Editor’s note: This is the second of a two-part series on concussions, causes and treatments.

By Kristine Porter

kporter@tnonline.com

Diagnosing and treating concussions have come a long way over the years.

More than 20 years ago, the medical community graded concussions based on how long a person was unconscious following a blow to the head, said Daniele Shollenberger, a nurse practitioner and director of the practice leader of the Concussion and Head Trauma Program at LVHN.

“We can’t just go on that any more, like we used to, because clearly that may not be indicative of what’s going on,” she said. “Now, we know that less than 10 percent of patients will have loss of consciousness.”

According to a surveillance report by the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, and the U.S. Department of Health and Human Services, the number of traumatic brain injury-related trips to the emergency room, hospitalizations and deaths have increased by 53% from 2006 to 2014.

In 2014 alone, there were about 2.87 million cases of TBI-related injuries in the ER, hospitalizations and deaths.

“Concussion is trauma,” Shollenberger said. “It is a traumatic brain injury, even though people refer to it as mild.”

Shollenberger said it’s thought of as mild because unless bleeding is involved, it doesn’t have the same urgency of treatment.

A TBI and its effects

TBI is also a prevalent injury in children aged 17 and younger.

In 2014, about 812,000 children were treated for a concussion or TBI alone or with other injuries in emergency rooms in the U.S., the CDC report said. About 56,800 people died from a TBI-related injuries in 2014, including 2,529 children.

Although most people survive a TBI or concussion, the effects can linger for weeks, years or a lifetime.

“The long-term effects of concussion are most significant when left untreated,” Shollenberger said. “We see people months and even years after an injury or injuries.”

Shollenberger said symptoms like headaches, trouble thinking or remembering things can be symptoms of other illnesses, but for this reason, they are often missed by doctors as actually latent symptoms of a concussion.

“There is not one diagnostic test, one lab result, one blood test, that’s going to say, ‘Oh my gosh that’s a concussion.’ In fact, if you are going to have a CT scan and your provider says it’s negative, that means there is no blood, which means hemorrhage, and there’s no fracture. But you are still having symptoms, that actually does validate that you do have a concussion,” she said.

Treating a TBI

The medical professionals at LVHN’s Head Trauma Program sites assess a person’s symptoms. From there, they create an individualized treatment plan for specialized therapy. This can include vestibular rehabilitation therapy, which is a form of physical therapy for balance. Cognitive therapy for thinking and memory issues, or work with a neuro optometrist and vision therapy, she said.

Treatment may also involve modifications to how a person lives his daily life. This could involve restrictions to lifting weight or climbing a ladder, for example. For students, the modifications could be requiring extra time for completing tests or projects.

Additional tips for treatment

The CDC’s website also listed tips for adults and children to follow in the days and weeks after a concussion.

Jumping back into daily life without allowing the body, or in this case the brain, time to heal can only make the recovery prolonged and the symptoms worse, it said.

For adults:

• Get lots of sleep at night, and feel free to rest during the day.

• Avoid physically demanding activities, such as heavy housecleaning

• Likewise, avoid mental tasks that require lots of concentration.

• Do not get involved in recreational sports that could cause another concussion, and don’t do leisure activities like roller coasters.

• Do not drink alcohol until the doctor says it is fine to do so.

• Only take medications that have been approved by the doctor.

• Avoid doing multiple tasks at one time.

• Write down the things that are hard to remember.

• Eat well and healthy.

• Consult family or close friends before making important decisions.

• Avoid using the computer or playing video games for long periods of time.

• Avoid flying until cleared by the doctor.

• Likewise, avoid driving, riding a bike or operating heavy equipment until cleared by the doctor. And ask when it is best to return to work. Consider a gradual schedule back to work.

• Return to normal life gradually, not all at once.

For children:

• They need plenty of rest, too. Keep a regular schedule. Don’t stay up late or have sleepovers.

• Avoid activities that could result in another concussion or additional injury, such as riding a bike, amusement rides, sports and playgrounds.

• Take only medications approved by the pediatrician or family doctor.

• Ask the doctor about modifications to daily life, such as a gradual return to school, and more time to complete tests and projects.

• And talk to the child’s siblings, teachers, coaches, babysitter and anyone else who interacts with him about his condition and limitations.