In November of 2000, 10-year-old Christopher knocked himself
out when he ran into a soccer goal post at school.
Christopher was lucky. His concussion was mild and he was back to school after 10 days of rest. He was also lucky because his father is
a neuropsychologist who specializes in concussion at a Toronto hospital, so he knew what to do.
The rest of us aren't that fortunate.
Toronto Family Physician Dr. Maria del Junco agrees. "We know very little about concussion", she says. "There are no guidelines for
diagnosis or management and the resources are sketchy".
But it looks like things are changing.
Most doctors know very little about concussion. They obviously feel poorly prepared and want to know what
to do. I once received an e-mail regarding when or whether a child could return to play after a concussion. The e-mail was from his parents,
both of whom are physicians.
(Psychologist Dr. Barry Willer, Professor at The Sports Medicine Institute at the University of Buffalo and an Adjunct Professor at
Brock University.)
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Subject of research
As this article is being written, there are at least six concussion studies going on in Canada. Researchers are looking at the following
questions:
- How does concussion affect the brain, both immediately after the injury and over time?
- How do we diagnose and manage concussion?
- What kinds of sports equipment and standards should be adopted to prevent concussion?
- When is it safe to return to play?
The last point, determining when it's safe to return to play, is where concussion research is going.
Once you've had a concussion, you are four times more likely to experience another one if you go back to
the activity that caused the concussion before you are completely recovered. One concussion on top of another causes far greater damage
than either one alone.
(Dr. Barry Willer)
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Although there is no rule about the number of concussions that will make the damage permanent, people with permanent brain injuries
have to deal with devastating consequences including:
- Personality changes
- Inability to process information
- Short-term memory loss
- Depressive symptoms
- Fatigue
- Sensitivity to light and/or sound
Often, people with permanent brain injuries can't do things as simple as get to the corner store and back or remember their own phone
numbers and are often frustrated by the lack of services available to them.
What is a concussion?
A concussion is a change in mental status that happens when a blow or jolt to the brain causes the brain to move in the skull. The
movement causes biochemical changes in brain cells. Having a concussion does not necessarily mean a loss of consciousness, but may include
symptoms like disorientation, poor coordination, and even vision difficulties.
How to treat concussion
So what do you do if you or someone you care for hits his or her head in a hockey game or a car accident?
Falls from a bike or a skateboard?
Slips in a bathtub or on the ice?
Dives into a pool without checking the water level?
Even though everyone agrees there is there is still a lot to be learned, opinions on how to treat concussion are pretty well unanimous.
How to treat concussion:
- Take children to the doctor whenever they hit their heads, whether the blow causes unconsciousness or not. Children are not as
susceptible to unconsciousness as adults.
- Take adults to the doctor if the blow causes unconsciousness.
- Wake the person up every two hours for the first 24 hours after a concussion. Ask something simple such as his or her name. If
thinking has deteriorated, get them to a doctor.
- The only true cure for a concussion is time and rest. Most people with mild concussions will feel better in a few days.
Cognitive changes however, make take longer to resolve.
- See a doctor if the following symptoms appear:
- Headache
- Dizziness
- Nausea
- Listlessness /fatigue
- Sleep disturbance
- Loss of balance
- Concentration, confusion or memory problems
- Sadness
- Irritability
- Do not use any medication, alcohol or street drugs without checking with your doctor. They could increase the chance of
complications.
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Concussion statistics
- A concussion occurs every four minutes in Canada.
- About 144,000 Canadians receive a complex concussion each year. (This does not include the severe brain injuries that generally
result from automobile crashes.)
- The average age of a first concussion is 10. The vast majority of concussions occur in young people.
- If you have already had one concussion, you are 4 times more likely to experience a subsequent concussion.
- About 20% of concussions result from organized sports activities and the rest from motor vehicle accidents, work-related
accidents, accidents in the playground or interpersonal crime.
- Over 60 children in Canada die in bike accidents every year, most from brain injuries.
Source: Ontario Brain Injury Association
How to prevent a concussion. Wear the right helmet!
There is still some disagreement between parents and schools about which helmets children should wear for ice-skating. Some parents
send their kids to skate wearing bicycle helmets, usually because they already own them. Unfortunately, bike helmets are not suitable
for a fall on the ice. They are constructed of collapsible foam, which is designed to absorb the energy of a single impact. Once that
impact has occurred, the helmet should be thrown away. Approved hockey helmets are the only safe helmets for ice skating of any kind.
The following is a compendium of prevention information from all the sources listed above plus ThinkFirst a
national and international brain and spinal cord injury prevention foundation.
When moving
- Wear a SNELL, CSSA-approved bicycle helmet and protective gear when riding a bicycle, skateboard or in-line skating.
- Wear neon, fluorescent or other bright colours when bicycling during the day.
- If you have to ride at night, wear something that reflects light, make sure you have reflectors on the front and rear of your
bike and that you headlight is on.
- Wear a motorcycle helmet when riding a motorcycle.
- Wear hockey helmets when playing hockey and when ice skating. Do chin straps up securely. Children playing hockey should also
wear a visor.
- Wear a seatbelt when driving or riding in a car.
- Follow manufacturers' instructions for children's seatbelts. They usually involve booster seat and specific instructions for
attaching the seat belt.
- Wear protective helmets on construction sites.
Outdoors
- Make sure playground surfaces are soft and free of debris or rocks.
- Wear shoes designed for ice when walking outdoors in the winter.
- Salt icy spots on your walk or stairs.
- Mark swimming pools clearly with height of water
Indoors
- Pad corners on tables to prevent infants' heads from getting hurt.
- Secure non-skid mats in the tub to prevent slipping.
- Install carpeting on stairs and add hand railings to prevent slipping.
- Remove loose rugs for children and the elderly.
- Install lighting in dark stairwells.
Although the vast majority of international concussion research is in the United States, Dr. Willer expects that Canadian research will
make some important contributions which will make all of us almost as lucky as Christopher.
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This article was prepared by Heather Chisvin for CHN. Heather Chisvin is a Toronto writer.
