September 18, 2024
Concussion can result from a variety of events, including sports injuries, car accidents or other direct blows to the head such as from falls. A severe hit to the body can also cause the brain to jolt around in the skull and cause a concussion.
"I like to say the brain is inside a hard box, which is great in protecting the brain, but also gives it a hard box to knock up against when you hit your head," says Michael Rippee, MD, sports neurologist and medical director of the Center for Concussion Management. "And so those brain cells, those neurons, they're kind of like electrical cords. They get stretched and they get twisted and they get kind of pulled apart. It creates this whole series of chemical changes that cause the brain cells to sort of stop functioning the way they should."
While concussion is not typically life-threatening, it is a type of traumatic brain injury that can cause long-term damage if not properly cared for. If concussion is suspected, it is important to be evaluated quickly, especially for student athletes.
“Up to 80% of people are better in about six weeks,” says Dr. Rippee. However, if concussion is suspected, it is important to be evaluated quickly, especially for student athletes, who can be at a higher risk of reinjury.
"Football is the sport with the highest number of concussions," says Thomas "Tom" Dagg, MD, sports medicine physician. "But the rate of concussion is highest in men’s wrestling, followed by men's and women's ice hockey."
If an athlete returns to play before symptoms have fully resolved, they are 4 times more likely to have a second concussion. This can lead to a rare condition called second impact syndrome that can result in brain swelling and even death.
Even with full healing, recurrent head injury or concussion can lead to chronic issues such as headache and memory difficulties. While a first concussion can’t always be prevented, a second injury during the recovery process should never be allowed to happen.
And athletes are not the only ones at risk of a concussion.
"I would love to say all I see are athletes, but I would say that's actually the minority of what I see," says Dr. Rippee. "It's more of these falls, the car accidents and icy winter incidents."
Recognize the symptoms
It’s important to recognize symptoms of concussion so it can be identified in a timely manner and treated appropriately. A person does not have to lose consciousness to have a concussion. In fact, most concussions don’t result in a loss of consciousness.
“People typically think of symptoms of concussion such as a headache that is worse with bright light or loud noise, symptoms that worsen when looking at screens,” Dr. Dagg says. “Other symptoms can include loss of memory, difficulty learning new information, nausea, balance problems or brain fog. People may also experience disturbance to their moods or sleep.”
Bill Condon, physical therapist with the health system, says after a concussion there are a few things he measures.
“First, we assess the central vestibular system or the brain eye connection. And how we do that is look at eye movements and head movements, and we look to see if anything looks out of the ordinary, or if they're symptomatic with those movements,” he says. “We also have outcome measures we use. So, we have a dizziness handicap inventory that we use to measure how much dizziness there is, and then we have specific balance tests that we use to assess and track progress.”
Concussion treatments
As research on concussion continues, we will likely continue to see changes in the way concussion is treated. For example, we now know that sleep and rest, mental rest as well as physical rest, is essential for concussion healing. Dr. Dagg notes that it is also important to limit screen time after a concussion.
If there are persistent physical symptoms, like balance and dizziness that Condon mentioned, working with a physical therapist may be recommended. The University of Kansas Health System orthopedics care team includes concussion management-certified physical therapists who provide rehabilitation services. Sometimes a speech therapist may also be needed.
“In concussion recovery we're working on the cognitive piece of things. Oftentimes what we see that can go awry with after a concussion is the thinking skills, and that can include executive functioning – so planning, organizing, problem solving – and things like memory or attention skills,” says Courtney King, a speech therapist at the health system.
There have also been some new developments in concussion treatment. Dr. Rippee and his co-researchers completed a trial using the hormone ghrelin to treat concussions.
“It's a hormone that works in the brain to tell your brain whether you're hungry or not hungry. And then they discovered it helps with inflammation, with protecting those nerve cells, with helping them communicate better with each other,” says Dr. Rippee.
In the trial, participants injected ghrelin into their abdomen or thigh for 2 weeks.
“We monitored them for another few weeks after they stopped the treatment. And you can see on top the groups that were treated, their symptom scores continued to trend down throughout the trial, versus the group that was standard of care and kind of stayed the same,” says Dr. Rippee.
So what we really focused on was, was, how was a patient feeling right? And so we had sort of two things on the left here, you'll kind of see what we call the PCSS or postconcussion symptom scale, and that's literally measuring how bothersome a symptom is. You know, is it a headache? Is it dizziness? Is it memory problems? And on the right, you'll see quality of life. How's your life, right? What's your quality of life in this situation? And on top of these two graphs, you'll see the group that was treated with ghrelin. Right on the bottom, you'll see the groups that were standard of care, vestibular therapy, speech therapy, and we measured them. We measured them at multiple time points, but we really focused on day one, the start of the study, day 15, which was the end of the treatment portion, the two weeks, and then day 44 which was the end of the study. So we monitored them for another few weeks after they stopped the treatment. And you can see on top the groups that were treated, their symptom scores continued to trend down throughout the trial, versus the group that was standard of care and was pretty flat. They kind of stayed the same.
Just as there is variation in concussion symptoms, there is also variation in the speed at which concussions resolve – some resolve quickly, while others can take weeks.
Speed matters
No matter how a concussion happened, or how old the patient is, getting proper treatment and observation from your healthcare provider quickly is essential.
If you suspect a concussion, seek medical treatment within 24 hours of the injury. There are many options at the health system when it comes to getting fast treatment for a concussion:
- Visit your established family medicine provider or sports medicine physician.
- Use the Convenient Care Walk-In Clinic in Great Bend or another health system urgent care location.
- After hours, an Emergency Department is the best option.