Written by Joanna Chartrand
Concussions. Have you experienced one? Maybe it was yours, and you remember the pain, nausea, or disorientation you felt. Maybe it was a student you were coaching, and you remember the weird way he was acting, or that stale blank look on her face. It’s a scary situation, isn’t it?
I’ll never forget mine—except that I did. About 20 minutes’ worth was just black. When I came to, another 10 minutes passed before I could remember what day it was, what time of year, even my own name. That’s scary.
Part of our fear lies in the unknown. Think about the questions that come to mind when you think about concussions. How long does it take to recover from a concussion? What are the long-term effects? What are ways to help prevent concussions? (These questions, by the way, do not have simple answers.)
Maybe you’re stuck on one simple question: What exactly is a concussion?
This is a valid question. So much of the confusion surrounding this injury lies in how difficult it’s been to define it.
Consider the fact that a committee commissioned by the Institute of Medicine and the National Research Council spent two years compiling all available research on everything to do with concussions, and one of the biggest problems they encountered was the inconsistency in defining the injury. In response, they put together the following definition:
Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include:
Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ‘impulsive’ force transmitted to the head.
Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, symptoms and signs may evolve over a number of minutes to hours.
Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.
Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. However, it is important to note that in some cases symptoms may be prolonged. (McCrory et al., 2013a)
Got it now? Or are you still a bit confused? (I wouldn’t blame you.)
You may be thinking: We can take our temperature to see if we have a fever. We can do a chest X-ray to see if our lungs are gunked up. Can’t there be some simple biomarker test to determine whether we have a concussion? Unfortunately, no. Sure, we can look at symptoms and do the ImPACT testing, but concussions manifest in so many different ways that it’s still hard to know what to do.
So where does this leave us? Hopefully, conservative and cautious. That “tough it out” culture we tend to emulate may, in fact, be the most harmful way to respond to a head injury. (More on that in part 2.) How should we respond instead?
As a teacher . . . Consider the cognitive side of this injury, specifically the impairments in functions such as attention, concentration, memory, processing speed, working memory, executive function, or verbal function (Covassin & Elbin, 2010). A student with any single impairment, let alone a combination of a few, necessitates that you adjust. Stay flexible with the academic support you give as well as the expectations you have of someone recovering from a concussion. We all want a simple timeline, but in reality each case will be different. So stay flexible.
As a coach . . . Consider the additional risks. Research shows that athletes who incur one concussion are at
3 to 6 times greater risk for incurring a second concussion (Covassin & Elbin, 2010). Post-concussive athletes also run higher risks for other injuries (think: ACL) (Brooks et al., 2016). Return-to-play decisions should be made for the sake of the player’s well-being, and not for the sake of the team’s record.
In general, we should also watch for the other troubling symptoms:
Physical: headaches, light-headedness, dizziness, nausea, or sensitivity to light or noise
Sleep: sleeping more or less than usual, or difficulty falling asleep
Emotional: anxiety, depression, or panic attacks
(“What is a Concussion?” n.d.)
If you’re wondering whether this is a real problem, consider this: the widely cited estimate reported by the CDC is that 1.6 million to 3.8 million concussions occur in the United States every year. Additionally, the Concussion Legacy Foundation reports that only 1 in 6 concussions are actually diagnosed.
Do the math on that.
Concussions may look very different in each case, but in every case we’re dealing with an injury to the brain. This is never to be taken lightly. Sprained ankles and broken bones often heal back to full function, but head injuries can compromise brain function, sometimes permanently. When it comes to our students, whether as teachers or coaches or parents, we are all in a position to care for their short- and long-term wellbeing, especially when dealing with concussions.
Look for more information from Joanna on concussions in an upcoming blog.
Joanna Chartrand (’11) is currently serving at Luther Preparatory School—Watertown WI.
References
Brooks, M. A., Peterson, K., Biese, K., Sanfilippo, J., Heiderscheit, B. C., & Bell, D. R. (2016).
Concussion increases odds of sustaining a lower extremity musculoskeletal injury after return to play among collegiate athletes. The American journal of sports medicine, 44(3), 742-747. doi:10.1177/0363546515622387
Covassin, T., & Elbin, R. J. (2010). The cognitive effects and decrements following concussion. Open access journal of sports medicine, 1, 55-61. doi:10.2147/oajsm.s6919
Institute of Medicine and National Research Council (2014). Sports-Related Concussions in youth: Improving the science, changing the culture. Washington, DC: The National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK169016/
McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, R. C., Dvořák, J., Echemendia, R. J., … & Sills, A. (2013). Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport, Zurich, November 2012. Journal of athletic training, 48(4), 554-575. Retrieved from https://doi.org/10.4085/1062-6050-48.4.05
What is a Concussion? (n.d.) Retrieved December 10, 2019, from https://concussionfoundation.org/concussion-resources/what-is-concussion