With June being Brain Injury Awareness month it seems fitting to discuss Traumatic Brain Injury (TBI) and specifically mild TBI (aka concussion). With the goal of spreading awareness, it’s important to recognize important facts about concussion, how it can be misdiagnosed, and a few areas of research that need more attention.
The Brain Injury Association of Canada estimates that there are over 165,000 concussions a year in Canada, this translates into 452 new brain injuries a day. They go on to report that in Ontario 92% of men and 100% of woman who sustain a TBI never return to full time work. The economic burden on the Canadian health care system of TBI is estimated at $12.7 billion per year and a large percentage of these injuries are concussion. Education and awareness around safety and prevention from TBI and concussion is a very important endeavor, as there is no cure once an injury is incurred. However, unless we decide to never play sports, drive cars, and commit to wearing helmets for all waking hours of the day, complete prevention is unlikely.
The stories I often hear from concussion patients involve some period of time where they were not aware they had a concussion, this seems to be due to shock, lack of information about typical symptoms, or other more obvious injuries occurring at the same time. These stories include concussions being completely overlooked because their doctors focused on treating more serious or visible injuries, patients not recognizing the symptoms, and/or didn't realize they even had a concussion until days later.
It is important to seek medical attention swiftly after concussion, so pay attention to the signs and symptoms of concussion after you or someone you know has been in some kind of accident that likely involved an impact to the head or whip lash. A great resource for this if you are ever unsure is the Concussion Awareness Training Tool (CATT) (http://ppc.cattonline.com/). Most people recover from a concussion within 3 months, but about 15% do not and go on to develop a set of symptoms known as post-concussion syndrome.
The typical clinical post-concussion syndrome includes cognitive impairment, balance problems, sleep disturbance, dizziness, headaches and emotional dysregulation. Interventions with some degree of evidence include meditation, psychological counseling, graded exercise, and pharmacotherapy. Care of patients with chronic symptoms after a concussion is fragmented and inconsistent across care providers, and regions. In part, this is a reflection of the lack of evidence-based treatments. The most commonly prescribed treatment is simply to rest, with rest referred to as the “cornerstone” of concussion management in previous guidelines. This is now changing, with both military and sporting consensus guidelines recently evolving to encourage a gradual return to activity after a maximum of 72 hours of rest.
Is rest the best?
According to a review by Silverberg, N. et al. rest is likely the most commonly prescribed treatment in history; however, clinicians and researchers have begun to question the efficacy of extended periods of rest. Studies have shown that inactivity may in fact have detrimental effects on health outcomes. One study looking retrospectively at stroke patients by Indredavik, B. et al. found that early mobilization and mental stimulation was the best predictor of discharge. Other studies looking at various other health conditions found that extended inactivity was consistently a risk factor for chronic disability. As you can imagine, spending extended periods of time sitting at home in a dark room resting could also have some serious mental health consequences- increasing risk for depression. Alternatively, exercise is consistently shown to increase mood and protect against symptoms of depression and anxiety. With this shifting opinion about rest, graded exercise has come into view as an important factor in recovery from brain injury.
However, many patients are afraid of exacerbating their symptoms with exercise, which is a common complaint. Graded exercise programs should be discussed with and monitored a physician or physical/rehabilitation therapist to regulate type, duration, and level of exercise. Further research is needed on what type of exercise is most beneficial in this group. A new approach is in its pilot stages at the University of British Columbia, looking at the potential benefits of yoga as an intervention for brain injury.
As a field, we are beginning to understand the seriousness and impact of TBI and concussion on both the lives of individuals and how that translates to the economic burden on our health care system. Recently the topic has gained traction and recognition in the broader community. Will Smith starred in the movie “Concussion” last year, garnering awareness and facilitating important discussions regarding brain health. The movie sheds some light on the changing perceptions of how to manage TBI, and highlights just how far we have come. However, much more research is needed to expand how we treat, and prevent brain injury.
For more information and a full list of natural compounds for Traumatic Brain Injuries, please visit Dr. Hrkals article featured here.
Delrae Fawcett is a Vancouver-based Research Coordinator at the University of British Columbia with a MSc in Health Psychology. She is passionate about yoga, health and wellness and believes in practicing and living what you preach.
Image by vege via Adobestock.