Head injuries and brain injuries come in all sort of ways. Some are little bumps on the head, others are damage to the brain tissue. The skin or skull might be damaged or not. Consciousness can be lost, or the person might maintain wakefulness. There is one type of injury that is a bit more difficult to detect. That is a concussion.

There is a lot of news about concussions these days. This has been propagated by sports injuries. Boxing was one of the first to relate blows to the head leading to Parkinson's Disease. American football players have been taking up the issue citing numerous blows to the head during play. Better protective gear has been a result of both and awareness has increased.

A concussion is an injury to the brain from inside the skull. Your brain floats in a cerebral spinal fluid within the skull. This spinal fluid circulates around the brain and the spinal cord. It is an immediate layer of protection of the delicate brain and spinal cord tissue. Other protections are the bones (skull and vertebrae), followed by soft tissue of the body (muscles), and finally skin. Because the brain is floating in this fluid, there is a tiny bit of ‘give' to its position. However, with trauma, the brain can bump up against the skull leading to damage of the tissue.

The most noted causes of concussion are from rough activity such as sports and fighting. However, accidental causes are far more common. These include work-related injury and car crashes. Falls are a huge source of concussions. Because of the head being proportionately larger in children, falls will propel the head faster to the ground. A concussion can occur from playground activities and biking without helmets. Some think concussion in adolescents might be increased because of the rapid body growth resulting in some incoordination. In adults, falls from the same level or changes in levels can lead to a concussion.

A concussion is sometimes difficult to recognize because there often is no visible sign of injury. There might be a bump or bruise but mostly there is no sign on the outside of the body. Knowing that there was an injury can help to diagnose a concussion. If there was an injury to the head or forceful bending of the neck, consider it an alert that a concussion could be possible.

Brain scansA person with a concussion might display mental status changes such as being dazed, dizziness, feeling confused, clumsiness, slurred speech, ringing in the ears, sensitivity to light, noise, or memory loss. Very important to notice is nausea, vomiting, headache, and sleepiness. You might eventually notice personality changes and memory loss. As noted from last week's blog, the brain is very complicated. A person might have one, some or all these symptoms depending on the location(s) of the injury to the brain.

A concussion is a traumatic brain injury. A person might have a blow to the head without injury to the brain. Others might have a concussion with symptoms not evident until much later. Others might not show symptoms until repeated injuries have occurred. The level of brain function could be small as in mild traumatic brain injury (mTBI) to extremely severe or anywhere in between.

Three grade levels are used to rate concussion. Grade 1 is mild with symptoms lasting only about 15 minutes. There is no loss of consciousness. To know about the loss of consciousness, the injury must be witnessed as the injured person will not be able to recognize if consciousness was lost or not.

Grade 2 level of concussion is no loss of consciousness, but symptoms last for longer than 15 minutes. Grade 3 is the loss of consciousness for any period of time, even just a few seconds. If you witness an accident, consciousness can be hard to assess as immediately after the accident, the affected person might be in shock and therefore not responding for a short time. Be sure to relate this information to the healthcare professional as loss of consciousness can be unknown even in a witnessed event.

Assessment and treatment of concussion are imperative. If someone seriously bumps their head, be sure to have an evaluation by a healthcare professional. It can be difficult to decide if assessment and treatment are needed. For example, toddlers fall and bump their heads often without incident. Adults might refuse assessment as they think they will just ‘walk it off' or ‘tough it out'.

If there are any symptoms of concussion or loss of consciousness, a medical assessment is necessary. Any hard bump to the head should be assessed even without symptoms. Loss of consciousness requires a medical evaluation. Just because time has passed since the head injury, does not mean that you do not need assessment. Symptoms of concussion can show up later. Symptoms can worsen over time. It is never too late to be evaluated for a concussion.

Testing for a concussion includes questions about orientation, name, address, etc. Reflexes will be tested to check connections in the central nervous system. This is to make sure messages from the brain through the spinal cord are being sent and received. You might have a CT scan or MRI to view your brain and perhaps neck. Often, the physical assessment and neuropsychological testing are the best evaluation of concussion as an injury to your brain might not be viewed on scans.

Treatment for a concussion is tailored to the needs of the individual. Reducing stimulation is one treatment for concussion. A person with a concussion can appear well but challenges might be too frustrating. Your healthcare professional will let you know when you can return to work or school. Aggressive sports should be avoided until cleared by your healthcare professional. Use protective equipment when you can. For example, helmets should be used when biking but also use them with children when on the playground. Adults will want to make sure they can read, handle money and drive safely prior to resuming work and other activities that require higher level thinking. Always wear your seat belt with or without a concussion. Stop rough or aggressive activities to avoid reinjury to the brain.

Individuals who have spinal cord injury should think about the symptoms of a concussion. An injury to the spine at any level is severe enough that you could have a brain concussion and not realize it. A force of trauma that strong enough to affect your spinal cord is also strong enough to create an internal bump to the head that can be a concussion.

Concussions to the spinal cord can occur just as they can to the brain. The spinal cord is anatomically thinner and longer than the brain, so there is not as much mass to force against the vertebrae. Traumatic injury to the spinal cord is most often caused by overstretching, a bone fragment pressing on it or a projectile such as a bullet or a knife affecting it. A concussion is a bump to the cord.

Sometimes, a temporary spinal cord injury occurs called a ‘stinger'. This is a compression or other injury to the cord that resolves over time with or without lasting effects. Stingers cause loss of function for a limited amount of time. It is a concussion of the spinal cord. If you watch football, you have probably seen this type of injury. The player is carried off the field with seemingly nobody movement but later or the next day, movement returns. Therapy is typically required for return of function. After a stinger type of injury or concussion to the spinal cord, the individual should stop engaging in the activity that led to the injury. Once injured, repeat injuries are easier to occur but with more serious outcomes. Not all concussions or stingers to the spinal cord resolve but can lead to long term paralysis.

Symptoms of a concussion to the spine include some or all of the following issues. Lower level spinal cord injury concussion symptoms include difficulty walking, loss of bowel and bladder control, numbness, and tingling. Upper level spinal cord injury concussion symptoms include all the lower level symptoms and difficulty breathing, coughing, neck stiffness, and loss of consciousness.

Concussion in the central nervous system is a very serious issue. For some, issues will resolve over time and with therapeutic treatment. However, there are individuals who battle the symptoms of concussion for extensive periods of time, even lifetimes.

Pediatric Consideration: Children bump their heads often. The head is larger in proportion to the body size which provides more power to the bump. Parents will see their child bump, hit their head and move on. If you have any feeling that your child has a change in ability or temperament, be sure they are checked for a head injury. It is best to keep your child safe.

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About the Author - Nurse Linda

Linda Schultz, Ph.D., CRRN is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

Nurse Linda

The opinions expressed in these blogs are the author's own and do not necessarily reflect the views of the Christopher & Dana Reeve Foundation.