Most of the focus on changing definition of concussion has come out of concern about concussions in sport. Thru that work, beginning in the early 1990’s, it became standard practice that if an individual suffered a concussion in a sporting event, they should not be allowed to return to competition until certain objective criteria of recovery had occurred.
That research led to the Practice Parameters of Sports from the American Academy of Neurology and other Sports and Concussion guidelines. This insistence on continuous at first, then periodic monitoring before allowing a return to competition has been a near revolutionary change in the approach to concussion. While in practical reality they are not followed to the letter, at a minimum they create a structure for determining whether or not the concussion needs to be taken seriously.
All concussions should be taken seriously but if someone has a 15 minute recovery from a concussion, they are allowed to return to play on that day. Especially with young jocks if a recovery occurs in 15 minutes, it is overwhelmingly likely that they will have a good result.
That work that was done with concussion has helped to change the way in which concussions are defined and diagnosed in the real world. By saying real world concussions, I am talking about concussions that happen to average people in accidents, not sports, not military. While the Concussion in Sports guidelines are not definitionally extended to real world concussions, it has changed perspectives and has lead to the CDC publishing this kit, Heads Up Brain Injury in Your Practice. This is not just for athletes, but for concussed individuals across the board. Click here for the CDC booklet.
The CDC materials included Facts for Physicians about Mild Traumatic Brain. That definition does not limit the definition of concussion to what would be in these neurological treatises discussed earlier this week, such Principles of Neurology by Adams and Victor. It now is using the type of definition that is used for concussion in sports. That is the basic introduction as to where we stand and we look to the future of diagnosing Mild Brain Injury.
I have used the term concussion and the way I use it is synonymous with Mild Traumatic Brain Injury (“MTBI’) in essence a concussion is a Mild Traumatic Brain Injury and the two terms do really mean the same thing, but I it is arguable that a concussion does not become a Mild Traumatic Brain Injury until the symptoms from that persist at least as long as the 15 minute requirement under the Sports and Concussion guidelines.
A concussion does involve injury to the brain. The kind of concussion that does involve injury to the brain that we would be concerned about in my practice as a lawyer who primary represents people with a mild brain injury is the kind of concussion where the symptoms are there the next day, there the next week, there the next month. The problem in determining whether or not someone is going to have a disabling concussion on the day of their accident is that it is not the symptoms they have at the time of their accident, not even the symptoms they have 15 minutes later but primarily their symptoms 24 hours later.
Tomorrow – the failure of the medical community to adopt the serial follow-up evaluations that are required in sport concussions.