How to spot a concussion and what to do next

Source: Re: News

Those under 30 made up 63% of ACC concussion claims between 2020 and 2021.

Ella Gomez says concussions are too dangerous to ignore.

By Zoe Madden-Smith of Re: News

But there are still no set guidelines for how to support young people as they return to work or the classroom.

Otago women’s rugby player Ella Gomez was concussed last year after colliding heads with another player during a tackle.

“I didn't really think anything of it at the time because I felt fine,” the 18-year-old says.

“But then the next day I woke up with constant headaches.”

Every day in New Zealand more than 100 brain injuries occur.

Neurological Foundation, a charity that funds neurological research, says men are twice as likely to suffer from mild brain injuries and three times more likely to suffer from moderate brain injuries compared to women.

Māori are also particularly vulnerable, with 23% higher risk of concussion compared with Europeans.

Whether a concussion happens on the pitch or at a party, concussion researcher Danielle Salmon says it’s crucial young New Zealanders know what a concussion is and how to heal from one because youth are more vulnerable to serious brain injury.

“This is because their brains are still developing, so it takes longer to recover when they do sustain an injury,” she says.

So, what is a concussion?

“The brain is kind of a bit like a jelly floating inside the skull,” says Salmon. “There’s this thin layer of fluid which floats around the brain.

“When you get a concussion, the brain shakes and rotates inside the skull.

“The issue with this is the brain doesn’t rotate freely because it’s attached to the spinal cord. So what can happen is it stretches the nerve cells that make up the brain. These nerves can release a chemical that impairs nerve cells from communicating with each other.”

Salmon says when you're recovering from a concussion, think about the brain requiring time for those nerves to be put back to where they were to allow proper communication again.

“If we push the brain too much too soon, we might never give the brain time to recover and so it’s continually in a state of stress,” she says.

How to spot a concussion

The biggest challenge with concussions is that no two are the same, says Salmon.

“This makes them really hard to diagnose because the symptoms are so varied. But some red flags to look out for are dizziness, nausea, neck pain, headaches, and sensitivity to bright lights and loud noises.

“If someone hits their head and is slow to get up and stumbles, they lose consciousness, have tingling or numbness in their arm or they vomit - especially if they vomit more than once - these are all signs of a potential brain injury.”

Sometimes people can feel fine at first and then become disorientated later on or, less commonly, their mood changes, says Salmon.

“If you see these signs we want you to see a doctor right away,” she says.

NZ lags behind in concussion recovery

The United States and Canada have legislation that legally protects young people as they gradually return to learning and sport. But in New Zealand, concussion recovery is patchy at best.

New Zealand Rugby, Auckland University of Technology, and University of Otago are campaigning to have set guidelines about how to support students as they return to the classroom, work or sport after a head injury.

So far, five schools have adopted the Graduated Return to Learn guidelines but the aim is to have the guidelines adopted nationally.

What to do if you have a concussion

Whether you are recovering to get back to school, work or sport, Salmon says the best thing to do is take it easy for 48 hours. This means no physical activities, avoiding screens, and not doing any thinking tasks like reading and writing.

“Doing absolutely nothing will give your brain the best chance to recover,” says Salmon.

Recovery for sport

The Graduated Return to Play guidelines recommend that after two days you can start to get back to light exercise like walking to increase your heart rate and send oxygen to your brain to help its recovery.

Salmon says this exercise should be symptom-led. This means if symptoms like a headache or nausea get worse from this activity, you need to decrease the intensity or go back to resting. When symptoms subside you can gradually work your way up again.

If after 14 days of light exercise your symptoms are improving, you can start to do non-impact activities like running drills.

After two more days you can increase the intensity of this exercise to weight training, passing and catching a ball.

At this stage in your recovery Salmon recommends incorporating cognitive tasks into your exercise.

“For example, if you are sitting on an exercise bike for 20 minutes you could count back from 100 in sevens or name the animals that start with A.”

If your symptoms have passed you can now see a health specialist to get medical clearance to play sport or get back to exercise as normal. Make sure to assess how you are feeling and listen to your body as you get back to training.

Unfortunately in some cases, symptoms can hang around and a gradual return to exercise won’t be possible in this timeframe.

If you are under 19 and still having symptoms after four weeks or over 19 and still having symptoms after two weeks, you need to go back to your doctor for advice.

Recovery for school or work

When Ella started back at school after her concussion she wasn’t able to concentrate at all.

“I had to take lots of breaks at school. Every half an hour I would step out of the classroom and have a walk around then come back.”

After taking 48 hours to rest away from screens and any physical activity, the Graduated Return to Learn and Work guidelines recommend starting with 5-15 minutes of reading, texting or screens at a time to see how your symptoms feel.

If you don’t have any symptoms like a headache, dizziness or fatigue you can gradually build this amount of time up each day.

When your symptoms have passed, you can start to go back to school part time and take breaks regularly.

Once you feel like your concentration and energy levels are back to normal you can return to school full-time but continue to take breaks when needed to rest your brain.

“You have to do everything in your power to heal yourself,” says Ella.

“I see some of my teammates get concussions and rush back too quickly when they really need to take it quite seriously.

“Don’t feel guilty calling out a head knock or recognising you’ve had one. They are too dangerous to ignore.”