Concussions

Many years ago I wrote to you about the “hidden epidemic” of undiagnosed, untreated concussions, and how they were quietly frustrating the lives of many Americans, who didn’t even realize that they were dealing with a concussion.  Today, the public and professionals are more aware of the gravity of any cerebral concussion, but we still see news stories about the military not recognizing that the blast of an IED can cause a concussion so serious as to warrant a Purple Heart, and we still see coaches returning concussed football players to the game even though they are still dazed.  Many people suffer serious aggravations of concussions because coaches and professionals so often don’t recognize the symptoms of concussion and the dangers of repeated head trauma.

Often a person who has been a hard worker and supportive family member for years can seem to come through an accident without serious injury, but then will become withdrawn from co-workers and family, strangely hostile and sensitive to ordinary criticism, forgetful, and exhibit other signs making it appear that he/she is “just not the same person.”

The diagnosis of concussion is so frequently missed because of the following popular misconceptions about concussions:

  • A concussion does not require a direct blow to the head. The sudden deceleration and acceleration of the brain inside the skull, smooth on the outside but surprisingly convoluted, with many bony ridges, on the inside, is enough to cause a concussion.
  • A concussion does not require a loss of consciousness (“LOC” in medical lingo). Most medical authorities agree that it is enough if the victim experiences a “stun,” or an altered state of awareness, the “ding” of the football player who keeps playing but thinks its first down when in fact it’s third.  Also, harried emergency room workers will ask the injured person if he/she suffered a LOC, when in fact the injured person is the last person who would know if he/she had a LOC–because he had a LOC!
  • Many people recover from concussions after six months or so. But concussion’s symptoms are usually cumulative; each concussion experienced through one’s life builds upon the damage caused by the previous concussions.

Since we have to be our own guardians against the harm caused by concussions, what should we do to protect ourselves and our family members from the damage of concussions?  Some of these cautions will be hard to take:

  1. Remove your family member from the circumstances in which he/she will be in danger of getting another concussion. Translation: Consider asking your boy to stop playing football after his first, or certainly after his second, concussion.  For decades the NCAA has adopted “Quigley’s Rule,” which says that a college football player with three concussions has played his last play.  It’s true that soccer players suffer more frequent concussions than football players, but offensive football linemen suffer more serious concussions.
  1. Another danger zone is the automobile. It would be unreasonable to expect everyone to stop driving, but at least minimize the risk by using your seatbelt.
  1. After any possible concussion, seek the treatment of a physician, ideally a neurologist. Ask him/her to refer you or your family member to a good neuropsychologist, for comprehensive neuropsychological testing (This costs about $3,500, so be sure to seek this testing early, before your $5,000 of auto medical insurance runs out).  If this testing confirms brain damage, you will then be eligible to seek the psychological remediation that will be necessary to help you deal with this problem.
  1. Once a diagnosis of concussion has been made, psychologists have amazingly simple but effective ways of dealing with the brain damage caused by concussion. For example, one of the most vexing symptoms of concussion is impaired memory, which in turn causes a host of other problems, from irritability with family members, missed appointments, blaming others for one’s own forgetfulness, losses of temper, etc.  For some people, carrying a note-pad, preferably on a chain around the neck, so that it is never forgotten, improves the memory so much that after time, the note pad can be discarded.  The tragic cases are of those people for whom these simple remediation steps are never taken.

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