Health

September: Traumatic Brain Injury Month

The Best Treatment of Concussion Is Prevention

Of course we cannot expect the general population to walk around wearing helmets, but many steps can be taken to avoid concussion. These include wearing a seat belt, never driving under the influence of any alcohol, wearing helmets when riding a bicycle, and making sure to avoid falls. Walk defensively in crowded urban areas. Avoid walking and talking on that cell phone.

If you have a relative or loved one with balance problems, it is imperative that you perform a home safety evaluation to ensure that the environment can be made safer for those prone to falling. This includes the installation of grab bars, non-slip mats, and the removal of tripping hazards. Provide a night light that illuminates a path from the bed to the bathroom. These small steps can prevent a major catastrophe.

If head trauma does occur, look for any signs of confusion, attention difficulties, or memory problems, as well as any personality changes or physical symptoms. If any of these are present, or if in doubt, please seek medical attention. Emergency evaluation should be sought if there is any nausea, vomiting, confusion, headache, or any loss of consciousness, since these may suggest bleeding within the skull.

 

Prescription: Don’t Overtax the Brain

The best treatment for post-concussion syndrome is time and rest. Most patients improve with this prescription. The vast majority—80 to 90 percent—of patients do recover from their symptoms  within 7 to 10 days.  However,  it is not uncommon for patients to have a prolonged post-concussive syndrome. When patients do not recover quickly, it is even more important for them to be evaluated by a physician trained in concussion management—usually a neurologist. In addition to ordering and evaluating imaging tests that are more sensitive at picking up small areas of damage that could be missed on a CAT scan (generally an MRI), a neurologist can help with strategies to manage symptoms that seem to persist longer than expected, and can work toward getting patients back to their pre-concussion functioning.

When behavioral and cognitive issues interfere with school, work, or social life, it is common for a treating physician to refer a patient for neurocognitive testing and therapy with a neuropsychologist. Anxiety, depression, and other psychological symptoms are very common with prolonged recovery from a concussion, and their under-treatment can cause apparent cognitive or attention issues after a patient may otherwise be recovered from the initial head injury. The only proven treatment is rest: avoiding strenuous physical activity, strenuous mental activity,  and exposure to screens (e.g. TV, computer, phone) as much as possible until symptoms resolve, with a gradual reintroduction of these things as is tolerated.

September is national traumatic brain injury awareness month.  We were unaware of the many long term consequences of concussion for far too long. Now we know that even mild traumatic brain injury which is the cause of concussion, can have serious and long lasting impact on the lives of those affected. More research is needed in the areas of prevention, diagnosis, acute and long term treatment. Much has been learned in the last decade about concussion and mild traumatic brain injury but there is much more to be done.

 

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  • Andrea September 12, 2016 at 11:50 am

    Thank you Dr Allen for this informative article. Your views on the elderly and TBI were particularly insightful. I recently got my 93 yr old father to use a rubber tip cane when out (after MUCH discussion and resistance on his part). He won’t admit it but I’ve noticed his gait appears stronger and he certainly is more confident and less fearful when getting around.

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