Signs and Symptoms

It is not just children that have difficulty describing symptoms after an accident and sometimes adults try and ignore the symptoms, so they can ‘carry on as normal.’

Watch out for any of the following signs as well as reported symptoms. These may develop hours to days after the incident.

The symptoms of a concussion can vary greatly. Some of the signs and symptoms from the table above may be present or a person may just describe themselves as feeling ‘off’ or just not ‘getting’ things. Sometimes it’s quite obvious that someone may have a concussion. But just as often the symptoms are vague and subtle.

In any case, there is no simple test for diagnosing a concussion and so getting a definitive diagnosis of a concussion typically requires looking at several factors which we will explore next.

Remember ‘IF IN DOUBT SIT THEM OUT’ and put that person out of harm’s way. A second impact on even a mildly concussed brain can have very serious consequences.

What is a concussion?

The definition of concussion is evolving thanks to an increase in awareness, funding and  research into concussion diagnosis and rehabilitation.

In the UK In 2016-17, there were 155,919 admissions for head injury. That equates to 427 every day, or one every three minutes.

Men are 1.5 times more likely than women to be admitted for head injury. However, female head injury admissions have risen 23% since 2005-6.

http://www.headway.org.uk

The current concussion definition comes from the Berlin Consensus Guidelines in 2016. The Concussion in Sport Guidelines (CISG)* also summarises each topic and recommendations in the context of all five CISG meetings (that is, 2001, 2004, 2008, 2012 as well as 2016). Approximately 60 000 published articles were screened by the expert panels for the Berlin meeting.

Concussion is a traumatic brain injury induced by biomechanical forces. Several common features that may be utilised in clinically defining the nature of a concussive head injury include:

1, Caused either by direct blow to the head, face, neck or elsewhere on the body with an ‘impulsive’ force transmitted to the head.

2, Typically results in the rapid onset of short lived impairment of neurological function that resolves spontaneously.

3, It may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than structural abnormality.

4, There are a set of clinical symptoms, which resolve in a sequential course, however in some cases may be prolonged.

This awareness and level of research into sport related concussions has enabled the development of multidisciplinary concussion assessments and improved our management and guidelines. It may be surprising to know that this is not the only type of patients we see and in the clinical setting we are seeing more and more concussion injuries from other causes, such as motor vehicle accidents, home and work based injuries. Some have started as a simple ‘I bumped my head on cupboard door’ or ‘the dog ran into me and knocked me down’ and so it pays to be vigilant to the signs and symptoms of a concussion after any type of accident, even if there is no obvious direct impact to the head. We will explore ‘the signs and symptoms of a concussion’ in the next blog.

* https://bjsm.bmj.com/content/bjsports/early/2017/04/28/bjsports-2017-097699.full.pdf

Finding the right person for the job

Vestibular rehabilitation, also known as vestibular rehabilitation therapy (VRT), is a specialized form of physiotherapy used to treat vestibular disorders.  Symptoms of a vestibular disorder are characterized by dizziness, vertigo, and trouble with balance, posture, and vision. These primary symptoms can lead to secondary symptoms such as nausea, fatigue, and lack of concentration.
There is high level evidence that VRT is beneficial for Unilateral Vestibular Disorders ‘Cochrane review Jan 2015 by McDonnell et al‘ and so it is worthwhile booking in with a Vestibular Physiotherapist for an assessment to see if they can help alleviate your symptoms.
An article released in Physiotherapy Journal ‘Physiotherapy 105 (2019) 307-314 by A.J. Male et al’ researched evidence based practice of Physiotherapists who have an interest in Vestibular Rehabilitation.
This paper picked up on some interesting findings…
Did you know that Vestibular Rehabilitation is not routinely included in a Physiotherapy Degree?
80% of Physiotherapists interviewed in this journal reported no training in Vestibular Rehabilitation within their degree program. Vestibular Physiotherapists rely on external courses, current research and in-house training to become specialists within this area.
So when you are looking for a Physiotherapist to help you with VRT it pays to ask about extra training to find the right person for the job.

To find a fully qualified and registered Physiotherapist in your area, use the Physio2u directory on the Chartered Society of Physiotherapy website: https://www.csp.org.uk/public-patient/find-physiotherapist/physio2u

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