Concussion

“Don’t let diminished brain health get in the way of living your life to the fullest.”

“If you are at risk for getting a concussion or have had a concussion, then a Brain Scan is right for you. Baseline data is very helpful in determining post-injury changes to brain health, and if you have already had a head injury, then a brain scan can help you understand your current brain health and physiological recovery.”

A ​Concussion​ is a type of traumatic brain injury (TBI) caused by an impact to the head or body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating damage to the tissues, blood vessels and nerves as well as altering the chemical physiology.

Know your Brain Health

Post Concussive Vulnerability: ​If the brain has suffered a concussion, then it is important to provide time to allow the brain to heal prior to return to play.

“Concussed brain cells are vulnerable for an undefined period of time, during which if they sustain a second insult, there could be irreversible damage.”

Our EEG Brain Scans​ can visually demonstrate changes in brain health following a concussion.

Below shows an EEG visual representation of the P300 brain voltage of an athlete before and after a concussion. The heat maps reflect brain voltage in the brain, with the red reflecting high brain voltage and the blue colors representing low voltage.

BASE = initial baseline scan; CN = after concussion

“Although, there is no single test to diagnose concussions, recent research in EEG studies has shown promising correlations between brain voltage and concussions.”

4-Year Study Using EEG Brain Scans To Assess Brain Health Recovery Following Concussion

(Clayton, et al., In-Clinic Event Related Potentials for Sports Concussion: A 4-Year Study, Children’s Hospital Colorado; University of Colorado School of Medicine; University of Colorado Dept. of Athletics: WAVi Co.)

Many studies have found changes in brain function following a concussion. This study examines the audio P300, EEG test and its ability to detect significant changes in brain function from baseline following a concussion. It also examined if these changes in brain function persist until and beyond the beginning of normal return to play protocols.

Participants: ​364 individuals from a NCAA Div. 1 men’s football team, a NCAA Div. 1 women's soccer team, a men’s high school football team, and a semi-pro men’s ice hockey team. 46 concussions were diagnosed over the 4 seasons.

Methods: ​ P300 EEG tests were performed throughout the course of 4 seasons on each athlete.

Conclusions

“This data corroborates previous results suggesting that concussions cause measurable changes in the electrophysiological markers of brain activity, concussed participants often pass clinical tests while still displaying electrophysiological deficits, and that ERPs may constitute a useful adjunct in determining return to play for injured athletes thereby preventing early return that may be a cause for prolonged post-concussive symptomology.”

Did the brains recover/heal by the time the players were released back to play?

The EEG was not used as a marker of when to return to play. Athletes were cleared to return to their sport using non-EEG methods such as the “Impact Test.”

Of the players that had been cleared to play by the “Impact” testing, the EEG showed that ​50% (23 players) had failed​ ​to return to normal.​ ​40% (18 players)​ continued to have changes at least 2 standard deviations from their baseline, and ​20% (9 players) had voltage drops of at least 3 standard deviations from their baseline scans. This demonstrates the idea that the current method of testing is not sensitive enough to ensure restoration of brain health at the time it is clearing athletes to return to play.

The graph below shows the initial brain voltage drops following the athletes concussions, as well as the 40% that continued to have deficits at the time they were cleared to play.

(% of players with voltage decreases greater than 2 standard deviations from baseline for CN = after concussion, RTP = return to play, Ref = reference/control)

Below is a visual representation of three players from this study, before and after a concussion, as well as at the end of the season.

Note: Player 7 had not recovered by the end of the season.

(Base = baseline, CN = after concussion, RTP = return to play, END = end of season)

This study sheds a big light on the idea that we are sending players back to play ​before their brains have fully healed​, and that the current, standard of testing is not sensitive enough to determine the persistence of injury. An EEG is a reliable way to assess the restoration of brain health prior to allowing an athlete to return to their play.

Concussion Facts

Prevalence of Concussion:(​According to the Center of Disease Control and Prevention)

  • Concussions compromise 6 – 7% of total injuries in all organized sports.
  • 19% ​of high school athletes will report having at least one concussion by the time they are 18.
  • 1.8 – 3.6 million head injuries occur in adolescents each year.
  • Studies suggest that up to ​50%​ of athletes experience concussion symptoms/year but only ​10% report them​.
  • From 2006 to 2014, the number of TBI-related emergency department visits, hospitalizations, and deaths increased by 53%.
  • Dose-response relationship​: If you have had one concussion, then the likely-hood of getting another one ​doubles​; if you have had 3 or more, then the likely-hood ​triples​.

High School Sports with a High Concussion Risk: ​(Based on 1000 athletic exposures)

  • Football:   .47 - .6
  • Girls’ Soccer:   .32 - .35
  • Boys Lacrosse:   .3
  • Boy’s Soccer:   .22
  • Girls Lacrosse:   .2

Leading Causes of Concussion:

  • Playing sports
  • Falls
  • Motor vehicles accidents
  • Unintentionally being struck by or against an object
  • Assaults

Symptoms of a Concussion: ​Each concussion is different and can have a wide variety of symptoms. Some symptoms can come on within seconds while others can be delayed for hours or days.
(Below are the most commonly reported symptoms among 1,438 concussed high school and college athletes within 1-7 days post concussion, Kontos et. al, 2012)

  • Headache:​ ​75%
  • Difficulty Concentrating: 57%
  • Fatigue: 52%
  • Drowsiness: 49%
  • Fogginess: 47%
  • Feeling Slowed Down: 46%
  • Sensitivity to Light: 45%
  • Poor Balance and/or Coordination: 39%
  • Difficulty with Memory: 38%

Other symptoms included:

  • Temporary loss of consciousness
  • Irritability, mild depression
  • Poor or inability to focus
  • Nausea or vomiting
  • Disorientation, or mental confusion
  • Difficulty sleeping
  • Ringing in the ears

What is Post-Concussion Syndrome (PCS): ​(10-20% of Concussions) Post-concussion syndrome may be given as a diagnosis if someone has continued symptoms lasting for 4 weeks after the concussion. Persistence of least three of these symptoms qualifies someone for a PCS diagnosis:

  • Headaches
  • Dizziness
  • Fatigue
  • Irritability
  • Sleep Problems
  • Concentration Difficulty
  • Memory Difficulty
  • Inability to Handle Stress/Emotions.

Symptoms of a Concussion that Require Emergency Care:

  • Repeated vomiting
  • Loss of consciousness lasting longer than 30 seconds
  • Worsening Headaches
  • Changes in behavior, such as irritability
  • Changes in physical coordination, such as stumbling or clumsiness
  • Confusion or disorientation, such as difficulty recognizing people or places
  • Slurred speech or other changes in speech
  • Seizures
  • Vision or eye disturbances, such as pupils that are dilated or of unequal sizes
  • Recurring or worsening dizziness
  • Symptoms that worsen over time

Diagnosing a concussion:

There are many types of doctors or concussion specialists that diagnosis and treat concussions. These include primary care doctors, neurologists, ENTs, sports medicine doctors, opthamologists and physical/occupational therapists. A final diagnosis takes into account​ a careful assessment of multiple symptoms. Some common tests are:

  • Standardized neurocognitive tests to assess memory and attention
  • Neuropsychology testing to assess mood/behavior
  • Balance and coordination testing
  • Oculomotor testing

Concussion Prognosis:

Most concussions will resolve within a few weeks after the event, however around 10-15% of patients will still report symptoms and cognitive deficits several months to years after the event. Adults tend to heal quicker than children. Here are some general age-based guidelines for healing.
  • 2–3 days for adult athletes
  • 7–10 days for college athletes
  • 14–21 days for high school athletes
  • 28–35 days for middle school athletes
  • If someone reports dizziness or amnesia immediately following an injury, these symptoms are linked with longer recovery times.

Treatment of a Concussion:

Most concussions will resolve within a few weeks and treatment during this time is mostly symptom management. Management includes:

  • Decreasing time in front of electronic devices
  • Avoiding bright lights and loud noises
  • Integration of aerobic exercise
  • Getting enough sleep
  • Avoiding acidic foods and drinks
  • Controlling headaches with medication
  • Avoiding anything that increases symptoms.

Some concussions may require additional treatment if symptoms persist. Persistent concussions generally present with more visual disturbances, dizziness, headaches, as well as balance and coordination issues. When this occurs, a course of physical or occupational therapy with a certified concussion or vestibular therapist may be warranted. Vestibular Therapy​ for concussion consists of a s​systematic progression of exercise protocols designed to address symptoms of visual disturbances, reduce exaggeration of motion or after-motion, balance and equilibrium impairments, as well as normalizing the coordination of head and eye movements.

Concussion Resources

NPR Science Friday: Concussion

MRI Rutgers Study