Talk:Concussion/Archive 1

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Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 19:25, 17 January 2022 (UTC)

Plenty of SLEEP?

--Ah: are you SURE about that one? Can we get an M.D. to check on this? I'd always been told that a person with a concussion who goes to sleep might not wake up -- ever. 76.118.23.40 (talk) —Preceding undated comment added 18:32, 27 September 2010 (UTC).

From below Pediatrics article:

(First off, you want to make sure that there’s not also a neck injury.)

And for the first couple of hours, you want to periodically check in with that person to make sure he or she is not getting worse.

And after that, it is the advice of a lot of rest; physical and cognitive (including, perhaps surprisingly, going easy on school work and video gaming.)

And then, there is perhaps a middle area of whether it’s useful to wake the person up every couple of hours that first night (“still debate about whether periodically waking the athlete during the night is necessary”).

But . . . I AM NOT A DOCTOR. FriendlyRiverOtter (talk) 20:32, 17 August 2012 (UTC)

From the American Academy of Pediatrics, Clinical Report, "Sport-Related Concussion in Children and Adolescents", Pediatrics, Mark E. Halstead, MD, Kevin D. Walter, MD, September 1, 2010:

INITIAL ASSESSMENT
On the Field
" . . Maintaining adequate cervical spine stabilization is critical until neurologic function in all 4 limbs is evaluated . . and the athlete has no reported neck pain or cervical spine tenderness on palpation. . . . The athlete should continue to be monitored for several hours after the injury to evaluate for any deterioration of his or her condition. Referral to the emergency department is warranted if an athlete experiences repeated vomiting, severe or progressively worsening headache, seizure activity, unsteady gait or slurred speech, weakness or numbness in the extremities, unusual behavior, signs of a basilar skull fracture, or altered mental status resulting in a Glasgow Coma Score of less than 15."

In the Office/Emergency Department
“ . . There is still debate about whether periodically waking the athlete during the night is necessary, because there may be more benefit from uninterrupted sleep than frequent awakenings, which may exacerbate symptoms.”

-------------------
(Further parts from this Pediatrics article are quoted in a below section.)

And yes, I would welcome several MDs taking a look at this article.FriendlyRiverOtter (talk) 17:46, 24 July 2012 (UTC) FriendlyRiverOtter (talk) 20:27, 17 August 2012 (UTC)

"32. An athlete should be awakened during the night to check on deteriorating signs and symptoms only if he or she experienced LOC, had prolonged periods of amnesia, or was still experiencing significant symptoms at bedtime. The purpose of the wake-ups is to check for deteriorating signs and symptoms, such as decreased levels of consciousness or increasing headache, which could indicate a more serious head injury or a late-onset complication,such as an intracranial bleed."

Emphasis added. [1] and referenced again in [2] ITasteLikePaint (talk) 13:59, 18 August 2012 (UTC)

Thank you for these two sources. I see that the first is 2004 and the second is 2011. FriendlyRiverOtter (talk) 16:00, 18 August 2012 (UTC)

concussion word derivation

Tue 3 Mar 2009 added latin derivation of word concussion from bc medical journal in addition to the european derivation

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—Preceding unsigned comment added by 209.17.145.34 (talk) 21:43, 3 March 2009 (UTC)

propose to change the latin derivation of the word concussion to fit that used in medical journal as referenced below

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"The word “concussion” derives from the Latin concussus, which means to shake violently."

  www.bcmj.org/node/851

BCMJ, Vol. 48, No. 9, November 2006, page(s) 453-459—Article

We can go from here until the next century on this article. If we seek to protect our most basic to our most elite athletes in the future we should openly and encyclopedically document known diagnostic and treatment criteria for repetitive head trauma. For crying out loud this is why the world needs an online open source encyclopedia! Let all those seeking their own literary glory seek licenses until the cows come home. They will publish their best in the medical journals. Document the open source stuff that falls from the table and make it useful to the rest of us. Dementia Pugilistica is an especially ugly medical condition caused by repeated concussions of varying intensity. Academics are necessary and necessarily slow the progress of medicine. Just deciding how to put the names in order on a major paper can take weeks. With a little work this article could be transformed into a relevant and useful reference. It very obviously requires an editor carrying current credentials as a neurosurgeon. (Sanjay are you listening?) --lbeben 23:13, 24 December 2013 (UTC)

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   www.latin-dictionary.net/info/word/12188.html

concussus, concussus, n declension: 4, gender: M 1. action of striking together 2. concussion 3. shaking (L+S) 4. shock Age: In use throughout the ages/unknown Area: All or none Geography: All or none Frequency: uncommon Source: Oxford Latin Dictionary, 1982 (OLD)

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—Preceding unsigned comment added by 209.17.145.93 (talk) 22:54, 29 January 2009 (UTC)

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Tue 3 Mar 2009 interesting info from Etymology website that says that Latin word concussus is derived from Latin word concutere

Etymology of the Latin word concussus

the Latin word concussus (action of striking together; shock; shaking; stirred, shaken up; restless) derived from the Latin word concutere (shake, vibrate, agitate violently; strike together, to damage; weaken) derived from the Latin word quatere (shake) derived from the Proto-Indo-European root *kwet- derived from the Proto-Indo-European root *kwēt- Derivations in Latin concussio, inconcussus Derivations in other languages English concuss, Portuguese concusso

see www.myetymology.com/latin/concussus.html —Preceding unsigned comment added by 209.17.145.34 (talk) 21:58, 3 March 2009 (UTC)

TV Medicine

Why would a person who has a concussion have to stay conscious? For example, a person falls in an icy cave and struggles through the episode to stay awake until help arrives. Does this have any basis in medicine? --Orthografer 20:34, 3 December 2005 (UTC)

The only basis I can think of is that staying awake faciliates ongoing assessment. Staying awake when in a cave is useful because one can call help to come closer when it arrives. Otherwise, there's little to it. JFW | T@lk 01:57, 4 December 2005 (UTC)

There's that, and the fact that the parents of a child who has had a head injury are often instructed to "wake him up every hour through the night" when they take him home - the purpose being to check that he's ok, but the instructions being mistaken as treatment rather than an aid to diagnosis. For Orthografer, the point of the exercise is to be sure that the person is still capable of consciousness (and get medical assistance if he is not), rather than to keep him conscious. - Nunh-huh 02:00, 4 December 2005 (UTC)

Ok - TV makes it seem like physical harm follows from loss of consciousness due to concussion. Thanks! --Orthografer 02:42, 6 December 2005 (UTC)

Orthografer is correct. In television and movies, it is said that a person should not fall asleep after a concussion because he\she will (might) die. FDPRO 23:42, 1 March 2006 (UTC)

Missing Citation?

Compare 1st para under Pathophysiology to description from Mayo clinic concussion article at http://www.mayoclinic.com/health/concussion/DS00320 : "Your brain floats within your skull surrounded by cerebrospinal fluid (CSF). One of the functions of CSF is to cushion the brain from light bounces of everyday movement. However, the fluid may not be able to absorb the force of a sudden hard blow or a quick stop."

Should this be referenced? Vandersluism 04:12, 31 May 2006 (UTC)

Excellent catch. I just rewrote it to The brain floats within the skull surrounded by cerebrospinal fluid (CSF), one of the functions of which is to protect the brain from normal light "trauma", e.g., being jostled in the skull by walking, jumping, etc., as well as mild head impacts. More severe impacts or the forces associated with rapid acceleration/deceleration may not be absorbed by this cushion. I'm not sure that's not enough to avoid any copyright violation, but it's a start. —Ryan McDaniel 01:31, 20 July 2006 (UTC)

Move to concussion

Does anyone really say "concussion of the brain"? Top google hits are wikipedia and mirrors. Is there any reason that having the article at Concussion would be confusing? I suggest that we move it. Any objections? If not I'll go ahead in a couple days. delldot | talk 06:02, 8 January 2007 (UTC)

Well, no objections, so I'm going to list it at WP:RM. The new section for discussion of the requested move is below. delldot | talk 02:15, 1 February 2007 (UTC)

Other symptoms

A friend of mine has just been asking me for advice. She had a bump to the head two days ago. Yesterday evening she was complaining of inability to walk, numbness and heaviness in her legs. Can these be symptoms of concussion? (As an aside, I've urged her to contact a doctor ASAP rather than rely on unqualified advice.) 89.241.180.143 20:56, 29 January 2007 (UTC)

Good job advising her to get professional help (We can't give medical advice at Wikipedia). But those symptoms sound like something more serious than a concussion, and you're right that she should get medical treatment right away. delldot | talk 02:15, 1 February 2007 (UTC)

Requested move

The following discussion is an archived debate of the proposal. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

The result of the debate was PAGE MOVED per discussion below. -GTBacchus^(talk) 00:49, 8 February 2007 (UTC)

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Concussion of the brain → Concussion — 'Concussion' is the more common usage, and no other meaning of the word is commonly used (i.e. there's no need for Concussion to be a disambiguation page). delldot | talk 02:15, 1 February 2007 (UTC)

Survey

Add  # '''Support'''  or  # '''Oppose'''  on a new line in the appropriate section followed by a brief explanation, then sign your opinion using ~~~~. Please remember that this survey is not a vote, and please provide an explanation for your recommendation.

Survey - in support of the move

1. Support while medically "concussion" could be used in more context then just the brain injury, this is by far the most common association of the term. 205.157.110.11 02:28, 1 February 2007 (UTC)

• Support - almost seems uncontroversial. Part Deux 02:46, 1 February 2007 (UTC)
• Support - should have been listed under uncontroversial moves. DB (talk) 03:13, 1 February 2007 (UTC)

Survey - in opposition to the move

Discussion

Add any additional comments:

The above discussion is preserved as an archive of the debate. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

RVD

What about seizures related to concussion?

My brother fell off the monkey bars at school and had a seziure before blacking out. He went to the hospital and had a catscan. Point of this is, it was caused by a concussion, they(the doctors there)concluded. Yet, no where on this page does it mention seziures, nor does the 'types of sezuires' page note concussion as a cause.(If it does, someone needs to tell me) I'm not ready to go listing things just yet, thought I'd get someone else's two cents. 67.171.167.106 04:15, 10 August 2007 (UTC)

Seizures are very rarely associated with concussion, sounds more like he was epileptic beforehand. —Preceding unsigned comment added by 80.229.27.251 (talk) 16:30, 19 July 2008 (UTC)

This is practicing medicine, which we really don't want to do. By all means, let's do the best research we can.

Now, this first post, from August 2007, is saying, hey, this happened to my brother. And it's brief. It's laying a topic on the table for research and possibly inclusion in our article.

The second post, from July 2008, is saying, you're wrong about your brother. And is drawing a definite conclusion. Which a doctor would not dream of doing before he or she examined the brother. FriendlyRiverOtter (talk) 19:25, 27 November 2012 (UTC)

Good research, yes; but specific advice to individuals, no.

So, let's look up our review articles, see what information they have on seizures and/or epilepsy, and leave it at that. FriendlyRiverOtter (talk) 17:39, 19 November 2012 (UTC)

From the American Academy of Pediatrics, Clinical Report, "Sport-Related Concussion in Children and Adolescents", Pediatrics, Mark E. Halstead, MD, Kevin D. Walter, MD, September 1, 2010:

" . . . Although a brief seizure immediately after a concussive impact may not be problematic, any athlete who has a seizure after concussion should be transported emergently to a medical facility for further evaluation. . . "

MTBI and the CDC

The CDC has started a campaign to increase awareness of and to optimise the care of MTBI, see here. JFW | T@lk 00:16, 22 August 2007 (UTC)

Thanks! I looked through it and added some stuff from it. delldot talk 10:14, 19 January 2008 (UTC)

Prevention

Any reason there isn't a prevention section in this article? Many if not most concussions could have been prevented with the use of proper precautions. Helmets: Consider the design changes to NFL helmets (they used to have hard exteriors, now resilient). Construction, hockey, bicycle and motorcycle helmets have become nearly universal. There must be some good epidemiological studies out there. LeadSongDog 15:18, 28 September 2007 (UTC)

I actually wondered about this too. I say go ahead if you can find sources for it! delldot talk 04:51, 9 January 2008 (UTC)

I've started a small stubbly section. Please add! delldot talk 22:36, 9 January 2008 (UTC)

Prevention could be helped by professional sports such as the National Hockey League pushing towards making hockey safer. Concussions have become a more common injury in hockey today and are being critiqued under a microscope for both there immediate and long lasting effects. Concussion symptoms can last for an undetermined amount of time depending on the player and the severity of the concussion. There is also the potential of post-concussion syndrome, which can last for months after the concussion. Concussions damage the brain of a person and the brain controls everything in the body so to limit this severe injury to the highest percentage possible would be in everybody’s best interest. National Hockey League Commissioners have been pushing towards stricter rules and longer suspensions to crack down on concussions. There have been great strides taken in changing the rules to help concussion prevention but officials still have to continue to look into this considering the game is evolving at an extremely fast pace. Players also need to make it a responsibility within themselves to protect each other and not take runs at each other with a player with their head down. Taking all these things into consideration this could help the prevention of concussions in the National Hockey League considerable. — Preceding unsigned comment added by Scotian15 (talk • contribs) 01:23, 25 October 2013 (UTC)

Tables

So what do people think, are the tables in Concussion#Grades helpful or annoying? Should we leave the text as well as the tables that say the same thing, or pare or remove one or the other? delldot talk 04:51, 9 January 2008 (UTC)

Images?

I think it would be nice if this article had images, but I can't find any free ones, and aside from graphs and so on, can't make them myself. Anyone have any ideas for what to use and where to get some? delldot on a public computer talk 10:30, 12 January 2008 (UTC)

Concussion#Other guidelines

I'm going to remove this section for a couple reasons: I'm concerned that the grades section is disproportionately detailed. Plus, I've only seen a reference to it in the Shepherd article cited, and it doesn't say what the system is called or why it's more special than any of the other 16 systems (whereas the other three systems mentioned are called the three most widely accepted in one source). I do think, though, that Concussion grading systems or some such could be a fine article, if someone wanted to research them.

Since not too many people are active on this article, and since I'm the one that added that text in the first place, I'm going to assume no one will mind my removing it. As always, though, let me know if there's a problem. delldot on a public computer talk11:06, 12 January 2008 (UTC)

Citation cleanup

Much better now, still many missing pmid and doi. LeadSongDog (talk) 21:06, 23 January 2008 (UTC)

Thanks for the hard work, Dog. I've been through and found all PMID's that I could, the rest apparently couldn't be found. I'll look for doi's for the rest. Apparently the {{cite journal}} template is case sensitive, i.e. you have to have lower case pmid= and issn= for it to work. delldot talk 21:48, 23 January 2008 (UTC)

DOI help

I can't get the doi to work for this article. It's listed there as 10.1136/jnnp.2006.106583, but it's a dead link if you add it to the template. A little help? delldot talk 22:05, 23 January 2008 (UTC)

Seems to be a malformed doi, even at source, common to all the Pract Neurol articles I could find.LeadSongDog (talk) 22:30, 24 January 2008 (UTC)

Hrrmm, do you think it can be fixed, or is that it? delldot talk 03:10, 25 January 2008 (UTC)

Argh! Now it seems to work.LeadSongDog (talk) 01:56, 28 January 2008 (UTC)

Argh, indeed. It's still not working for me.  :-( delldot on a public computer talk 02:01, 28 January 2008 (UTC)

My mistake, I clicked on the url, not the doi. It points to the author's archived pdf, not the journal. As the error message says, "If you believe you have requested a DOI that should be found, you may report this error to doi-help@doi.org. Please include information regarding where you found the DOI in your message: http://en.wikipedia.org/wiki/Concussion "LeadSongDog (talk) 04:23, 28 January 2008 (UTC)

Thanks! I sent the email, hopefully they'll fix it! delldot talk 08:59, 29 January 2008 (UTC)

URL's to abstracts

I'm not really worried about it either way, but about URL's to abstracts, I had actually asked about this at WT:MEDMOS#Citing journal articles. Colin replied there that a URL to an abstract should only be given if there's no doi or PMID, and it should be linked as (abstract). Like I said, I'm not concerned either way, but I'd argue for taking them out entirely when we have doi's or PMID's (unless the URL adds something, like if the doi takes you to an intermediate page and the url takes you right to the abstract), and including the link with "abstract" in parentheses when we don't. delldot on a public computer talk 06:43, 9 February 2008 (UTC)

Spinning out grades section

I had an idea to move most of the grades section to a new article, maybe concussion grading systems, leaving a summary here. I'm excited about the idea for a few reasons. The article is stupidly long (my fault), plus, moving this to its own article will help with some of the sports-heaviness brought up in the peer review. Hope no one objects (doubt they will, I'm the one that added the material anyway). I think I'll go ahead in a bit, if there are any problems, we can of course discuss as usual. delldot on a public computer talk 03:52, 15 February 2008 (UTC)

Move to Mild TBI?

My progress with this article is stalling because I can't find any non-sports-related info on concussion per se -- all journals use "mild traumatic brain injury" rather than "concussion", except in sports medicine. Should the name of the article be changed? It's a problem because "MTBI" and "concussion" are sometimes considered the same thing and sometimes not, and no one can agree on the definition of either one. But at least most people consider concussion to be subsumed under MTBI. However, changing the name would require a big rewrite. And more laypeople are familiar with the term "concussion". Should they be two separate articles?

I'm really not sure what to do. Any input would be much appreciated. delldot talk 19:13, 22 February 2008 (UTC)

If there is a complete overlap between the concepts (i.e. all MTBI = concussion) then leave it at "concussion" with a clear emphasis on the MTBI concept. If there is an incomplete overlap, make it clear that this is the case (e.g. very mild concussion is not termed MTBI but ****). JFW | T@lk 09:56, 24 February 2008 (UTC)

Since I was one of the people that recommended an attempt to incorportate more medical literature from outside the sports domain, I guess I should add my two cents. I think that the distinction between the two (MTBI and concussion) is made fairly clear in the lead, and makes clear that MTBI is a broader concept that includes concussion. Perhaps in both the lead, and the diagnosis section it might be worth making clear that concussion has traditionally be used in a sports-related context, while MTBI is used in a broader medical context. One way to do so would be to find the first reference to MTBI in the medical literature, and clarify that concussion is also an older (generic) term, while MTBI is a more recently introduced, technical term. The first reference to MTBI (although there is used as "minor traumatic brain injury") that I find in the pubmed database is 1992 [3]. There is an earlier 1982 reference, but it seems to have nothing to do with traumatic brain injury. Based on this, and the fact that most readers will look for concussion, and not MTBI (which currently redirects here) I would keep it as is. Edhubbard (talk) 15:03, 24 February 2008 (UTC)

Thanks much to both of you. It sounds like maybe it should be left at "concussion" but the distinctions and uses made clearer, right? Good idea about finding the original use of MTBI, Edhubbard, maybe I can even find the original statement where the term was proposed or something. Thanks again, delldot talk 21:44, 25 February 2008 (UTC)

Review of the first few sections

Well, I thought delldot was going to go for GAN, so I started reviewing...then got the message saying not yet. Anywhere, here's the review I did...basically just the first few sections of the article. Hope you find it useful!

• "may be used interchangeably with concussion,[2][3] but" - I think the "with concussion" is implied and thus not necessary, and the "but" would work better as an "although"
  • Reworded slightly delldot talk 05:49, 7 March 2008 (UTC)
• "'Concussion', an older term, has been used for centuries" - this doesn't read too well IMO
  • Reworded slightly delldot talk 05:49, 7 March 2008 (UTC)
• I'm not aware of the referencing standards for articles in this area (it sure aint music or video games!), but should it be said on ref 5 that registration is needed?
  • Having it this way was a suggestion at Wikipedia:Peer review/Concussion/archive1#Colin. It doesn't matter to me how we link it though, if there's an established way I'm glad to change it. delldot talk 05:49, 7 March 2008 (UTC)
• "however it may be more than 600 per 100,000 people" - why not just say a percentage?
  • It's a standard way of writing incidence, maybe because the person years thing. Tourette syndrome has it in per 1,000, which may be logical (since they're both divisible by 100...), so I'll change it to that for now. delldot talk 08:42, 7 March 2008 (UTC)
    • OK, sounds good. As I said, I have no idea what consensus in this area is. :) dihydrogen monoxide (H₂0) 08:50, 7 March 2008 (UTC)
• In reading the last para of the lead I felt that it sort of ended too soon, as if something was missing...although as the discussion is ongoing I'm not sure what I'm leading it! :)
  • Added a little and reworded, how is it now? delldot talk 08:42, 7 March 2008 (UTC)
• "In 2001, a group of concussion experts" - you might want to say who they were, how they were chosen, etc. just to display potential POV in their definition (oooh, conspiracy theory!)
  • Done, but it might be too bulky now... delldot talk 08:57, 7 March 2008 (UTC)
• "may have helped make them more" - rather than "may have" can't you find a source that says that they did?
  • I doubt a source would say that it did help (too committal), but I made the wording a little more specific, hopefully this will clarify why the source expected it to. delldot talk 09:26, 7 March 2008 (UTC)

*"where it is frequently used interchangeably with "MHI" and "MTBI", while the latter is more common in general clinical medical literature" - this doesn't read well. Perhaps "where it is frequently used interchangeably with "MHI" and "MTBI", the latter of which is also common in general clinical medical literature"

• Woah, 2 boxing images...and nothing from any other sport? I'm sure you could find a relevant Gridiron one, for instance
  • Other folks mentioned the sport-heaviness of the article in the peer review, so I replaced the image with an image of someone with a headache. Is this OK? delldot on a public computer talk 01:06, 8 March 2008 (UTC)

Cheers, dihydrogen monoxide (H₂0) 01:27, 7 March 2008 (UTC)

[possible vandalism removed Jojopeanut (talk) 02:01, 13 March 2016 (UTC)]

Good Article nomination

GA review (see here for criteria)

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Overall, very good work. I made did minor MOS (in particular, images) work, but otherwise it definitely meets the GA criteria.

1. It is reasonably well written.

   a (prose): b (MoS):

2. It is factually accurate and verifiable.

   a (references): b (citations to reliable sources): c (OR):

   Especially nice job on providing adequate in-line citations, it is rare for me to not have to request a single one.

3. It is broad in its coverage.

   a (major aspects): b (focused):

4. It follows the neutral point of view policy.

   Fair representation without bias:

5. It is stable.

   No edit wars etc.:

6. It is illustrated by images, where possible and appropriate.

   a (images are tagged and non-free images have fair use rationales): b (appropriate use with suitable captions):

7. Overall:

   Pass/Fail:

   Again, great work. Congratulations! Just as a side note: GA is currently enduring a hefty backlog of nominations. If anyone is willing, please consider reviewing at least one article. For those new to the process, there are mentors willing to guide you through the it. Thank you, VanTucky 03:20, 8 March 2008 (UTC)

Thanks a ton for the very quick review! delldot on a public computer talk 12:16, 8 March 2008 (UTC)

I hate to say I told you so! dihydrogen monoxide (H₂0) 10:15, 8 March 2008 (UTC)

Oh shut up. Just kidding XD Thanks much, H₂O, for giving me just enough of a, uh, kick in the pants to get around to nominating it :D delldot on a public computer talk 12:16, 8 March 2008 (UTC)

New source re microhemorrages in boxing

"How Dangerous is Boxing for the Brain? The 'Heidelberg Boxing Study' does not find any clear risks from amateur boxing / Publication in American Journal of Neuroradiology" (PDF) (Press release). Heidelberg. {{cite press release}}: Text "2008-03-28" ignored (help) Opinions on this one?LeadSongDog (talk) 20:30, 31 March 2008 (UTC)

Deceleration

Why is it necessary to include acceleration and deceleration. Acceleration is a term in physics that describes a change in velocity. Deceleration is a bastardization of the word.

Proper uses of acceleration. The drag racer accelerated at a tremendous rate over the quarter mile track. The fool accelerated at a tremendous rate when he ran into the brick wall.

Msjayhawk (talk) 04:42, 13 February 2009 (UTC)

Low/high severity

I took out the 'broadly speaking... low severity and high severity" info because it didn't have a citation and in the research I did getting this up to GA and in the other head trauma research I've done, I haven't seen anything like that. (That doesn't mean it doesn't exist, just that I don't recall happening across it). I'm guessing that this was added by a knowledgeable person, maybe an expert, speaking from personal experience or judgment. Does anyone have any sources to verify that classification system? If so it should definitely be added back in. Thanks! delldot ∇. 21:21, 29 June 2009 (UTC)

I think I've found a decent ref for terminology in Kirkwood et al. Although the title references pediatrics, much of the review is more general, it is recent (2008) and a free full-text version is available. Have a look and see what you think at PMID 17896204. Note table 1 especially. LeadSongDog come howl 14:31, 11 May 2010 (UTC)

Hockey "head shot" discussion

Following Sidney Crosby's recent injuries, the discussion of concussions has once again come to the fore in hockey circles. See: this Globe and Mail piece and this New York Times piece, which may be helpful. Oddly, nobody seems to be talking about instrumenting the helmets with accelerometers, which today could presumably done simply by fitting them with a smart-phone sleeve inside. After all, no player really wants to leave their cell in the locker room anyhow. LeadSongDog come howl! 20:10, 20 January 2011 (UTC)

Small Note

Rad (under "Mechanism"; as in "...7900 rad/s2...") should redirect to the Radian page, not the Rad disamb. page. —Preceding unsigned comment added by 67.180.86.254 (talk) 00:14, 21 February 2011 (UTC)

Edit request on 15 April 2012

Prevention in sports Prevention of undiagnosed and repeat injury is of importance in sports-related concussions. Rapid sideline testing using short neuropsychological tests that assess attention and memory function have been proven useful and accurate. The Maddocks questions and the Standardized Assessment of Concussion (SAC) are examples of validated sideline evaluation tools. The Return To Play (RTP) protocol aims to decrease repeat concussions within a short time frame to minimize second impact syndrome. It assures players who experience a concussion have complete cognitive and clinical recovery before returning to play. Best practices of RTP involve graduated activity intensification with each step taking at least 24 hours to assure full rehabilitation within one week (includes asymptomatic at rest and during exercise). In cases in which resources (i.e. neurospychologists, neuroimaging) are available on-site, RTP may be more rapid. Baseline assessments, performed before concussion occurs, provide a comparison from which to measure severity of post-concussive symptoms. However, they have not been shown to decrease risk of injury. Use of protective equipment such as headgear has been found to reduce the number of concussions in athletes. Improvements in the design of protective athletic gear such as helmets may decrease the number and severity of such injuries. New "Head Impact Telemetry System" technology is being placed in helmets to study injury mechanisms and potentially help reduce the risk of concussions among American Football players. Wearing a helmet is associated with a decreased risk of head injury for skiers and snowboarders. Changes to the rules or the practices of enforcing existing rules in sports, such as those against "head-down tackling", or "spearing", which is associated with a high injury rate, may also prevent concussions. The National Football League (NFL) implemented the sideline concussion assessment protocol in 2011 which oversees the treatment of any possible concussions and ensures that the medical staff on each sideline are following proper league protocol and testing for any head trauma. In 2011 the NFL enforced a kickoff rule change which moved football kickoffs five yards forward, resulting in reduced concussion incidence by 50%. Rules aimed at promoting fair play, while minimizing outwardly aggressive behavior, should be encouraged in all sports.

Tbigroup (talk) 23:50, 15 April 2012 (UTC)

Typically we try to use references in the last 5 or at most 10 years. Also we use inline referring.Doc James (talk · contribs · email) 00:39, 16 April 2012 (UTC)

Tbigroup included inline referencing, they just didn't format it correctly. I've fixed that. Adrian J. Hunter^{(talk•contribs)} 15:06, 20 April 2012 (UTC)

References

Still requires work but I have placed it on this subpage Prevention of concussions Doc James (talk · contribs · email) 16:52, 20 April 2012 (UTC)

2012 review article

Scorza, KA (2012 Jan 15). "Current concepts in concussion: evaluation and management". American family physician. 85 (2): 123–32. PMID 22335212. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help) Doc James (talk · contribs · email) 22:50, 7 June 2012 (UTC)

Abstract: “ . . . Cognitive and physical rest are the cornerstones of initial management. There are no specific treatments for concussion; therefore, focus is on managing symptoms and return to play. Because concussion recovery is variable, rigid classification systems have mostly been abandoned in favor of an individualized approach. A graded return-to-play protocol can be implemented once a patient has recovered in all affected domains. . . ”

I don't see how we're getting, "Cognitive and physical rest are the cornerstones . . . There are no specific treatments for concussion." I mean, rest is real treatment. Maybe they mean something the doctor can do.

And maybe the doctor talking with the patient is taken as a given in most professional publications, unless that happens to be the specific topic. And this is where we can run into translational difficulties, taking a professional publication and translating it for the general public. FriendlyRiverOtter (talk) 14:57, 16 July 2012 (UTC)

Well, rest is real, but it isn't specific to concussion. I try to selfadminister rest every night, and I haven't had a concussion in decades. I find it also helps treat fatigue and eyestrain. ;-) A "specific treatment" is one "particularly adapted to a given disease" according to Dorland's. LeadSongDog come howl! 16:12, 16 July 2012 (UTC)

I think a doctor should tell his or her patients, first and foremost, be even more careful not to get a second concussion before the first one has completely healed (and a number of sources say this). And then, I was surprised that recommended rest includes cognitive rest, too, including going easy on schoolwork. I did not know that, and my guess would be that a fair number of other people don't know this either.

And okay, point well taken. Rest is not a "specific" treatment. So, this source is not contradictory. It's just not real great communication with the general public. Hopefully, once doctors are sitting there with living, breathing (intelligent) patients, they do a little better job at explaining.

And yes, I use the non-"specific" treatment of rest on a fairly regular basis myself.  :-)

(Please note: I myself can only find the abstract of this article on the Internet.) FriendlyRiverOtter (talk) 20:37, 18 July 2012 (UTC)

serious miscommunication in our article

Before this edit in June 2012:

https://en.wikipedia.org/w/index.php?title=Concussion&diff=next&oldid=499957846

our article used to say:

"Usually concussion symptoms go away without treatment,[70] and no specific treatment exists.[71] There has been one treatment intervention that has shown to be particularly effective. It is called activation database guided EEG biofeedback. . . "

And that is woefully incomplete to the point of being inaccurate, at least in communicating with the intelligent layperson. We leave out "Cognitive and physical rest are the cornerstones . . . " We leave in "no specific treatment exists . . ", which is presumably the part talking to fellow physicians. And rest being general rather than specific. Fine, point well taken.

All the same, it is a real question how we drifted to this serious miscommunication in an article classified as "good." And I think part of the answer is that we so focus on "well-written," that is, the wordsmithing, at the expense of doing the diligent, patient work of checking that we have in fact done a good job summarizing our sources. FriendlyRiverOtter (talk) 17:27, 9 October 2012 (UTC)

Cogitive and physical rest as the cornerstone of concussion management is also in this source: Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008, Journal of Clinical Neuroscience, P. McCrory, W. Meeuwisse, K. Johnston, J. Dvorak, M. Aubry, M. Molloy, R. Cantu, 16 (2009) 755–763.

2010 review article in Pediatrics

From the American Academy of Pediatrics, Clinical Report, "Sport-Related Concussion in Children and Adolescents", Pediatrics, Mark E. Halstead, MD, Kevin D. Walter, MD, The Council on Sports Medicine and Fitness, Vol. 126 No. 3, September 1, 2010:

INITIAL ASSESSMENT
On the Field
'As with all acute head and neck injuries, initial assessment of the “ABCs” (airway, breathing, and circulation) and stabilization of the cervical spine are of the utmost importance. Cervical spine injury should be assumed in any athlete who is found to be unconscious after head or neck trauma. Maintaining adequate cervical spine stabilization is critical until neurologic function in all 4 limbs is evaluated and found to be intact and the athlete has no reported neck pain or cervical spine tenderness on palpation. . . '

" . . . The athlete should continue to be monitored for several hours . . . Referral to the emergency department is warranted if an athlete experiences repeated vomiting, severe or progressively worsening headache, seizure activity, unsteady gait or slurred speech, weakness or numbness in the extremities, unusual behavior, signs of a basilar skull fracture, or altered mental status resulting in a Glasgow Coma Score of less than 15."

NEUROIMAGING

" . . . CT is the test of choice to evaluate for intracranial hemorrhage during the first 24 to 48 hours after injury. . . "

[So, apparently it's not only the first couple of hours after injury.]

MANAGEMENT

"The goal of managing a young athlete with concussion is to hasten recovery by ensuring that the athlete is aware of and avoids activities and situations that may slow recovery. It is important to stress to patients and their parents to allow adequate time for full physical and cognitive recovery. . . "

Cognitive Rest

" . . . Reading, even for leisure, commonly worsens symptoms. . . "

" . . . may include a temporary leave of absence from school, shortening of the athlete's school day, . . "

" . . . Because students physically look well, it is not uncommon for teachers and other school officials to underestimate the difficulties . . . "

" . . . Sunglasses may be considered for athletes with significant photophobia. Athletes often have slowed reaction times after a concussion and may need to avoid driving temporarily."

Physical Rest

" . . . An athlete in the acute phase of a concussion should be restricted from physical activity. However, results of preliminary studies that evaluated patients with postconcussion syndrome have shown potential benefit from subsymptom threshold exercise training, which involves short durations of light cardiovascular activity without inducing symptoms. . . "

" . . . Leisure activities such as bike-riding, street hockey, and skateboarding should also be restricted, because they may impose a risk of additional head injury . . . "

" . . . a concussion may result in depression, in part from the injury itself but also from the prolonged time away from sports, difficulties in school, and sleep disturbances."

RETURN TO PLAY

" . . . numerous studies have demonstrated a longer recovery of full cognitive function in younger athletes compared with college-aged or professional athletes--often 7 to 10 days or longer. Because of this longer cognitive recovery period, although they are asymptomatic, there should be a more conservative approach to deciding when pediatric and adolescent athletes can return to play."

Concussion Rehabilitation

“ . . . a graded return-to-play protocol after a concussion is recommended. This may also be referred to as “concussion rehabilitation.” Once asymptomatic at rest, the athlete progresses in a step-wise fashion (Table 5) through the protocol as long as he or she remains asymptomatic. . . ”

“ . . . Each step should take at least 24 hours, . . ”

“ . . . An athlete who has recovered from prolonged postconcussion syndrome or with a history of multiple concussions may need a longer period of time to progress through each step.”

From Table 5, the steps are: no activity (cognitive and physical rest), light aerobic activity (say walking or stationary cycling at 70% max heart rate), sport-specific exercises, noncontact training drills (more complex, may start light resistance training), full-contact practice, return to game play.

From this I take that the focus is on intial rest, then taking it medium step by medium step and staying symptom free. And not so much on the actual specific steps themselves. Other people may come to different conclusions. And also light touch, willingness to back away and give it a rest for a day or so, and then ease back in and try a level again. FriendlyRiverOtter (talk) 02:32, 25 October 2012 (UTC)

COMPLICATIONS

Second-Impact Syndrome

“ . . . Second-impact syndrome results in cerebral vascular congestion, which often can progress to diffuse cerebral swelling and death. Although there is debate whether the cerebral swelling is attributable to 2 separate hits or a single hit, there is no question that pediatric and adolescent athletes seem to be at the highest risk of this rare condition . . . . Catastrophic football head injuries are 3 times more likely to occur in high school athletes than in college athletes.”

Postconcussion Syndrome

“ . . . Postconcussion syndrome is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition as 3 months' duration of 3 or more of the following symptoms: fatigue; disordered sleep; headache; vertigo/dizziness; irritability or aggressiveness; anxiety or depression; personality changes; and/or apathy. . . ”

“ . . . A recently proposed definition of postconcussive syndrome is the presence of cognitive, physical, or emotional symptoms of a concussion lasting longer than expected, with a threshold of 1 to 6 weeks of persistent symptoms after a concussion to make the diagnosis.”

Retirement From Sports

“ . . . No evidence-based guidelines exist for the consideration of retiring an athlete from a sport. It has been proposed that any athlete who has sustained 3 concussions in an individual season or has had postconcussive symptoms for more than 3 months should be strongly considered for a prolonged period of time away from sports. . . ”

That may well be a good clinician judgement call, but like the article says, not that much actual information or evidence. And there may not be that many ethical ways to get information regarding human beings and concussions. FriendlyRiverOtter (talk) 18:30, 2 January 2013 (UTC)

I am slowly working my way through this article. Please help if you have the time. FriendlyRiverOtter (talk) 21:35, 18 July 2012 (UTC)

(redacted copyvio from http://neoreviews.aappublications.org/content/pediatrics/126/3/597.full.pdf+html )LeadSongDog come howl! 05:07, 30 September 2012 (UTC)

Alright, I'll see if I can make it shorter. FriendlyRiverOtter (talk) 16:50, 4 October 2012 (UTC)

I have now finished reading this article. I am not a doctor. I have excerpted and quoted the parts which I feel are most important and have integrated some but not all into our article. Someone else, especially someone who is a physician, may well excerpt other parts. I would say that this review article in Pediatrics does seem to generally agree with the journalism ESPN has done on concussions. FriendlyRiverOtter (talk) 18:51, 2 January 2013 (UTC)

iffy part previously from our Pathophysiology subsection

Part previously in our article:

" . . . Since the neuron firing involves a net influx of positively charged ions into the cell, the ionic imbalance causes cells to have a more positive membrane potential (i.e. it leads to neuronal depolarization). This depolarization in turn causes ion pumps that serve to restore resting potential within cells to work more than they normally do. This increased need for energy leads cells to require greater-than-usual amounts of glucose, which is made into ATP, an important source of energy for cells. The brain may stay in this state of hypermetabolism for days or weeks. . . . "

Please notice the beginning "Since the neuron firing involves a net influx of positively charged ions into the cell . . . " Well, maybe. The Pediatrics source is mainly talking about potassium efflux to extracellular space.

For the time being, I have deleted this part and went with a summary of the information from Pediatrics (Halstead, Walter, 2010), which in my judgment, provides a cleaner narrative of possible biochem pathways established from animal studies. FriendlyRiverOtter (talk) 22:26, 18 July 2012 (UTC)

References

Consensus statement from 3rd International Conference on concussion in sport, Nov. 2008.

We currently use this consensus statement for " . . the international consensus meeting in Zurich recommend the use of the SCAT2.[11] [54]" in our Diagnosis section, but I think there are probably other valuable parts we can pull from it. FriendlyRiverOtter (talk)

Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008, Journal of Clinical Neuroscience, P. McCrory, W. Meeuwisse, K. Johnston, J. Dvorak, M. Aubry, M. Molloy, R. Cantu, 16 (2009) 755–763.

also . . (different format which gives quicker access to end material)

McCrory, P (2009 Jul-Aug). "Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008". Journal of athletic training. 44 (4): 434–48. PMID 19593427. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

“ . . . . the authors acknowledge that the science of concussion is evolving and therefore management and return to play (RTP) decisions remain in the realm of clinical judgment on an individualized basis. . . . ”

1.1. Definition of concussion “ . . . . In a small percentage of cases, however, post-concussive symptoms may be prolonged. . . . ”

1.2 Classification of Concussion “There was unanimous agreement to abandon the “simple” versus “complex” terminology . . . . The panel, however, unanimously retained the concept that most (80–90%) concussions resolve in a short period (7–10 days), although the recovery time frame may be longer in children and adolescents.”

2.1. Symptoms and signs of acute concussion
“ . . . . The suspected diagnosis of concussion can include one or more of the following clinical domains:
(a) symptoms: somatic (e.g. headache), cognitive (e.g. feeling like in a fog) and/or emotional symptoms (e.g. lability)
(b) physical signs (e.g. loss of consciousness, amnesia)
(c) behavioral changes (e.g. irritablity)
(d) cognitive impairment (e.g. slowed reaction times)
(e) sleep disturbance (e.g. drowsiness).”
. .
2.2. On-field or sideline evaluation of acute concussion “ . . . and particular attention should be given to excluding a cervical spine injury. . . . ”

“ . . . . Brief NP test batteries that assess attention and memory function have been shown to be practical and effective. Such tests include the Maddocks questions and the Standardized Assessment of Concussion (SAC). Standard orientation questions (e.g. time, place, person) have been shown to be unreliable . . . . It should also be recognized that the appearance of symptoms might be delayed several hours following a concussive episode.”

3.2. Objective balance assessment “Published studies, using both sophisticated force plate technology, as well as those using less sophisticated clinical balance tests (e.g. the Balance Error Scoring System), have identified postural stability deficits lasting approximately 72 hours following a sport-related concussion. . . . ”

4) CONCUSSION MANAGEMENT
“The cornerstone of concussion management is physical and cognitive rest until symptoms resolve and then a graded program of exertion prior to medical clearance and RTP. . . . Activities that require concentration and attention (e.g. scholastic work, video games, text messaging) may exacerbate symptoms and possibly delay recovery. In such cases, apart from limiting relevant physical and cognitive activities (and other risk-taking opportunities for re-injury) while symptomatic, no further intervention is required during the period of recovery and the athlete typically resumes sport without further problem.”

4.1. Graduated return to play protocol
“ . . . . With this stepwise progression, the athlete should continue to proceed to the next level if asymptomatic at the current level. Generally each step should take 24 hours . . . . If any post-concussion symptoms occur while in the stepwise program, then the patient should drop back to the previous asymptomatic level and try to progress again after a further 24-hour period of rest has passed.”

4.5. The role of pre-participation concussion evaluation “ . . . . A structured concussion history should include specific questions as to previous symptoms of a concussion; not just the perceived number of past concussions. It is also worth noting that dependence upon the recall of concussive injuries by teammates or coaches has been demonstrated to be unreliable. . . . Questions pertaining to disproportionate impact versus symptom severity matching may alert the clinician to a progressively increasing vulnerability to injury. . . . ”

5.4. Depression
"Mental health issues (e.g. depression) have been reported as a long-term consequence of TBI including sports-related concussion. Neuroimaging studies using fMRI suggest that a depressed mood following concussion may reflect an underlying pathophysiological abnormality consistent with a limbic-frontal model of depression."

7) INJURY PREVENTION
“There is no good clinical evidence that currently available protective equipment . . . . In specific sports such as cycling, motor, and equestrian sports, protective helmets may prevent other forms of head injury (eg, skull fracture) . . . . ”

7.3 Risk Compensation “ . . . . This is where the use of protective equipment results in behavioural change, such as the adoption of more dangerous playing techniques . . . . ”

Concussion injury advice (To be given to concussed athlete)
“If you notice any change in behavior, vomiting, dizziness, worsening headache, double vision or excessive drowsiness, please telephone the clinic or nearest hospital emergency department immediately.”
“ . . Use paracetamol or codeine for headache. Do not use aspirin or anti-inflammatory medication . . ”

International conference on concussion and sport scheduled for Nov. 2012

Physicians must be brought up to speed on concussion risks, CMAJ News, Canadian Medical Association Journal (CMAJ), Jordan Fallis, Vol. 184 (2), February 7, 2012, (first published electronically December 19, 2011).

" . . . Revisions to international concussion guidelines are also needed, the panelists argued [special seminar on concussions in hockey held at Scotiabank Place in December 2011]. The current guidelines were developed in 2008, when the Third International Conference on Concussion in Sport developed the Consensus Statement on Concussion in Sport, which lays out evidence-based guidelines for physicians, trainers and other health care professionals on how to treat concussed patients (http://sportconcussions.com/html/Zurich%20Statement.pdf). An update is expected to be released after a conference to be held in Zurich, Switzerland in November 2012 [Emphasis added]."

So, when the subsequent publications come out, we can probably update and incorporate into our article. FriendlyRiverOtter (talk) 19:15, 28 June 2012 (UTC)

Some issues with treatment section.

"Usually concussion symptoms go away without treatment,[70] and no specific treatment exists.[71] There has been one treatment intervention that has shown to be particularly effective. It is called activation database guided EEG biofeedback. . . "

Wow, hardly know where to start. Okay, first off, rest is real treatment. It is to an orthopedic. And it is to a doctor who handles back injuries. If the doctor recommends rest, the patient tends to do a heck of a lot better if he or she rests than if he or she doesn't. Then, it looks like we're immediately jumping to the flashing high-tech intervention.

Okay, from the above 2008 Consensus statement, it's recommended that it be both physical and cognitive rest (including going easy on such activities as school work and video games). And for athletes, a graded series of return to activity is recommended, making sure you stay symptom free at each stage, or drop back one previous stage and give it at least 24 hours.

I am not a doctor, far from it. I'm just a person interested in this topic, willing to do some of the patient work of looking things up. Please jump in and help out if this is something which interests you. FriendlyRiverOtter (talk) 19:26, 29 June 2012 (UTC)

Might need to temporarily lose the following source, which I'd rather not do, but at least we can keep it here:

[70] Komaroff A (1999). The Harvard Medical School family health guide. New York: Simon & Schuster. p. 359. ISBN 0-684-84703-5.

Because we have the more specific information from the 2008 Consensus Statement:

Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008, Journal of Clinical Neuroscience, P. McCrory, W. Meeuwisse, K. Johnston, J. Dvorak, M. Aubry, M. Molloy, R. Cantu, 16 (2009) 755–763.
1.2 Classification of Concussion
“ . . . The panel, however, unanimously retained the concept that most (80–90%) concussions resolve in a short period (7–10 days), although the recovery time frame may be longer in children and adolescents.”

The review at PMID 22533212 looks to be very useful. It is current as of Feb 2012, freely accessible, and discusses the changes in the 2008 Consensus statement. Give it a read.LeadSongDog come howl! 16:26, 3 July 2012 (UTC)

Thank you. That's the kind of more current, hopefully readable information I'm looking for. Now, I was planning to read the review article recommended by Doc James next, but this sounds pretty good, too.

And it turns out to be the same article! Good, great minds think alike. Now, my time is still pretty limited. I am interested in this topic obviously, will dive in when I can. My next immediate project is to finish up on some of the dynamic aspects below. FriendlyRiverOtter (talk) 21:51, 3 July 2012 (UTC)

same serious miscommunication in our article (corrected June 2012)

Scorza, KA (2012 Jan 15). "Current concepts in concussion: evaluation and management". American family physician. 85 (2): 123–32. PMID 22335212. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help):

" . . . Cognitive and physical rest are the cornerstones of initial management. There are no specific treatments for concussion; therefore, focus is on managing symptoms and return to play. . . "

From the American Academy of Pediatrics, Clinical Report, "Sport-Related Concussion in Children and Adolescents", Pediatrics, Mark E. Halstead, MD, Kevin D. Walter, MD, The Council on Sports Medicine and Fitness, Vol. 126 No. 3, September 1, 2010:

"MANAGEMENT
"The goal of managing a young athlete with concussion is to hasten recovery by ensuring that the athlete is aware of and avoids activities and situations that may slow recovery. It is important to stress to patients and their parents to allow adequate time for full physical and cognitive recovery. . . "

References and information on dynamic aspect of concussions.

Sometimes it's not merely one concussion, but a series of concussions and that's what I mean by the dynamic aspect. FriendlyRiverOtter (talk) 19:53, 2 July 2012 (UTC)

Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008, Journal of Clinical Neuroscience, P. McCrory, W. Meeuwisse, K. Johnston, J. Dvorak, M. Aubry, M. Molloy, R. Cantu, 16 (2009) 755–763:
" . . Questions pertaining to disproportionate impact versus symptom severity matching may alert the clinician to a progressively increasing vulnerability to injury. . "

The Merck Manual Home Health Handbook, Concussion, last full review/revision January 2008 by Kenneth Maiese, MD:
“ . . . People who have had a concussion also seem to be more susceptible to another one, particularly if the new injury occurs before symptoms from the previous concussion have completely gone away. . . . Repeated concussions may increase a person's risk in later life for dementia, Parkinson's disease, and depression. People should not return to contact sports after a concussion until all ill effects have resolved and medical evaluation has been completed.”

I put some of this at the beginning of our Prognosis section where it seemed appropriate since it's talking about the the possibility of future concussions or not, and about longterm prospects and health. I would like to also move some of this into the lead. Now, our lead currently has the sentence "Repeated concussions can cause cumulative brain damage such as dementia pugilistica or severe complications such as second-impact syndrome," which is free-floating, currently unsupported by any reference whatsoever. FriendlyRiverOtter (talk) 22:42, 3 July 2012 (UTC)

We currently talk about second-impact syndrome as a subsection of Prognosis, with references. I'm not sure whether it's common enough, or serious enough (probably is on this count) to move back to our lead. My next immediate project for the topic of concussion is the 2012 review article recommended by both LeadSongDog and Doc James. FriendlyRiverOtter (talk) 18:45, 12 July 2012 (UTC)

Mayo Clinic Health Letter, Aug. 2012

Mayo Clinic Health Letter, Managing Editor Aleta Capelle, Medical Editor Robert Sheeler, M.D., “Concussion, The brain in crisis,” Aug. 2012, pages 4-5.

“ . . . when a first-time concussion brain injury is identified and the brain is given adequate rest and time to heal properly, most recover completely. However, changes that occur in the brain due to concussion make it potentially vulnerable to repeat injury and possibly even permanent damge. For someone who’s had multiple concussions, recovery becomes less certain with each concussion. . . ”

This article is reprinted by Michigan Brain & Spine Surgery Center and available online. http://www.brainandspinesurgerycenter.com/concussion-the-brain-in-crisis/

Please be careful about the potential for wp:CCVIO here. If this blog is just copypasting from the Mayo Clinic article, simply use and cite the original without linking the copy. LeadSongDog come howl! 12:56, 30 October 2012 (UTC)

This is not a blog. This is a medical practice's professional website where they include health information on a variety of topics. Now, that said, they may or may not get fair use right.

I do want us to get fair use right. I suspect we agree on that point. Of course once we get into some details, we might agree, we might disagree. The few times I've looked at fair use, I've been surprised at how much is allowable and permissible. One of the major cases on the other side was when one of the newsweeklies which includes longer pieces (I think back in 1979) was going to include excerpts of former President Gerald Ford's book A Time to Heal. The court basically ruled (in my non-legalese), hey, normally, excerpts this length would be just fine, but you've stolen the man's thunder by focusing on his reasoning for his pardon of former President Nixon, and by stealing his thunder you've reduced sales of the book. Now, what I take from this, it's not enough that we ourselves have a nonprofit motive. It is also the case that our use should not substantially reduce the profits of the copyright holder. Okay, with the Mayo Clinic Health Letter, it's one article which is now dated three months. If anything, we're promoting the Mayo Clinic Health Letter. Of course, that is not my goal either. My goal is to simply give ourselves access to good, authoritative information on concussion.

Okay, all this said, we might concur even if we don't agree, because I believe short and sweet is often the way to go anyway. As in art, less is more. But sometimes I need to understand something better and really take my time, before I can make it short. FriendlyRiverOtter (talk) 18:05, 17 November 2012 (UTC)

Classification

This section is quite complete but the readability is threatened by the detail. I do understand the historical importance of the conflicting definitions, but it must be hard reading for someone not involved in the area. I am happy to trim the less important parts but I don't want to offend unnecessarily. Guidance would be appreciated. Mdscottis (talk) 03:14, 18 December 2012 (UTC)

I wrote that section, and I don't have a problem with you pairing it down. Reading back over it it does seem like way too much detail with the explanation of all the diferent symposia and their different definitions. I think the MTBI vs. concussion is important, and the question of whether or not there is physical damage to tissues is important, but that could be summed up more succinctly. Also the damage question could go further down in pathophysiology, a section a casual reader might skip anyway. Thank you for working to improve the article! delldot ∇. 04:35, 18 December 2012 (UTC)

I like the idea of narrative arc, where our entire article, say, starts at the 10th grade level (absolutely assuming the reader is just as intelligent as we are, simply doesn't know certain information), progressing through college freshman, all the way to post-doctorate research questions. This later of course would be toward the end of the article.

Mdscottis, it's great having you as a physician involved. Doc James has also done good work. Now, if the two of you sometimes disagree, that might actually be the best outcome of all. I am more and more of the opinion that the focus of wikipedia often becomes merely the formality of the writing, rather than the accuracy of the information. FriendlyRiverOtter (talk) 02:30, 27 December 2012 (UTC)

I didn't realize how fatiguing this process could be. I think that's what degrades the accuracy. When I saw that you and Doc James had written, the first and main emotion was relief. It's quite amazing to watch the bricks turn into an actual wall. I have learned so much from it. A real privilege. Mdscottis (talk) 02:53, 27 December 2012 (UTC)

You're very welcome! As a non-doctor, I'm glad I'm able to do what I can. My academic background is in the social sciences, such as psychology, history, philosophy. I actually come to this topic through my interest as a football fan and am slowly ( . . ever so slowly! . . ) working my way through my second review article on concussion. Mdscottis, please keep going. FriendlyRiverOtter (talk) 19:30, 28 December 2012 (UTC)

Concussion may or may not involve loss of consciousness.

We probably should include this in the first paragraph of our lead, since it is a well-informed response to a common misconception (yes, probably even today).

From the American Academy of Pediatrics, Clinical Report, "Sport-Related Concussion in Children and Adolescents", Pediatrics, Mark E. Halstead, MD, Kevin D. Walter, MD, The Council on Sports Medicine and Fitness, Vol. 126 No. 3, September 1, 2010:

“ . . . Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness (LOC). Resolution of the clinical and cognitive symptoms typically follows a sequential course; however, it is important to note that in a small percentage of cases, postconcussive symptoms may be prolonged. . . ”

“ . . . Headache is the most frequently reported symptom. LOC occurs in less than 10% of concussions but is an important sign that may herald the need for further imaging and intervention. Along with LOC, amnesia may be an important indicator of more serious injury. . . ”

---

Our article, at times, seems to lean too heavily toward the skeptical side. For example, the following is currently the last sentence of our first paragraph:

" . . Frequently defined as a head injury with a temporary loss of brain function, concussion can cause a variety of physical, cognitive, and emotional symptoms. . "

For a minority of patients, it is not all that temporary. And this is an area where some of the excellent journalism of ESPN comes through. FriendlyRiverOtter (talk) 21:45, 3 January 2013 (UTC)

I understand the frustration with the minimalist approach. The problem is that we really don't know as much as we would like, or others desire. One area of silence in the article is the role of genetics - mainly the apo-E4 gene, and its relationship to dementia, poor outcomes from closed head injury etc. Have you come across much about it? --Mdscottis (talk) 16:48, 4 January 2013 (UTC)

I think we need to separate journalism and evidence based medicine. Scottis, I haven't come across anything about the apo-E4 however I would like to look into it a bit more, let me know if you come across any journals about it. Mike (talk) 14:59, 5 January 2013 (UTC)

Mike, is this your first comment here? ...or did I miss part of the conversation? --Sue Rangell ✍ ✉ 19:25, 5 January 2013 (UTC)

Umm yes but not my first comment on the subject since sports medicine is my specialty. Mike (talk) 01:26, 6 January 2013 (UTC)

I don't think it's journalism, but it certainly comes under the heading of research, and I realize that that is problematic for Wikipedia articles. The problem is that most of this subject matter is close to research. In any case, if you are interested, here are a few citations. There are lots more out there. Regards.
Neuropsychol Rev. 2003 Sep;13(3):153-79. The neuropsychology of heading and head trauma in Association Football (soccer): a review. Rutherford A, Stephens R, Potter D. PMID 14584910 J Alzheimers Dis. 2002 Aug;4(4):303-8. Head trauma and Alzheimer's disease. Nandoe RD, Scheltens P, Eikelenboom P. PMID 12446932 Neuron. 2012 Dec 6;76(5):871-85. doi: 10.1016/j.neuron.2012.11.020. Apolipoprotein e sets the stage: response to injury triggers neuropathology. Mahley RW, Huang Y. PMID 23217737 --Mdscottis (talk) 22:41, 5 January 2013 (UTC)

thanks doc! More for my own interest. Mike (talk) 01:26, 6 January 2013 (UTC)

Hi, I was talking with a customer at work. She had a near serious fall when a handrail at an apartment complex gave way. She spun 180 degrees and barely held on. She had shoulder injury and was also having headaches. I asked her, Is your doctor at least a pretty good listener? And I encouraged her to go back and tell him or her this. She asked me if a person could get a concussion without a direct blow to the end. I told her I think so. And I again encouraged her to find a doctor who she feels understands what is going on. (I guess it could also be whiplash and probably three or four other things.)

So, from the above Pediatrics article, yes, it seems like acceleratory or rotational forces can also cause a concussion. No direct blow required. Another issue, are there cascading biochem reactions, perhaps involving trauma to the cell membranes, where symptoms can get worse over several days? And, since both cognitive and physical rest is recommended, with the Pediatrics article recommending that even reading can worsen symptoms for the child or adolescent patient, what is a person to do? I mean, neither video gaming nor texting is recommending. So, the standard thing, of when a person is sick, of he or she crashing out in front of the TV just making sure to stay hydrated, that may not be the greatest thing for concussion. The 'normal' thing of 7 hours of TV may be entirely too much for the concussion patient (even the person with probably concussion). Are there good sources which do give specific patient recommendations? I guess the person can rest and occasionally have conversations with a friend or family member in a quiet room. That is merely a guess on my part. I would like something authoritative if possible. FriendlyRiverOtter (talk) 01:10, 11 January 2013 (UTC)

Wow! You pose such difficult questions. Yes, there isn't much to do and no school, reading or television is awful, particularly for an adolescent. It pretty well leaves playing with the dog. Of course, all of this falls under the headings of "consensus" and "opinion", not actually studied in a randomized fashion. Regarding television, there are studies indicating an increased mortality in those who watch television on average more than six hours per day, but again no cause and effect. Good luck! --Mdscottis (talk) 14:51, 11 January 2013 (UTC)

I thought I would share this with you both of you, UNC's Matthew Gfeller Center does extensive concussion research (both studying the MOI as well as RTP/Return to life protocols) [[4]]. As for Friendly's question, the sports med physician I work under treats concussions with a two fold approach. When S/S are present they are to refrain from school, work, sport and any stimulus that causes the S/S to become worse (i.e. if light bothers them then dark room, nose then no TV/music , etc). Once S/S free we follow a 5 step graduated return to play that slowly introduces varying degrees of activity and intensity. You are also correct, a concussion does not require a direct blow to the head. Mike (talk) 17:54, 11 January 2013 (UTC)

I don't really know this lady well. I think I may have done a little bit of good by just good listening and encouraging her to follow up with a doctor. Okay, as far as what is sale-able socially, I can see recommending a day and a half of complete rest and then maybe a light outing in the early evening where someone else is driving. I have no idea whether that is medically enough or not.

I have read about the step-by-step return to play: complete rest, light aerobic, sports specific exercises, noncontact drills . . . , where each step is at least 24 hours and you graciously ease back to the previous step if symptoms return. What I take from this is that what's important is taking it step by step, taking your time, and staying symptom free, and not so much the specific steps themselves. And this might be extendable to non-athletes. In particular, attending half days of school might really drive the point home to teachers that, no, the student is not yet fully recovered.

Regarding football, what I understand is really bad is to "stack" concussions (another concussion before the first one is fully resolved). And additionally, let's say the person does take adequate time and fully recovers from the first two concussions, but starts running into trouble following the 3rd, or the 7th, or the 12th, and on this last part, no doctor in the world can predict in advance.

So, the player's going to sit out from the district championship because of a headache ? ? ? And that seems to be the real difficulty socially. And the answer seems to be, yes. It's about cascading chemical pathways and not wanting to reinjure cell membranes (and a fuller discussion of this might help).

And I think the biggest solution socially might be for starters to stand up for other starters.

And to point out the obvious, not every head injury is a concussion. Some can be more serious, like that which killed the actress Natasha Richardson. FriendlyRiverOtter (talk) 18:38, 16 January 2013 (UTC)

I think you have summed it up. The initial question always is "is this concussion?" and that probably dictates the early investigation i.e. CT if in doubt within the first three - four hours, when it might be an epidural hemorrhage as in the case of the unfortunate Richardson. After that interval, the utility of CT drops off and later investigation is more likely to be neuro-psych. The recent RGIII fiasco shows just how great the pressures are for key players to play, and how easy it might be to downplay "soft" findings as in concussion. --Mdscottis (talk) 02:44, 17 January 2013 (UTC)

I want us to be at the point where we consider the brain as important as the knee. Of course, the brain is more important than the knee. But socially, if we can get to the point where the more nebulous findings of concussion are considered just as important, that will be a substantial improvement.

And I want teammates to stand up for other teammates. For example . . .

“Robert (or José, or Stan), you might be hurt. We’re your teammates. Let us do our part, too.” Or . . .

“Sonia (or Carol, or Ann), you might be hurt. We’re your teammates. Let us do our part, too.”

High school kids are already predisposed to do this. Toward the end of his book Head Games, Chris Nowinski talks about how he was invited by a high school football coach to talk with the players at the beginning of the season about concussion safety. When he went back at the end of the season, the players reluctantly told him that the coach had kept in a linebacker even though he was clearly injuried, didn’t really know what he was doing, and had to be pointed in the right direction. The coach reasoned that he was better injuried than the backup linebacker not injuried, and to that limited question, may be true. The players felt really let down.

High school age young people have patchy skills of maturity, very mature in some areas and not so much in other areas. That's okay. We can work with that. It’s all about coaching and building from positives.

Chris also talks about how parents put a lot of creed into modern helmets, probably much more than is warranted. And he brings up the point that for a 200 pound linebacker, maybe the foam in the helmet provides a quarter-inch of give and slow down (my estimate). But for a 70-pound youngster running around playing little league football, the stiff foam in the helmet may provide very little give indeed.

And perhaps for different reasons or additional reasons, Dr. Robert Cantu currently says that children under the age of 14 should not play football (well, just because Bob Cantu says it does not make it true, but should not be too readily dismissed, all that standard stuff. I mean, we do not need to take a block of granite and etch everything the man says into stone, but . . he has been practicing in his field for a good while.)

And now, for last point, concussion vs. something more serious such as epidural hemorrhage. This would scare the heck out of me trying to make this determination. I am not a doctor, and I guess this is precisely why people do go to medical school. I suppose like a lot of other things in medicine, such as influenza vs. pneumonia. And my guess would be that a large part of the answer is warning signs and red flags. FriendlyRiverOtter (talk) 21:36, 29 January 2013 (UTC)

Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008, Journal of Clinical Neuroscience, P. McCrory, W. Meeuwisse, K. Johnston, J. Dvorak, M. Aubry, M. Molloy, R. Cantu, 16 (2009) 755–763.

1.1 Definition of Concussion
1. .
2. .
3. .
4. “Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. In a small percentage of cases, however, post-concussive symptoms may be prolonged.”
5. .

5.1. The significance of loss of consciousness
“In the overall management of moderate to severe TBI, duration of loss of consciousness (LOC) is an acknowledged predictor of outcome. While published findings in concussion describe LOC associated with specific early cognitive deficits, it has not been noted as a measure of injury severity. Consensus discussion determined that prolonged (>1 minute duration) LOC would be considered as a factor that may modify management.”

Artifact (radiology)

In the 6th para of the lead, the term artifact is used. Requires lay definition? No suitable wikilink, perhaps closest X-ray computed tomography#Artifacts ?? Lesion (talk) 23:35, 31 January 2013 (UTC)

I agree and have added this edit for you. Mike (talk) 13:57, 1 February 2013 (UTC)

Worthy of Nomination as Featured Article?

I'm thinking of nominating this for a featured article and would like to know if others think it is worthy of the standard. Haon 2.0 (talk) 22:00, 6 June 2013 (UTC)

The subject certainly is, but the article needs some focused update work first. The subject has seen substantial developments in the last three years, yet the article has many source more than ten years old. It's worth updating... LeadSongDog come howl! 04:02, 7 June 2013 (UTC)

Semi-protected edit request on 6 January 2014

Focusing is spelled incorrectly in the introduction. Rfork24 (talk) 22:02, 6 January 2014 (UTC)

Not technically incorrect (see wikt:focus#Verb) but it is inconsistent. I've changed it. Done --ElHef (Meep?) 00:12, 7 January 2014 (UTC)

Semi-protected edit request on 31 July 2014

please change MTBI to mTBI. The majority of concussion and brain injury literature uses a lower case "m" for the "mild" descriptor attached to the TBI or Traumatic Brain Injury abbreviation.

Also the early comment "Those who have had one concussion seem more susceptible to another, especially if the new injury occurs before symptoms from the previous concussion have completely resolved.[9]" is not entirely correct. The second half is correct, Those suffering from a concussion are more susceptible to a 'new injury occurs before symptoms from the previous concussion have completely resolved'. However the first half of the statement, suggesting that one concussion makes you more susceptible in and of itself (assuming you have since recovered) has been debunked by more recent concussion/mTBI research. Bjsmithmd (talk) 20:30, 31 July 2014 (UTC)

Not done: please provide reliable sources that support the change you want to be made. Acalycine^{(talk/contribs)} 06:50, 10 August 2014 (UTC)

Patho

Moved from article here

Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:38, 2 August 2014 (UTC)

Reference 31 in Diagnosis169.230.242.45 (talk) 08:06, 11 September 2014 (UTC)

Reference 31 does not support claim re: PET and SPECT scans in concussion, only that pre-existent conditions may complicate their interpretation. Further, article in 31 is a review article, not a primary source.

Edits from an undergraduate class studying research and concussion

I realize this page is semi-protected, but I've asked a class of 125 students to see what they can do to improve this article. Would you like for each of them to post their suggested changes here or should I summarize them? I'll point them to the To-Do list as well, but I'd love some clear direction about how to proceed if they want to help with sources and/or expand sections of this entry. Many thanks for your help. Eugenezed (talk) 20:15, 12 October 2014 (UTC)Eugenezed (reference librarian)

On field diagnosis

This article talks about the practices necessary to diagnose a concussion on the field. Including the management of a concussion while on the field and symptoms to be aware of which may be difficult to detect upon first examination.

Putukian, Margot. “The Acute Symptoms of Sport-Related Concussion: Diagnosis and on-Field Management.” Clinics in Sports Medicine 30, no. 1 (January 2011): 49–61, viii. doi:10.1016/j.csm.2010.09.005. — Preceding unsigned comment added by 71.221.72.194 (talk) 01:47, 21 October 2014 (UTC)

Prevention expansion

I think we should include more on the Prevention section. I know that there are many studies done on sports that do not require helmets with head gear and if they prevent concussions. Sports like Soccer, Basketball, Field Hockey, Women's Lacrosse, etc. do not require head gear. Would it be beneficial for those sports to require some sort of head gear. What are the best types of football, lacrosse, hockey, etc. Do the helmets for those sports work as well as they say?128.223.223.86 (talk) 02:56, 21 October 2014 (UTC)10/20/14

Prognosis

A 2006 study found that gait control and balance can be compromised for up to 28 days (Parker). Subjects who had experienced concussions in this study walked slower in dual tasks compared to uninjured subjects for the duration of the study. This data suggests that concussions may have long lasting effects on motor control.

References:

Parker, T. M., Osternig, L. R., Van Donkelaar, P., & Chou, L.-S. (2006). Gait stability following concussion. Medicine and science in sports and exercise, 38(6), 1032–1040. doi:10.1249/01.mss.0000222828.56982.a4 — Preceding unsigned comment added by 71.220.229.15 (talk) 19:18, 22 October 2014 (UTC)

MTBI

Lancet Neurology doi:10.1016/S1474-4422(15)00002-2 JFW | T@lk 10:25, 15 April 2015 (UTC)

Semi-protected edit request on 21 September 2015

Please include a reference to the BBC1 "Panorama" programme Monday 21st September 2015 with former Scotland Rugby Union player John Beattie. He examines the increased concussion in Rugby Union and long-term brain injury. The programme includes a visit to the NFL in the USA to witness the steps American Football is taking to reduce concussion. 86.26.120.152 (talk) 22:33, 21 September 2015 (UTC) 86.26.120.152 (talk) 22:33, 21 September 2015 (UTC)

Can you provide a link? I will have a look however it is often best to look at the peer reviewed articles before including media productions. Mrfrobinson (talk) 23:46, 21 September 2015 (UTC)

Depersonalization a symptom of concussion?

Today I was talking with a friend who most likely has a minor concussion- hasn't seen a doctor about it because she hasn't felt a need to, but she got hit in the head with a basketball and has had a lasting headache with some dizziness. We were talking and she started complaining of fatigue and nausea as well, so pretty basic symptoms of a minor head injury. What I found intriguing was that she also described some feelings of depersonalization. I recognized the description from my own experience due to long-term anxiety, and how it's often worse when I'm sleep-deprived, so I told her to rest. But it made me wonder if depersonalization is a common symptom of concussions. Is there any research regarding this? Jojopeanut (talk) 02:56, 11 March 2016 (UTC)

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Semi-protected edit request on 26 December 2016

In the section "Research," change [[lithium]] to [[lithium (medication)|lithium]]. 71.63.240.155 (talk) 22:45, 26 December 2016 (UTC)

Done. Thank you for your contribution. ITasteLikePaint (talk) 20:53, 29 December 2016 (UTC)

No problem. :) 71.63.240.155 (talk) 00:25, 30 December 2016 (UTC)

Semi-protected edit request on 5 February 2018

We propose an edit to the treatments section to the statement "Those with concussion are generally prescribed rest,[76] including adequate nighttime sleep as well as daytime rest.[51]"

We would like to change this statement with more current references. "Rest although the previously accepted as an initial treatment, is being challenged by new research stating that exclusive rest may not be as beneficial as resuming symptom free physical activity. New literature suggests that sub-threshold symptom free exercise can improve the outcome of recovery, this threshold is established using the Buffalo Concussion Treadmill Test(BCTT) to develop an exercise program Dakotach (talk) 15:39, 5 February 2018 (UTC)

the #4 reference[5] is not a review per MEDRSWikipedia:Identifying_reliable_sources_(medicine) (please see link)--Ozzie10aaaa (talk) 22:23, 5 February 2018 (UTC)

 Not done: Per above. Nihlus 21:07, 6 February 2018 (UTC)

Helmets

Can I ask why helmets are listed as a prevention mechanism? I know the ref says it helps, but this one from 2009 disagrees, as well as the consensus report from 2017. Tøndemageren (talk) 19:38, 21 May 2018 (UTC)

Tall Persons

Common Injuries for tall persons are hitting heads on low door frames. The only prevention would be to build new houses with larger doors, or wear helmets at home and at work. Even in office environments. Door closing devices, alarm devices and magnetic locks reduce the available space at the top of a door frame further. Advertising boards are hanged low, subway cars now contain TVs for advertising in the head room of tall persons. — Preceding unsigned comment added by 64.47.214.68 (talk) 10:17, 9 July 2018 (UTC)