The brain is protected from most ordinary knocks and tumbles by a thick, hard skull and a cushioning fluid lining. But sometimes bumps, blows, or jolts to the head or impact to the body that makes the head and brain bounce back and forth can result in a concussion. This is also known as mild traumatic brain injury (TBI). While you can’t see a concussion on the outside, the impact can create symptoms that result from damage to brain cells and a temporary change in the brain’s chemistry.

According to the Centers for Disease Control, approximately 1.7 million people experience a concussion each year. Most often we associate concussions with athletic activities such as football, soccer, hockey, boxing, and automobile racing where there are experts on the sidelines or monitoring the activity to actively looking for incidents. However, concussions can happen to anyone, anywhere and when they occur outside of sports — falling off a bicycle, slipping and falling resulting in a bump to the head at home — they often go undetected, which is troubling. While not typically life-threatening, the effects of a concussion can be serious and should be evaluated.

To diagnose a concussion, your doctor looks for a compilation of symptoms that are linked to that impacting event. Your doctor will ask you several questions during your evaluation to determine the types and severity of your symptoms. In some cases, symptoms don’t appear right away and develop over a few days or weeks following the event. There are four categories of symptoms:

Cognitive – slow thinking, difficulty remembering, difficulty concentrating, difficulties remembering new information
Physical – headaches, dizziness, nausea, vomiting, sensitivity to light and sound, balance problems
Emotional – irritable, sad, anxious, depressed
Sleep – more, less, or unable to fall asleep

Treatment is tailored to the individual. Your provider will develop a care plan based on your individualized needs. Your brain is an extremely busy organ that works all of the time and only slows down when you are asleep. Rest is an important part of every care plan. You can get good brain rest by eliminating audiovisual stimulation such as television, computers, and smartphones and taking a break from work, school, and/or caregiving responsibilities as prescribed by your provider.

Most symptoms of a concussion will go away within four-to-six weeks, but every case is unique. If your symptoms continue past this point, your doctor can refer you for treatments to address your specific symptoms such as physical therapy to restore balance, occupational therapy for vision problems or medications for anxiety or depression.

While the emotional symptoms following a jolt or blow can be the result of the concussion, anxiety can also be a response to the traumatic experience. After a brief break, to give the brain rest, the patient should try to return to normal activities. Just as there are “Return to Sport” programs, your physician, physical and occupational therapists and human resources representatives can assist with a plan to help you return to the demands of daily life. Everyone involved must understand that each case differs in terms of how long symptoms will remain.

In rare cases, an event can result in a severe TBI. If the impact causes a dangerous level of blood to collect and squeeze the brain against the skull, the condition can be a life-threatening hematoma.
Call 9-1-1 right away if the injured person has any of the following symptoms:

• An enlarged pupil
• Drowsiness or inability to wake up
• A headache that gets worse and will not go away
• Slurred speech, weakness, numbness or decreased coordination
• Repeated vomiting or nausea, convulsions, restlessness, and agitation
• Unusual behavior
• Loss of consciousness

While not all brain injuries can be prevented, avoiding activities that put your head at risk for a hit is a good step. Always wear protective headgear, such as a helmet, appropriate for your activity, and buckle your seat belt when riding in a car. To prevent falls at home keep walkways well lit and free of tripping and slipping hazards.

Dr. Yevgeny Zadov is a specialist in physical medicine and rehabilitation. A graduate of New York College of Osteopathic Medicine, he completed fellowships in traumatic brain injury and polytrauma at Virginia Commonwealth University.

By Yevgeny Zadov, DO
Physical Medicine and Rehabilitation, UPMC Susquehanna