What is a Concussion?
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If you suspect you might have a concussion, please take a moment to go through the Concussion Assessment Tool to help understand your symptoms and next steps.
Recognize
Concussions are the most common form of head injury caused by an impact or forceful motion of the head or other part of the body, or a quick motion of neck and head, resulting in rapid movement of the brain within the skull.
A concussion can happen to anyone at any time. Common causes include falls, motor vehicle crashes, and sports and recreational activities.
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MYTH: If the person was not hit in the head or did not lose consciousness, they do not have a concussion.
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FACT: A blow to the head is not the only way an individual can sustain a concussion—a concussion may be caused by a direct blow to the head, face, neck, or a blow elsewhere on the body with an ‘impulsive’ force transmitted to the head. Concussion can also be caused by or a quick motion of neck and head, such as whiplash during a motor vehicle crash. A relatively minor event may result in a concussion, while a high-magnitude event may not. There is no way to know for certain whether a particular event involving the brain will lead to a concussion.
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Note: Most concussions DO NOT include a loss of consciousness. Loss of consciousness occurs in less than 10% of diagnosed concussions.
The following is a list of signs and symptoms consistent with a concussion. If any of these signs or symptoms are present, medical attention should be sought.
Image courtesy of Holland Bloorview Kids Rehabilitation Hospital
Concussion signs and symptoms to watch for in an infant/toddler include:
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Crankiness and irritability (beyond their usual)
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Cannot be comforted or excessive crying
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Sudden changes in nursing, eating, sleeping, or playing patterns
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Loss of balance, such as unsteady walking (more so than normal)
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Lack of interest in favourite toys or activities
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Listlessness or tiring easily
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Loss of ability to carry on with newly acquired skills (across any social and emotional, language, physical development domains)
Any head injury needs to be taken seriously. Most concussions, managed appropriately, resolve without complications. On some occasions, concussion injuries can be more serious and can result in long-term disabilities.
The real danger of most concussions occur when the injury is not recognized or is managed incorrectly. Returning to full activity too soon may result in more severe symptoms or long-term problems. As well, returning to high risk activities (contact sports, dangerous job duties) before full recovery and medical clearance can put the person at risk of sustaining another concussion with more severe symptoms and a longer recovery period.
Second Impact Syndrome is a rare but typically fatal injury that may result if an individual sustains another concussion before their brain has healed.
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MYTH: Concussions aren’t a big deal. An individual with a concussion or a suspected concussion doesn’t need to go to the Emergency Room.
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FACT: Anyone showing signs of a suspected concussion should seek assessment from a doctor, nurse practitioner, or healthcare professional with relevant training. If the person shows any of the Red Flag Symptoms, call 911 or seek emergency care immediately.
See below for the list of Red Flag Symptoms.
Respond
Refer to the Red Flag symptoms at the bottom of this page. If there are no Red Flag symptoms:
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Notify an emergency contact person, parent, or guardian
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Do not leave the person alone
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Continue to monitor for Red Flags and signs of a concussion
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Do not let the person return to the activity or sport
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Do not give the person any immediate medication
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Do not let the person leave alone
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Do not let the person drive or ride a bike
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MYTH: A person with a potential concussion can return to sport, play, or normal activity the same day if they are feeling okay.
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FACT: If a person has a suspected concussion, they should NOT return to sport or activity the same day. They should be seen by a medical professional and/or monitored for delayed symptoms for 48 hours.
Initially, a person with a suspected concussion should not be left alone. The person should NOT be woken up, but should be monitored throughout the night for anything out of the ordinary. Only wake the person if you have concerns about the person’s breathing, changes in skin colour, or how they are sleeping. Call 911 if the person is slow to wake or shows any of the Red Flag symptoms. If sleeping comfortably, let them sleep to allow the brain to rest. Sleep is an important part of the recovery process.
If no signs or symptoms appear within the first 48 hours, the person can return to normal activities but should be monitored for several days. If no signs or symptoms appear within a few days, chances are that no concussion was sustained. If unsure, please see a medical professional for clearance.
Depending on the circumstance, the emergency contact person, parent, or guardian should take the person to a medical professional and/or monitor for delayed symptoms for 48 hours.
If you are going to see a medical professional, the following forms may be useful:
Questions to Ask Your Doctor
Concussion Incident Report
The Concussion Incident Report was developed to help you document a potential concussion-causing incident. It outlines how to respond to a potential concussion at the time of the incident, and provides important information on caring for the person at home.
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Note: It is important to know that any advice or directions given to the person at the time of incident may not be remembered. The Concussion Incident Report is an important communication tool for sharing information from the scene of the incident.
Manage
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MYTH: Complete recovery from a concussion only takes 2 to 3 days.
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FACT: Concussions typically resolve within 4 weeks; however, up to 30 percent will continue to experience persisting symptoms beyond this period. Persisting symptoms have the potential to cause long-term difficulties.
If there is no improvement or symptoms are worsening 2-4 weeks after a concussion, physician referral to an interdisciplinary clinic is recommended, where available.
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MYTH: A person needs to stay in bed and rest for at least a week to recover from a concussion.
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FACT: The recovery process for concussion begins with relative rest for a maximum of 2 days, followed by a gradual and well-managed return to activity. This is best done in collaboration with key individuals in the person’s life, such as healthcare providers, family members, friends, employers, teachers and school staff, coaches, etc.
Recovery from concussion spans the home and work/school/sport settings. It starts immediately following the concussion-causing incident and ends when the individual has gradually returned to normal activities, including work, school, and physical activity.
A concussion can have a significant impact on an individual’s physical, cognitive, and emotional functioning. The recovery process involves balancing activity levels so that they do not do too much or too little. It is a fluctuating process where the person can be doing well one day but not the next. Having had a previous concussion increases the chance an individual will have a delayed recovery.
The recovery period may be negatively influenced by many factors, including:
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Previous concussions
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History of headaches or migraines
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Learning disabilities
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Attention-Deficit / Hyperactivity Disorder (ADHD)
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Mental health issues
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Use of drugs or alcohol
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Returning to activities too soon
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Lack of family or social supports
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Participating in a high-risk sport or activity
Symptoms should decrease over the course of time. Follow-up with a licensed medical or healthcare professional with relevant training if you are worried that the person is not improving or that symptoms are prolonged.
The Recovery Process
The first and most important step in an individual’s recovery from a concussion is RELATIVE REST for a maximum of 2 days. The person will need both physical and cognitive rest after sustaining a concussion to to begin the healing process. Activities at home that do not result in more than mild and brief worsening of concussion symptoms are permitted, such as social interactions and light walking. Mild and brief worsening is considered to be no more than a 2-point increase when compared with the pre-activity level on a 0 to 10-point symptom severity scale, for no more than one hour.
During this period:
Physical exertion should be limited to those daily life activities that do not result in an increased heart rate or breaking a sweat. Restrict: physically strenuous work, exercise, sports, running, biking, rough play, etc.
Cognitive activity should be limited, minimizing activities that require concentration and learning. Restrict: work or school work, reading, electronics (computers, smartphones, video games, TV), musical instruments, loud music, etc.
Once symptoms start to improve, or after the 48-hour period of relative rest, the individual should begin to increase activities in a step-wise process to return to regular levels of activity, including work, school, and physical activity.
Symptoms should decrease over time, but some symptoms may return, worsen, or new symptoms may appear as new activity levels are introduced. If more than mild and brief worsening of symptoms occurs, return to a lower level of activity for at least 24 hours. If you are worried that the individual is not improving, follow-up with a licensed medical professional with relevant training, such as a physician or nurse practitioner.
It is recommended that the person successfully return to work or school before fully returning to sports or physical activities. Returning to full activity too soon may result in more severe symptoms or long-term problems.
For more information, please review the following resources:
Mental Health
Social interactions are important in preventing social isolation, depression, and anxiety. Some suggestions of low-level social interactions during concussion recovery include brief phone conversations with friends and family, meeting someone for coffee, or a short visit.
A concussion can cause emotional or behavioural changes. It is normal to be anxious, irritable, angry, or depressed after sustaining a concussion. The person may worry about school, work, or missed social activities and being away from their peers. Offer encouragement and support as the person works through the graduated stages of return to activity.
Depression can be a long-term consequence of concussion. The person may feel a loss of place at work, school, on a team, or in a social group. Depression in some children and youth can be the result of physical changes in their brain associated with the injury itself.
Seek medical attention or counselling for support in dealing with emotional or behavioural difficulties.
Prevent
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FACT: Although not all concussions can be prevented, there are steps you can take to decrease the risk of sustaining a concussion or reducing the severity of a concussion.
Educate: Learn more about concussions
Educating yourself is the first step in preventing concussions and reducing associated risks in yourself and others. You can educate yourself further by taking the CATT training and visiting the Resources section, where you will find concussion information, including reports, handouts, and articles.
Promote: Responsibility & Fair play
Behaviour and attitude have a major impact on concussion causing incidents. Be responsible for your own actions and inaction to protect yourself and others from concussion. You can encourage fair play in sport by modelling respect and sportsmanship in the presence of others.
Equipment: Use the appropriate equipment for the activity
Hard hats at worksites and helmets worn during sport and recreational activity DO NOT prevent concussions. Hardhats, helmets, and mouth-guards are vital pieces of equipment that protect from serious skull and dental injuries, but they do not prevent the brain from moving around when there is an impact to the head.
Ensuring that you have the required equipment for work, sport, or activity, in good condition and fitting correctly, could decrease the severity of a head injury.
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Note: Current research is focusing on helmet modifications to reduce rotational forces on the brain; however, these products are still undergoing testing and evaluation.
Encourage: Support concussion reporting
People may hide symptoms of concussion because they don’t want to fall behind or disappoint their employers, colleagues, teachers, parents, coaches, and/or teammates. Supporting a positive environment for reporting concussion symptoms sooner can make the biggest difference in preventing more serious concussion outcomes and associated risks.
Awareness: Educating yourself and others
Learning about concussions helps everyone understand how serious this type of brain injury can be. It provides the tools to recognize and report a suspected concussion. An informed person is also more likely to follow the guidelines during the recovery process.
Safe work environments: Strategies to decrease the likelihood of concussions
Creating a culture of reporting incidents, supporting injured workers, conducting workplace risk assessments, and providing concussion prevention training are key to ensuring a safe work environment. Avoiding slips, trips, and falls is easier if walkways and work spaces are free of clutter, cords, puddles, and other hazards, as well as using appropriate signage and stepstools/ ladders as needed. Wear proper safety footwear and exercise caution when working from heights. Strategies to prevent hits to the head include: ensuring shelves and work areas are clean and organized to avoid falling objects, the appropriate use of signage on low hanging obstacles, and stacking heaviest objects on or close to ground. Strategies to prevent motor vehicle crashes include reducing driver hours and implementing a distracted driving policy.
Violence prevention: Strategies to decrease the likelihood of concussions
It is important to have policies for those working directly with people who have a history of violence, substance abuse, or gang involvement, as well as providing training for recognizing and managing hostile and assaultive behaviors. Personal safety can be enhanced by addressing hazardous physical environments, like those with inadequate lighting or barriers that block sight lines and escape routes. Safety can be increased by adjusting staffing levels, providing means of emergency communication, and exercising vigilance.
Red Flag Symptoms
Consciousness
or Burning in Arms/Legs
concussion@bcchr.ca
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