Members of the International Congress for Athlete Brain Health have advocated for new terminology to better frame how individuals are managed and treated when they do not recover within the typical time frame after concussion.
In Persisting Symptoms After Concussion: Time for a Paradigm Shift,[1] the authors argue the word “syndrome” indicates a typical group of symptoms that occur in a cluster and define the conditionor that a cause is not understood; neither are true with concussion. They feel more precise terminology is needed to convey that individual symptoms occurring after concussion can and should be evaluated, identified, and actively treated. They cite research studies that have highlighted the problematic nonspecificity of the term Post-Concussion Syndrome by demonstrating how often it is indistinguishable from symptoms commonly reported in healthy controls or persons with other disorders
Their preferred term is Persisting Symptoms after Concussion (PSaC), and they hope it calls attention to the appropriateness of active rehabilitation with the goal of recovery and improved quality of life. Rather than using terminology that conveys that symptoms are unrelenting and untreatable, the authors explain that changing terminology to persisting symptoms after concussion communicates hope and a plan for recovery.
Concussion and Long-Term Recovery
In a recent study published in the Journal of Neurotrauma, researchers investigated the association between the causes of concussion and recovery in 600 patients. Data were obtained from patients who had not recovered after at least one month from the time of concussion. They were grouped into four causes: sports and recreation, motor vehicle collisions, falls, and being struck by an object.
The motor vehicle collisions group had the highest percentage of females, the oldest participants, the most symptoms, and the longest symptom duration. In contrast, the sports and recreation group had the highest percentage of males, the youngest participants, the best recovery outcome, and shortest symptom duration. Significant differences among the four causes included age, sex, number of previous concussions, history of psychiatric disorders, and migraine. Complete recovery occurred in only 10% patients; 68% experienced an incomplete recovery and 22% of patient outcomes were unknown. [2]
If you’ve sustained a concussion by someone who made a bad choice behind the wheel, make sure you’ve got a legal team on your side that knows how to win. Cantor Grana Buckner Bucci is that team. Call us.
Neurobehavioral Symptoms After Concussion in Women
Women make up 19% of officers and 17% of enlisted personnel in the US military, but are seriously underrepresented in military research. A few studies which do consider gender have shown women report significantly more post-concussive symptoms than do men. Recently, researchers in the Traumatic Brain Injury Center of Excellence examined the effects of gender specific to mild TBI (MTBI) and investigated the role of post-traumatic stress disorder PTSD in symptom reporting. The total sample size was 966, and groups were broken up by PTSD presentation; post-concussive and quality of life symptoms were compared for men and women, and combat exposure was controlled.
In the MTBI group, women had worse scores on the Neurobehavioral Symptom Inventory and 2 clusters that assess physical and emotional states, and the TBI-Quality of Life Anxiety, Fatigue, and Headache scales. When PTSD was present, women had worse scores on the NSI physical cluster only; when absent, women had worse scores on both as well as the TBI-QOL Anxiety and Headache scales compared to men. [3]
Virtual Reality as an Evaluation and Treatment Tool
In a recent study, scientists at the Toronto Rehabilitation Institute’s highly confirmed that individuals with concussions are at a higher risk of experiencing visually-induced motion sickness. [4]
Concussions can cause symptoms including balance problems, memory impairments, dizziness and headaches. It’s surmised that after concussion, those with balance and sensory integration difficulties rely more heavily on visual cues to navigate their environments, and that the increased dependence on visual cues makes individuals more prone to suffer the symptoms.
Over my years of treating patients, I can tell you the grocery store was one of the last things we’d tackle; so many of them found it entirely too overstimulating for months after their injury. For this study, researchers exposed participants with and without recent concussions to a virtual reality scene simulating motion through a grocery store aisle at varying speeds. Individuals with concussions were found to experience more severe VIMS compared to healthy individuals.
Virtual reality has become a popular method for assessing and rehabilitating concussions due to its ability to visually simulate real-world scenarios, and as it’s use is more widely adopted, it will be important to ensure protocols are carefully designed to titrate treatment exposures so as not to aggravate but rather to treat the symptoms.
If you’ve sustained a brain injury after an accident due to someone else’s negligence, it’s important to understand your rights. The experienced personal injury lawyers with Cantor Grana Buckner Bucci can help you understand your options for compensation; call us.
Concussion at Trial
A seasoned personal injury lawyer will tell you “cases are won and lost on lay witnesses.” Nowhere is this more true than in a mild brain injury case. Lay witnesses, from bystanders to family, friends and colleagues provide testimony on facts and provide valuable insights into the extent to which someone’s injury affects their daily life.
It may be someone witnessed the event and can describe what they saw to the jury, or perhaps someone provided assistance and comfort after the accident and can describe the plaintiff’s condition immediately after the accident. Or it may be after the accident that the extent of someone’s challenges comes into full focus. The memory problems and the getting lost; the tendency to blurt things out and the inability to control their emotions; the pain and dizziness and vision problems that won’t go away and make someone feel like they can’t get out of bed. Their families are living it, their friends are seeing it, and their employers are observing it.
To maximize the verdict, juries must feel the difference the injury caused in someone in a visceral way, and lay witnesses, especially those who do not stand to gain from the outcomes, may be your best hidden weapon.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10087676/
[2] https://pubmed.ncbi.nlm.nih.gov/38468550/
[3] https://doi.org/10.1002/pmrj.12237
[4] https://hospitalnews.com/virtual-reality-for-rehabilitation/
