The REAL Story about Mild Brain Injury and Concussion By Marilyn Lash, MSW
The REAL Story about Mild Brain Injury and Concussion
By Marilyn Lash, MSW
Confused About “Mild Brain Injury”?
The term “mild brain injury” is a huge misnomer. It implies that it’s no big deal; it’s a minor injury; it has no serious consequences; there’s no need for immediate medical attention or follow up care. None of this is true. A popular public awareness campaign captures the critical fact about mild brain injury in the statement that there’s nothing “mild” about it. It is an injury to the brain.
Why No Diagnosis?
So why is mild brain injury so often undiagnosed and misunderstood? You can start with the terminology. Concussion is the more common term used to describe a mild brain injury and somehow that seems less serious to folks. In fact, when patients are questioned about a history of head trauma, they are more likely to respond positively when the term concussion is used rather than brain injury. Simply put, the idea that the brain has been injured is a scary thought.
Loss of consciousness or coma is one of the landmarks of moderate and severe brain injuries. This brings immediate medical attention and specialized care. By contrast, most cases of concussion or mild brain injury do not involve a loss of consciousness. Although the person may feel dazed, confused or disoriented, there may be no immediate dramatic signs that the brain has been injured. Most people who sustain a mild brain injury are not evaluated in an emergency department and are not admitted to the hospital. They may not even see a local physician.
The truth is that concussion is a type of traumatic brain injury and it changes how the brain functions., but there may be no evidence of damage on an MRI or CT scan. Even a standard neurological examination may not reveal symptoms. However, this does not mean that a mild brain injury has no consequences.
Numbers Reveal “The Real Story!”
The numbers are staggering. The Centers for Disease Control reports that at least 1.7 million traumatic brain injures occur every year. They estimate that 75% of these are concussions or other forms of mild traumatic brain injuries. Some estimates are even higher at 80 – 90%. The age groups most often injured are young children under 4 years, adolescents between 15 – 19, and adults ages 65 years and older.  The good news is that most of these people will have symptoms which will improve within hours, days or weeks and they will recover fully. This transient effect has often been described as feeling dazed, stunned, or just “out of it.” However, age does make a difference. Older adults, young children and teens generally have slower recoveries and thus need careful monitoring.
Take Any Brain Injury Seriously! Especially Sports-Related!!!
Despite these high numbers, mild brain injuries are too often not taken seriously because they are usually not life threatening. This attitude among the general public and even many health care professionals is now changing. This is partly due to new scientific evidence on concussions with the examination of brains of deceased athletes with long histories of multiple concussions, the settlement by the National Football League, and advances in brain imaging. There are also the rare but too frequent stories of healthy young student athletes, typically high school or college players, who are injured during a game and then die within hours or days due to undiagnosed trauma and bleeding in the brain. These stories have directly contributed to the passage of concussion legislation in all 50 states requiring a concussion education and management program in schools to protect student-athletes.
Athletes Aren’t The Only Ones with Mild Brain Injury
But concussions do not occur solely in athletes. Traumatic brain injury has become known as the signature wound among veterans of the wars in Iraq and Afghanistan and most of these are classified as mild. These concussions are largely caused by the explosive blasts from improvised explosive devices (IEDs), rocket propelled grenades and landmines. The percussive wave that results from the explosion can be particularly damaging to the brain. Many of these injured service members have been exposed to multiple blasts and have incurred multiple concussions.
The Department of Defense has become increasingly vigilant about screening troops during and following deployments for symptoms of concussions and setting up treatment programs. Among wounded warriors, the combination of mild brain injuries and post-traumatic stress disorder or PTSD results in a very complex condition with both overlapping and distinct symptoms. The most common comment by families is that the service member who came home “is not the same person,” yet many service members consider treatment a sign of weakness and resist seeking help.
No Discrimination When Brain Injury Happens
Sports and war are the scenarios that are receiving the greatest media attention these days. But a mild brain injury does not discriminate. It occurs to athletes, service members, and civilians. It happens to people of all ages, races, ethnic groups, and across all incomes. Falls, biking accidents, motorcycle and ATV accidents, car crashes, assaults – these are the most common causes of mild brain injuries among civilians. The sad part is that so many of them could be prevented with greater attention and use of safety devices – protective helmets, child safety seats, bath mats.
Greater Risk for More Concussion Injuries
We also know that people who have had one concussion are at a greater risk for having another concussion and they also face a longer recovery period. It is not just the number of concussions that pose greater risks but the time between concussions that is a factor. If the brain has not recovered from the earlier concussion and sustains another, the damage to the brain may be more serious. For the unfortunate estimated 10% who have persistent and chronic symptoms that are described as “post concussion syndrome” the impact can be life changing and life altering.
Concussion Symptoms – A Quick Look
The symptoms of concussion fall into four categories of cognitive, physical, emotional, and sleep changes. You can readily see how they can alter not only a person’s ability to get though life’s daily activities, but to pay attention and concentrate in school, or to perform at work. Cognition is the clinical term for how you think, learn, process information, and remember. A person who has had a concussion often complains of being unable to think clearly, of being in a fog, having a hard time concentrating, or remembering new information. Physical changes can range from headaches to fuzzy or blurry vision, nausea, dizziness, light or noise sensitivity, poor balance, and fatigue. Emotional changes can create additional stress on relationships as the person becomes more irritable, emotional, anxious, nervous, or sad. Changes in sleep are also very common but may have different effects – sleeping more or less than usual or having trouble falling asleep.
Brain Injury Is Unique to Each Person
The exact combination of these symptoms is different for each person because each injury to the brain is unique. But it’s easy to see how exhausting, worrisome, and confusing these symptoms may be for the person and for family, friends, and colleagues. A concussion is an invisible injury. There is no outward sign like the broken bone covered in a cast that signals “Caution! This person is hurt.” In fact, it is just the opposite. The person who has had a mild brain injury or concussion may look just fine – but that doesn’t mean that all is well. Some symptoms may appear right away, others show up over time as people go back to school or work. As people return to more complex tasks, the brain has to work harder. People often describe how they feel in vague terms such as “not feeling like myself” to more alarmingly “thought I was going crazy.” Obtaining an accurate diagnosis is the first step to getting treatment.
Most Common Treatment Regimen
Rest may be the most important treatment for a concussion – and it may be both the easiest and hardest instruction for patients to follow. Just as you would not expect to go out and run a marathon after spraining or breaking an ankle, you can’t expect to work your brain too hard after a concussion. Just as your ankle needs physical rest after a sprain, your brain needs cognitive rest after a concussion. The “push through it” and “tough it out” philosophy so common among soldiers, athletes and teens just doesn’t work here; it may worsen symptoms and slow down recovery.
How Important is Sleep?
Getting plenty of rest at night, napping and resting during the day is part of the healing process. It’s not just contact sports that should be avoided while recovering from a concussion. Any activities that are physically demanding – whether it’s housecleaning or working out at the gym should be avoided. Likewise, lighten the cognitive demands – this is not the time to do things requiring lots of concentration, problem solving or organization. Your brain needs a break. As you monitor the physical, emotional, and cognitive symptoms, you will be able to judge when you can resume activities. But there are some cautions here – alcohol and drugs can not only slow your recovery but increase your risk of another injury so talk with your health care professional first. Slowed reactions may jeopardize your safety for driving, biking, or operating equipment. Even time in front of the computer or playing video games should be avoided or minimized during the early recovery period.
Becoming Informed Is Critical
The brain is a complex and vulnerable organ. As you can see, there is nothing mild about an injury to the brain. But by becoming more knowledgeable about mild brain injury, you can become an informed consumer of health services, effective health care provider, supportive family member, caring friend or colleague. It can happen to anyone.
Sources for more information:
Nish, Bonnie, Ed. (2016). Concussion and Mild Brain Injury: Not Just Another Headline. Youngsville, NC: Lash and Associates Publishing/Training.
Centers for Disease Control http://www.cdc.gov/concussion/index.html
Defense Center for Excellence for Psychological Health and Traumatic Brain Injury http://dcoe.mil/
About the Author
Marilyn Lash has over 35 years’ experience working with persons with disabilities and their families in medical, rehabilitation, educational and vocational settings. Author of many publications and a national speaker, her primary focus is supporting and educating families about brain injury. She is a founding partner and President of Lash and Associates Publishing/Training in North Carolina, a leading source of information on concussion and brain injury in children, adults and veterans.