Concussions
What is a concussion?
A concussion is a type of traumatic brain injury. Concussion is caused by a direct or indirect force which gets transmitted to the head. Symptoms include headache, nausea, vomiting, dizziness, confusion, sensitivity to light, sensitivity to noise, and fatigue.
When should someone who experiences a head injury get imaging?
According to the Canadian CT Head rule, if someone experiences a GCS score less than 15 two hours after injury, has a suspected skull fracture, any sign of basal skull fracture (raccoon eyes and CSF leaking from ear/nose), more than one vomiting episode, or if they are over 65 they should have a CT of their head. If there is greater than 30 minutes of amnesia or there is a dangerous mechanism (pedestrian and care or higher than 5 stairs) of injury CT should also be performed. These rules are specific to patients over 16 years of age.
What are the clinical signs of a concussion?
Loss of consciousness for less than 30 min, lack of memory of events surrounding or right after for less than 24 hours, confusion, disorientation, slowed speech, are all symptoms of concussion. Physical symptoms can also include headache, nausea, vomiting, blurred or double vision, seeing stars or lights, balance problems, dizziness, sensitivity to light/noise, tinnitus, and vertigo. Behavioral symptoms include drowsiness, fatigue/lethargy, irritability, depression, anxiety, sleeping more than usual, difficulty falling asleep. Cognitive symptoms can include feeling “slowed down”, “in a fog” or “dazed”, difficulty concentrating or remembering.
What can someone who experiences a concussion do?
Treatment can improve symptoms allowing you to return to normal activities. Seek out care by a licensed healthcare practitioner. Some options you may want to discuss are coping strategies, sleep hygiene tips, use of melatonin, acupuncture treatment, cognitive behavioral therapy, vision therapy, stress management, medications and work/school modifications.
When should I go back to see my healthcare provider?
If you are experiencing headaches that worsen, repeated vomiting, slurred speech, increased irritation, increased confusion, weakness or numbness in arms or legs, neck pain, or any unusual behavioral change.
What should I avoid?
Anyone who has experienced a concussion should immediately be removed from sport as well as any sport activities where concussion is a risk for at least the next 7 to 10 days. Transient sympto increase can be normal, but screens, loud noise, bright lights should all be avoided early on in recovery. Once a patient can tolerate basic activities of daily living they should be reintroduced, as well as light walking/movement. A detailed plan can be worked out with a licensed healthcare provider.
How should gymnasts and dancers approach a return to rehearsal/class/training protocol?
Parachute and Gymnastics Canada pose a series of graded stages. In the first stage, the aim is to perform symptom-limiting activity. This means only activities of daily living that do not provoke symptoms are allowed. This will allow a gradual reintroduction to school as well. The next stage aims at light aerobic activity. These could include a stationary bike, walking, light stretching (nothing upside down). The aim should be to increase heart rate. Resistance training should be avoided during this phase. Stage 3 is more activity specific (more related to dance or gymnastics). This could include conditioning class, light jogging or elliptical, easy resistance work, choreography without jumps or any tumbling, nothing with impact to the head. Stage 4 is partially back to normal training. This means partial hours, but taking it easy with running choreography or routines, this stage is where upside down tricks are introduced, but support and spotting from coaches and teachers is recommended. This stage increases coordination, exercise, and thinking around activities. Stage 5 is return to full practice/rehearsal schedule. Focus should remain on building back confidence and having dance instructors and coaches assess difficult skills to ensure they are ready to return to competition. Stage 5 has a large involvement from coaches and choreographers. Stage 6 is a full competition return.
For more information, please email hello@madetomove.ca or consult your local licensed healthcare provider. Concussions are an injury that needs attention and care just like any other sprain or strain.
