We hear a lot about concussion these days, but the hard fact is that most people — especially parents — don’t know enough about it to keep their kids’ brains safe.
And while medical guidelines by the Ontario Neurotrauma Foundation were produced in Canada in 2014, practitioners are not applying them consistently, says Catherine Ross, ’95 BSc(PT), who works at Lifemark Physiotherapy in Edmonton and is trained to work with concussion patients.
“It can be frustrating [as a parent or patient] because people get a lot of different advice,” she says.
The way parents handle a concussion in a child can have far-reaching consequences, says Codi Isaac, ’92 BCom, ’07 MSc, who works at the Glen Sather Sports Medicine Clinic and at her practice, Isaac Physiotherapy. If managed appropriately, 100 per cent recovery is possible; if mismanaged, problems can continue for months, even years. And in the case of a second brain trauma (now we’re talking worst-case scenario) death is possible.
Here are some facts that parents — and anyone, really — should know about concussion.
Fact #1: Any child is at risk of concussion
Concussion, also known as mild traumatic brain injury, can be caused by any direct — or indirect — shearing force. The three most common ways kids get concussion is through sports, falls and motor vehicle accidents. However, Ross says, “it’s important for parents to know that a child doesn’t need to be hit on the head in order to have concussion.” Also, notes Isaac, while critical for preventing other brain injuries, helmets do not prevent concussion.
Fact #2: Losing consciousness is not a symptom
“In most concussions, there’s no loss of consciousness,” says Ross. The most commonly reported symptoms are signs of confusion, irritability, fatigue and headaches. Others include dizziness, blurred vision and nausea. “Symptoms can start almost immediately or take a few days to peak,” she says. She advises parents to watch their children carefully for a change in behaviour. “Children will cry or be frustrated easily.”
Fact #3: If you suspect concussion, get to a doctor
If you see symptoms of concussion — even if you have any doubt — ensure your child rests, body and brain, and have them checked out by a doctor within 48 hours. It’s not necessary to go to emergency or call an ambulance unless your child is losing consciousness, vomiting repeatedly or having trouble speaking; it could indicate a more serious injury such as a skull fracture, subdural hematoma or cerebral bleeding. Note that diagnosis is strictly symptom-based; a diagnostic image will not reveal a concussion.
Fact #4: There’s no medical intervention that treats concussion
While concussion isn’t fully understood, it is known that, in the simplest terms, it involves an imbalance of potassium and calcium in the brain. “We’re careful when we talk about treatment because there’s nothing we can do to restore the chemical imbalance that’s occurred,” says Ross. “The brain is in an energy crisis and it needs to rest.” That’s why sleep is paramount — in fact, in contrast to advice given long ago to wake a child every two hours, parents now are advised to monitor the child without waking them. "Unbroken sleep is important and restorative," says Isaac. "If they wake with an excruciating headache or a marked decrease in function, that would be time to head to an emergency room." It's also important to avoid any stimulation of the brain or any physical activity that raises the heart rate. That means no reading, television, gaming or computer screens for at least the first 48 hours. Moving around the house is fine, but walking outside isn’t recommended. Isaac adds that current guidelines encourage individualized rest plans for each individual, which is why it’s important to see a doctor.
Fact #5: Most concussions heal within seven to 10 days
A recent Canadian study by Dr. Roger Zemek, a Children’s Hospital of Eastern Ontario researcher, suggests that two-thirds of kids will heal from a concussion, while one-third will continue to have symptoms. “The determination for when kids return to school and sports is when they are symptom-free,” says Ross, and that is usually seven to 10 days. If the rest guidelines are followed and the child heals, then recovery can be 100 per cent.
Fact #6: Other interventions may be needed
Even though most concussions heal within 10 days, other related problems can continue to cause symptoms. Problems such as learning difficulties, especially with memory and concentration, frequent chronic headaches, motion sensitivity and more can last for months or even years. Additional assessments may be needed to address or rule out vision, inner ear or neck injury which can contribute to headaches, dizziness and balance issues. “It’s never too late to get someone assessed and to treat the symptoms of concussion,” says Ross.
Fact #7: The greatest danger is rushing recovery
A child should be free of symptoms before returning to normal activity, particularly physical activity, and should return at a gradual pace, preferably under the care of a physician. “It’s important for parents to know that if their child has a second concussion before the first one is fully healed, it can be very dangerous,” says Ross. It’s called Secondary Impact Syndrome, and it can cause death.
“The bottom line,” she says, “if there is any doubt, go get it checked out.”