you are tired, so rest will also help.

» Anxiety or depression

Feeling anxious, worried, frightened, angry and low in mood are normal emotions after sustaining a mild brain injury. These feelings often pass in the weeks following the injury, as a person gradually resumes their usual activities. Recognise that emotional upset and worry is a normal part of recovery, even though you may have suffered an injury in the past and not felt like this before. Explain any difficulties that you are experiencing to your family and friends, so that they can understand the effect the injury has had on you and support you in managing your difficulties. Recognise if your worry about symptoms intensifies and a vicious circle develops. If that happens remind yourself of the point above. If symptoms nevertheless do not improve, or if you have suffered from anxiety or depression before the injury and the brain injury has intensified those feelings, visit your doctor.

» More sensitive to lights or sounds

You may find that your eyes are sensitive to bright light. Wearing dark glasses in strong light can help to manage this and the need for dark glasses will likely clear up within a few days. When you want to shut out something you don’t want to look at, all you have to do is close your eyes. It is much harder to shut your ears. When your brain is fully awake it uses part of its energy to dampen down noises that would interfere with what you are doing. After a mild brain injury your brain may not have enough energy to spare to do this, and you may find that most noises bother you. Explain to your family and friends, and ask them to keep the noise level down if they can.

» Change in sleep patterns. Trouble sleeping or sleeping too much.

Don’t worry about the sleep disturbance. This is usually temporary and your normal routine will come back gradually. If you are having trouble falling asleep you may try things like reducing stimulation by not watching TV in bedroom or spending long times on the computer, avoiding a large meal before bed, avoiding caffeine, using relaxation techniques (controlled breathing, progressive muscle relaxation), or getting up for about 30 minutes if you are unable to sleep for long periods. It is best to avoid sleep medications but if your sleeping pattern has become very disrupted, discuss with your doctor if a short course of medication may be helpful in re-establishing your sleeping pattern.

» Reduced tolerance to alcohol.

After a mild brain injury you may be more sensitive to the effects of alcohol. A small amount may worsen the effects of the brain injury. It can cause unsteadiness and dizziness which may lead to a fall and further injury. It is sensible to avoid alcohol for at least one week after injury and then monitor carefully how alcohol affects you. Reduce your normal intake until you feel fully recovered.

 

Information included here was adapted from the Motor Accidents Authority of NSW, Guidelines for

MildTraumatic Brain Injury following Closed Head Injury (MAA NSW, 2008) and the Information about Mild Head

Injury or Concussion booklet (Ponsford, Willmott, Nelms & Curran, 2004).

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