ArticlesBlog

Concussion management and return to learn

Concussion management and return to learn


[scribbling] Hi, my name is Dr. Mike Evans, and this is a quick review
of concussions – what they are and what they do. Now, you might have watched
our concussions 101 video, and this is just an updated version
that covers even more. Concussions
have got a lot of press. I think we can all now name a player or,
or a friend that has had one, and I think we tend to hear
about the bad cases, but I think it’s also important to know
that a concussion can be well managed by you and your family,
your school, and your care team. The first thing you need to know
about concussions is that they
are like your other injuries, and yet completely different.
[buzzer sound effect] When you injure your knee,
you rest it initially and you, and you see how it feels
after a few days. You probably get it looked at,
sometimes it’s something more serious, but most get better,
a- and you slowly resume activity. Well, all that’s true
for concussions – it’s, it’s estimated
that 80 to 90 percent of concussions resolve within 3 weeks. The big difference is that most people
aren’t used to resting their brain. There are no crutches, no ice pack,
no injury that people can see. If you go right back to school,
physical activity, work, digital life, it’s, it’s like going for a run
on your injured knee. Let’s start
with what a concussion is. A concussion is a blow to the head, or elsewhere on the body
that shakes your head, [spring noise] where you have
some other stuff going on. These other things tell us
that your brain has been affected. Now, your brain is Mission Control
and responsible for so many things. So, there are a lot of different ways
a concussion can feel. We generally think
of four categories. So, physical problems like headaches,
poor balance, being more tired, blurry vision, dizziness,
sensitivity to light or noise, [horn] and so on. Next are thinking problems such as feeling mentally foggy or,
or slowed down with difficulties
remembering or concentrating. Then there are emotional symptoms like feeling sad or,
or less control over your emotions. You might feel
more worried or irritable. And finally, there are sleep issues
which can work both ways. You might feel you’re drowsy or,
or sleeping more, or the reverse –
you may have trouble falling asleep or are sleeping less. These symptoms can appear immediately
or take 24 to 48 hours to happen. It’s also important to step back and wonder if any of these symptoms
get worse when you’re working harder, either physically or cognitively,
when you’re using your brain. Concussions can be scary
at the beginning, so it might be helpful to start by making sure there isn’t something
more serious going on. If things take
a sudden turn for the worse, for example,
an unusual worsening of a headache or repeated vomiting, seizures,
weakness in your arms or legs, or you seem way more out of it – slurred speech, confusion,
drowsiness, or you can’t be woken up. This needs to be urgently assessed. The two key words here
are sudden change. Concussions don’t show up on CT
or MRI scanners in the Emergency Room, but these tests can be useful
when there is a sudden worsening to look for brain injuries
other than a concussion. The reality is most concussions
can be managed without going to the ER, but, but check with your doctor
just to be sure. My advice is to take the first week
after concussion in 24 hour chunks. Things might get a bit worse or better
in the first 24 hours [screeching] and we tend
to err on the side of caution and focus on resting the brain. This means taking time off from screens,
taking it easy, no sports, and getting lots of sleep. Sleep is good for a concussion. Again,
if you injured your knee, you would probably
still make it to school or work, but with a concussion,
you need to rest that brain. So, you may have to take a few days
or even a week off. This seems like a lot,
but it may pay off down the road. So, speaking
of the road of recovery, this is hard to predict
at the time of injury. Usually things get better
in days or weeks, but it can also take months. There are some factors
that may make your recovery stretch out a bit longer and that you need to consider
in your “get better” strategy. For example,
have you had a previous concussion? Especially a recent one or,
or one that lasted a long time. Or is there a story
of multiple concussions where it took less force
to cause symptoms? [zapping] If you have a history
of headaches or migraines, these can worsen. If you have had some learning
or mental health issues such as ADHD,
anxiety, depression, a sleep disorder,
a learning disability, and so on, these conditions may or may not
become more of a challenge when you injure your brain.
[book shuts] Now, as I’ve said, helping your brain
self-repair is different. [sound effect] [receiving signal] It might be helpful
to imagine your brain like a cell phone. When you get a concussion, it’s as if your baseline battery life
goes down. It’s just harder to recharge
to 100 percent, as a lot of your power
goes to healing your brain. If we try to do all of the activities
we normally do, chances are we’ll run
out of power quickly, and this is when we feel run down
[sound effect] and our post-concussion symptoms
get worse. One way to conserve energy
is to use the four P’s. So, the first P is to prioritize
our activities each day – we only wanna use up
our limited charge on the activities
that are most important to us. The second P is to plan out
which activities we are gonna to do and when to do them. It is best to plan
difficult or important activities when you have more of a charge –
so after a rest or on a day you don’t have
many other activities to do, or at a time when you feel best –
[sound effect] could be the morning. The third P is to pace yourself. Instead of reading a full chapter
of your textbook, try reading a few pages at a time with breaks
to allow your battery to recharge. And the fourth P
is to position yourself in environments
that won’t use up extra battery. Just being in noisy
and distracting environments, or feeling stressed,
drains your charge. So, with the four P’s in mind, let’s talk about return to learn
and return to physical activity. [bell] Both these strategies
can be modified by your unique situation, school,
and/or your healthcare professional, but they’re a great starting point. Being at school
makes the brain work hard and so you wanna return gradually. Perspective is important here. Each of us are different
in how we respond to a concussion, so your recovery plan is unique
and needs to be individualized. [deep breath] [blows]
Sometimes, this means taking more time, and it’s important
for you and your family to see this as a smart response
that will get you better sooner, not a failure. We generally begin by starting
with no school for a few days, and getting lots of rest at home. Next is a small increase in home,
cognitive, and physical activity, with light walking, easy reading,
and some screen time. A diary of your planned activities
and what happened can be helpful. If you can do 30 minutes
with no symptoms, you can start school-specific activity
like homework in 30 minute chunks. When you can tolerate
30 minutes of school-type activity without your symptoms getting worse,
with breaks to help your symptoms, then you are ready
to go back to school part-time for one to three hours a day with realistic
productivity expectations. When you can do
four to five hours of school activity with two to three rest breaks, you can consider
a return to full time school with supports
that acknowledge the four P’s. This might mean extra help,
more breaks, limited testing in a day,
preferential seating, and so on. When you have no active symptoms
and no problems with exertion, you can return
to your regular school schedule. To make all this happen, I think it is very important
to have a contact person at the school who can make staff
and volunteers aware, assist in scaling your activity
up or, or down, and individualizing your supports
to get better. This means facilitating
a collaborative team approach involving the family,
doctor, school, coaches. It means education, and I think
it also means paying attention, and reacting to subtle signs, and check-in meetings
to discuss strategies around homework, testing, breaks,
distraction-free environments, seating, access to class notes,
phys. ed., and playground planning. Returning to physical activity
when you are symptom free is a similar stage-based approach, and having the team on the same page
is key. Step one is no activity at all. In step two, we try
light aerobic exercise, like a jog. If you can do that
with no symptoms, then step three is returning
to your sport in a low risk setting. So, going for a skate,
kicking a soccer ball, [sound effect] shooting some hoops,
but just by yourself or with a partner. This makes the activity
more predictable and less likely you will be hit
by an object or a person. Monitor yourself
and see how you do. If all good,
and you wanna return to team play, step four
is being “yellow shirted” for practices. Now, the yellow shirt
tells the other players that they cannot
come into contact with you. If you remain symptom-free
with this high level of activity, then you can go to step five,
which is full-contact practice. We usually try
and stretch out this stage out a bit to really test for symptoms, but I think also
to help the player feel confident that she or he is back to normal. If all goes well, then step six
is you return to competition. [cheering] Each step
must take at least a day, and so,
depending on how the person does, this process can take a week,
a month, or even a year. All this can take time
and be frustrating. [sound effect] It’s hard to slow down
and it’s easy to feel down. Talking is key. It, it’s so important that you are open
with your parents, teachers, coaches, family, and friends
because it’s hard to see concussions. People presume you’re okay, so you need to be up front
about how you’re feeling. Things like being in a fog
or being anxious can be hard to put a finger on. So, you don’t need to dwell on it,
[sound effect] but, but you do need to be clear
and honest about how you’re feeling. The good news is that I think the world
is much more accepting of concussions. The reality
is that we are still figuring out exactly the best way for each person
to come back from a concussion. The data thus far suggests that people
who don’t let their brains rest tend to do worse, especially if they expose themselves
to re-injury before they are ready. What we’re still figuring out
is the right balance between challenging yourself
and overdoing it. We don’t want you do too much, but we also don’t want you
do too little. It seems that, you know,
as with other injuries, people who increase their activity
gradually without triggering problems
seem to do well. [scribbling] So, take care of yourself
if you have a concussion. You know,
your brain is you. Everything you’ve got good at – your memories,
how you figure things out – all that
is sitting inside your brain. So keep positive, share any concerns
with the people that care about you. You can solve this together. And take care
of that fantastic brain of yours. Thanks for listening.

Comments (30)

  1. I absolutely love this new video by Dr. Mike Evans, a family physician in Ontario. In teaching groups about concussions, I have often used Dr. Mike's first video Concussions 101 “white board.” This new video was funded by the Canadian govt, and Cat McGill. One of my favorite people in the concussion world, Dr. Gerry Gioia helped with the revision of the video which now covers RTL. Great Job!!

  2. Check out our Concussion infographic http://bit.ly/1tZmYF1 

  3. Wow, this is great!  How do we get this info to the ER docs who tell kids and parents, since the CT scan was clear, everything's "Fine" and they can resume normal activity????  Rest and assess is an excellent strategy.  

  4. Mike would have liked to see athletic trainers included in the video but overall an excellent way to pose this information to parents and athletes. Nice!

  5. Such a cool video! As an athletic trainer, this is great to show an concussed athlete's family!

  6. excellent video. do you know how I can have subtitles in a different language? like Hebrew?

  7. What about traumatized stuttering from concussions? Do you need to go through something traumatizing or is it just a name?

  8. Great video. Can you make some on mental health disorders and acquired brain injury?

  9. Growing up in high school and a little bit in college even, I have witnessed some sports players (mostly football) who always want to continue playing even after a head rattling blow.  In the old days coaches would have put the smelling salts to their nose and thrown them back in the game, but now-a-days coaches will lose their jobs for that.  Today the problem is with the players themselves because they are too prideful to give up their spot on the field, even if it means risking further injury.  Sports are becoming better and better as time progresses forward from heavier padding in the helmets to concussion screening after any big hit or if there is any hint of symptoms.  Head injuries are nothing to joke around with, there is plenty of concussion research and it all shows that the more head injuries one receives, the more the brain is affected and may not heal.  It's important to realize how serious a concussion actually is to prevent further injury and to allow the brain to heal.

  10. Thanks for making this video, Most of my problems are fixed in this version. The only problem I have is that a concussion can be caused by every day means, You can even get a concussion without hitting your head in any way.

  11. I have a concussion right now 😟

  12. Dr. Mike is entertaining and pioneering…..great material!!!

  13. Thank you… I'm in my ninth year with post commotio syndrome, and still counting.

  14. They r awful I have post concussion syndrome

  15. Let's say someone was riding a go cart and it spun around backwards, then someone came at them going full speed on a go cart and ran into them. Their head hit the back of the cart so hard that everything went black. Then they were said for no apparent reason, and their vision was super fuzzy for while, and they had a headache for along time that isn't going away. What if in in two days they have to take end of the school year exams. Their memory is very fuzzy from the 1 hour before it happened to 2 hours later. Did they get a concussion? And will they fail their many exams?

  16. When you have an exam next week and you have a couccsion

  17. Best concussion video I've watched. Clear with all the facts. Helps to know what I'm experiencing is normal. Thank you.

  18. Brilliant video! Thanks. It has been two months since i hit my head skateboard now. Still dizzy when walking, slow, etc. Need to stop when outside walking… Slow. But i am trying to walk a bit now every Day. Hope that will heal dizzyness.. And a foggy slow feeling also. Might take a while. Was a hard hit.. Shit happens. Thanks for sharing this video. Informative and good.

  19. Good video, but very hard to watch the quick movement with my concussion. I had to scroll down and just listen.

  20. You make it sound like ALL Concussions heal within weeks! Where's the info on the ones that don't heal? My daughter is not unique (according to the support groups) after 3 years (at 16 yrs old) she is still suffering daily! Where's the help? Where's the support? Healthcare in Canada is not always so great! And neither are our schools! After 3 yrs! I'm still waiting for help! SAD! Because that's my reality!

  21. I really really hate u

  22. This video is so dumb

  23. At Mercaptor Discoveries, our mission is to beat brain injury. We are developing a breakthrough drug for concussion-related brain trauma.

  24. i banged my head pretty hard while playing football,disoriented for some time,others videos are fucking depressing,u r atleast positive,make me feel better so good job

  25. What is a syndrome? I forgot. 🙁

  26. Thanks for the upload. This is the most helpful and complete video I've found so far.

  27. Great video. Very informativ

Comment here