Know what to do

Head injuries need special treatment, writes Tom Spears.

NO VISIBLE DAMAGE

The problem: If a blow to the head or body makes the head speed up or slow down violently, the brain is like a passenger inside a car that crashes. It is thrown around inside the head and bangs against the hard skull. But there’s no visible brain damage.

“It’s not really seen on standard imaging — CTs or MRIs,” says Dr. Lisa Fischer, director of sport and exercise medicine at Western University in London.

VARIETY OF SYMPTOMS

Diagnosing the problem is done through the symptoms, and these can vary widely.

They include headache, blurry vision, nausea, dizziness, confusion, irritability, loss of balance and more. There is often a “constellation” or group of several symptoms at once.

But there’s a catch. These symptoms may not appear for some minutes or even hours after the head injury. And the delay happens most often in children.

“That’s why the current recommendation is if you suspect concussion, the player is removed from play and not allowed to go back that day,” Fischer says.

Players sometimes seem fine, keep playing, and then can’t remember the game after it’s done.

“They’re playing OK but they have altered concentration. And those are the people who are very prone to having this second-impact syndrome,” the severe damage or even death from a second hit.

In rare cases it makes the brain swell. “When you hear of somebody dying it’s usually (after) going back too soon while the brain is still trying to heal.”

IT BEGINS WITH REST

Treatment begins with rest: two to three days before easing back in to school or work. But treatment can continue: “Physiotherapy is fantastic” after whiplash, and there are rehabilitation therapies for balance, vision and more.

SLOW RECOVERY

Recovery typically takes seven to 10 days for adults, two to five weeks for children. But it can require months. “Somebody can come in with very high symptoms but recover quickly. Someone can come in with milder symptoms but they don’t recover for months.”

LOOKING FOR CLUES

Research at Western is looking at “biomarkers” — tiny physical changes in blood cells after a concussion. It’s also asking whether a functional MRI (one that shows brain activity, not the physical structure of the brain) can find signs of concussion.

KEEP PLAYING

The final word: “The majority of sport concussions do get better. That’s one message I really like to give because parents and kids are getting quite fearful. The important thing is to recognize it, take the kid out of play, don’t let them go back, and then make sure they are safe before they do go back.”