by Dr. Dillon Cuppusamy

concussion-imageWe work extensively here in Bahrain with contact athletes, as well as a wide range of patients who have had a recent trauma such as a road traffic accident. Unfortunately this means we often encounter concussions.

A concussion is a traumatic brain injury that changes the way your brain works.

Effects are usually temporary, but can include headaches and problems with concentration, memory, balance and coordination.

Concussion or mild traumatic brain injury (MTBI) is not a problem for only professional athletes, but also children and lay-adults. Children and adults can suffer MTBI after motor vehicle collisions and falls, and these patients all need to be informed of the course of events that come with MTBI.

In the initial stages of management of MTBI patients, importance is placed on identifying the rare, but serious complications that can potentially occur after head injury, such as intracranial bleeding (brain bleeds). Clinicians need to quickly identify those with new symptom onset, or increasing symptom severity, as immediate surgical attention may be required. While complications can occur, recovery is generally good for the majority after MTBI or concussion.

By educating and informing patients, while offering positive reassurance, we as medical professionals can help patients to a path to good recovery, while offering treatments aimed at reducing associated spine and headache-related pain. MTBI patients may benefit from early, but careful activation, while limiting manual therapies such as manipulation, mobilization, ultrasound or muscle stimulation.

We are an integrated clinic and prefer a multidisciplinary approach to care.

It is important to work closely with the patients’ primary medical doctor

in order to facilitate a plan for the return to work/play after MTBI.

While there is much work to be done to better understand the prognosis of MTBI, the recent ICoMP review has provided strong evidence which clinicians can use to help improve and inform clinical decision making and thus promote better recovery and limit disability after MTBI.

By understanding sport concussion prognosis, clinicians can help to better educate athletes, coaches, and parents regarding issues such as the likely duration of symptoms, return-to-play (RTP), and consequences of repetitive concussions. Similar to the results of the WHO Task Force, recent literature suggests that most athletes recover quickly (i.e., days to a few weeks) with respect to both cognitive functioning (e.g., attention and memory) and post-concussion symptoms (e.g., headache, fatigue, dizziness, etc.).

Although RTP guidelines are popular there are no high-quality studies assessing their impact on recovery or prevention of additional injury, and most of the research on RTP focuses on contact sports that include male professional American and Australian football players. There is some evidence that the majority of athletes do RTP within the same game or within a few days afterward.

Despite the growing concern over RTP after sport concussion, research quality continues to be poor, demonstrating little to no methodological improvement since the World Health Organisation (WHO) Task Force review. Firm conclusions regarding the long-term outcome of repetitive sport concussion cannot be made at this time due to the lack of evidence. Conversely, short-term recovery after sport concussion was found to be delayed in athletes with a history of previous concussion and clinicians need to consider this when making future decisions about RTP or even ending sports participation, especially in younger-aged athletes and those at high risk for repeat concussion such as in contact sports.

References:

Cancelliere C, Hincapié CA, Keightley M, Godbolt AK, Côté P, Kristman VL, Stålnacke BM, Carroll LJ, Hung R, Borg J, Nygren-de Boussard C, Coronado VG, Donovan J, Cassidy JD. 2014. Systematic review of prognosis and return to play after sport concussion: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Arch Phys Med Rehabil. 95(Suppl 3): S210–S229.

Cantu RC. 1998. Second-impact syndrome. Clin Sports Med.17:37–44.

Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, Kraus J, Coronado VG. 2004. WHO Collaborating Centre Task Force on MTBI Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO collaborating center task force on mild traumatic brain injury. J Rehabil Med. 36(Suppl 43):28–125.

Donovan J, Cancelliere C, and Cassidy JD. 2014. Summary of the findings of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Chiropractic Manual Therapy. 22:38.

McCrory PR, Berkovic SF. 1998. Second impact syndrome. Neurology. 50:677–683

McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvorak J, Echemendia RJ, Engebretsen L, Johnston K, Kutcher JS, Raftery M, Sills A, Benson BW, Davis GA, Ellenbogen RG, Guskiewicz K, Herring SA, Iverson GL, Jordan BD, Kissick J, McCrea M, McIntosh AS, Maddocks D, Makdissi M, Purcell L, Putukian M, Schneider K, Tator CH, Turner M. 2013. Consensus statement on concussion in sport: the 4th international conference on concussion in sport. Br J Sports Med. 47:250–258.

Saunders RL, Harbaugh RE. 1984. The second impact in catastrophic contact-sports head trauma. JAMA. 252:538–539.

Tator CH. 2013. Concussions and their consequences: current diagnosis, management and prevention. CMAJ.185:975–979.

 

 

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