Concussion / Mild TBI
A concussion is a traumatic brain injury but not an immediately life threatening one.
There is no severe brain swelling that requires intensive care unit management and no bleeding that requires brain surgery.
But a concussion is definitely a traumatic injury to the brain. Some people use the term mild traumatic brain injury" to describe concussion, but "mild" means - soft" or "gentle," like mild soap or a mild-mannered person. There is, nothing "mild" about the experience for many people.
Clinical diagnosis
Traumatic brain injury, especially concussion. is a clinical diagnosis, not based on any lab test or scan. Impairments in brain function caused by force applied to the brain sufficient to cause concussion usually involve loss of consciousness, amnesia, disorientation, or problems with balance and coordination.
Other impairments in brain function can include changes in vision - seeing things in a distorted fashion, "seeing stars"- confusion, inappropriate behaviour (running the wrong way on the football field) or changes in emotions. The symptoms may evolve over the hours or days following the injury.
While all concussions should be assessed by a doctor, most will resolve without the need for specific treatment. Rest, followed by gradual return to activity is the main treatment.
All concussion is serious.
Recognising mild TBI can be difficult
Recognising mild TBI is critical to correct management and prevention of further injury. However, the symptoms and signs are variable, non-specific and may be subtle.
Onlookers should suspect a mild TBI when an injury results in a knock to the head or body that transmits a force to the head. A hard knock is not required, mild TBI can occur from relatively minor knocks.
There may be obvious signs of mild TBI such as loss of consciousness, brief convulsions or difficulty balancing or walking. However, the symptoms of mild TBI can be more subtle.
Recovery times: Days, months or lifetime impact
The nature and degree of injury to the brain can vary significantly from one person to another. While most make a full recovery some do not.
Some people's symptoms subside within 48 hours. Other have symptoms persisting greater than a couple of weeks; and these require careful assessment and reassessment.
Some people's symptoms last months - post concussion syndrome.
The majority of people with post concussion syndrome recover completely in 3 to 6 months.
Some people do not fully recover and have life-time impairments.
Difficulties for people with mild TBI
The difficulties with diagnosis and the uncertainty about how long recovery will take create numerous difficulties for people dealing with mild TBI, especially for those for whom symptoms don't subside within a few days or weeks.
Difficulties include:
Misdiagnosis - there is not a medical test that’s accurate enough or detailed enough to really tell you which axons and dendrites might be sheared or which cell nuclei might be affected by the impact.
Misinformation - for example being told by GPs, “Oh, it’s four to six weeks. You’ll be better. It’ll be fine. It’s all good. Just go home, rest, do not push yourself.”
Unpredictability of Prognosis - “The hardest thing - a lot of people want an end date. They want an answer. They want—“When am I going to be back? When am I going to be healed? When am I going to be better?””
Complexity of symptoms - It’s challenging, and it takes a lot of time to make sure that you’re managing all of their symptoms, because they have so many, and trying to make sure that you’re addressing everything.
Invisible nature of the injury - “I think because mild traumatic brain injury individuals look completely normal, even their family and their friends say. “What’s wrong with them? Why cannot they do the things they did before?””
Impaired Self-Awareness - It is not uncommon for survivors of mTBI to be unaware of their own symptoms or the extent of their own deficits “I do not think some of them realize that they have changed—either the personality or their anger or their memory. They do not realize that it is all normal—it is all tied together.””
