Post Concussion Syndrome: Why giving up screen time is part of the solution & problem

LCD screens surround us. Many people stare at computer screens throughout their workdays, taking breaks only to check social media on their smartphones.

While there are far fewer concussions in the world than there are screens, the frequency with which these injuries occur has been increasingly acknowledged in the mainstream media. Athletes such as Sydney Crosby, Steve Young, and Eric Lindros just to name a few, have brought the severity of Post Concussion Syndrome (PCS) to the forefront of public discourse.

A person who suffers from PCS will experience symptoms such as dizziness, nausea and headaches for an extended period of time after the initial injury. This can last for weeks or months, and there is no clear answer as to how it can be minimized.

image of an office with a laptop and no one at the desk, next to a close up of a man who looks like he has a headache

The few treatment options that health professionals agree to are: rest, and a complete break from LCD screens.

While all cognitive activity can worsen the severity of headaches and dizziness in people with concussions, there are several reasons why the use of LCD screens in particular can exacerbate these symptoms:

  • Images that appear on LCD screens are made up of pixels that refresh at a rate of 60 times per second, even when the content on the screen is not changing.
  • The rapid movement of these pixels means when we look at screens for too long, we strain our eye muscles.
  • For someone who has suffered a brain injury, this strain can be detrimental.
  • Further, the backlighting of LCD screens can cause cognitive fatigue, headaches, dizziness and nausea in concussion patients.

22-year-old Maggie Callaghan, a varsity athlete who has suffered several sports related concussions over the past few years says she tried to avoid computer screens all together for weeks after her first concussion.

“I couldn’t look at a screen for more than a few minutes without feeling intense pain behind my eyes that would quickly evolve into a full blown migraine” Callaghan said. “I tried to avoid computer screens altogether for as long as I could.”

Maggie is one of many young concussion victims for whom the inability to study using a computer screen resulted in severe stress.

“It sort of becomes a cycle,” says Joe Ross, a 20-year-old student who, like Maggie, has suffered from concussions. “You feel sick when you use your computer to do school work, but when you aren’t able to keep up with your school work you feel anxious which can be harmful to the recovery process.”

Anxiety is just one of many mental health problems that disproportionately affects concussion patients. In fact, two out of three concussion patients experience depression following their recovery.

The social isolation that comes from being unable to communicate using computer and phone screens, as well as the stress associated with being unable to complete day-to-day tasks, are thought to be two of the primary causes of depression in concussion victims.

As difficult as it can be for students to abstain from using screens following their concussions, the struggle to recover from PCS without the use of computers can be even more intense for working adults.

“The recovery process would have been even more stressful if I had been working in a professional environment at the time of my concussions,” says Maggie. “So many jobs involve, if not completely revolve around, using computers. Being unable to work and not knowing when I would get better would be seriously nerve-wracking.”

Currently, treatment options for PCS do very little to account for the importance of screens in the average person’s everyday life. Patients have to work hard to engage in society and keep up with school or work without the use of their computer screens.

This can often be one of the most unexpected challenges of dealing with PCS.

So where does this leave people needing to return to a pre-concussion life while dealing with PCS?

While there are no solutions, one recent pilot study commissioned by the Canadian Concussion Centre indicated that people experiencing PCS were able to use a non-LCD screen, thus enabling a quicker return to school or work life.

PHOTOS via pixabay


Colin Harding is the CEO & Co-founder of Iris Technologies – a Canadian healthcare technology company that is improving the lives of people who have suffered from a mild traumatic brain injury (MTBI) or live with chronic migraines.
 
A version of this article appeared on the Iris Technologies Blog
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Why didn’t my bike helmet prevent my TBI?

BY: SOPHIA VOUMVAKIS

15 per cent of the approximately 18,000 traumatic brain injuries (TBIs) that occur in a year in Ontario are a result of a cycling accident. Every year in Canada, over 11,000 people die as a result of a traumatic brain injury (TBI) – using the same 15 per cent – that’s over 1600 people in Canada who die as a result of a TBI caused by a cycling accident. 85 per cent of all cyclists’ deaths in Canada involve a brain injury.

A little over five years ago, I sustained a TBI while riding my bike. It was a beautiful spring morning, and I was riding my bike to work, as I had hundreds of times before. I remember leaving my home that morning, and then waking up in the emergency room at St. Michael’s Hospital, several hours later. I was told by the doctors in the emergency department that I had been knocked off my bike, hit the ground, passed out, and taken to the ER by ambulance. Several hours later I was diagnosed with a brain injury. To this day, I have no memory of the incident.

I was wearing a bike helmet, which I always did, but my helmet did not protect me against acquiring a TBI. I’d always wondered why, and recently I got my answer. I came across a TED Talk by bioengineer (and former football player) David Camarillo, who, along with his team at Stanford University, has been able to demonstrate what really happens to our brain during a concussion, and why bike helmets, and other sports helmets, such as football helmets are not designed to protect against concussion, but rather, they are designed and tested to determine how well they protect against skull fracture.

What happens to your brain during a concussion?

The standard thinking of what happens to your brain during a concussion is that the head moves, the brain lags behind, catches up, smashes into the skull, rebounds off the skull and then proceeds to run into the other side of the skull. This dynamic is repeated many times. This understanding of what happens to the brain during concussion suggests that the brain is damaged on the outer edges.

In his Stanford University lab, Camarillo and his team, with the aid of new technology, have looked closely at what happens to the brain when it is experiencing a concussion. Their investigations suggest that the current thinking about what occurs to the brain during a concussion is not entirely accurate. Firstly, he does not believe that the brain moves around as much as current wisdom suggests. Camarillo argues that there is very little room in our cranial cavity for movement, perhaps a few millimetres, and our cranial cavity is filled with spinal fluid, which acts as a protective layer. Secondly, he suggests that the brain does not move as a whole.

Football player with ball about to fall to the ground

Our brain is one of the softest organs in our body – the consistency of Jell-O – and as the brain moves around in our skull during a concussion, it is probably twisting and turning and contorting – the tissue is getting stretched. Concussion does not appear to be something that is happening to the outer edges of the brain, but rather it is happening somewhere much deeper, in the centre of the brain.

The Laboratory – The Stanford Football Team

To help Camarillo and his team better understand what is happening to the brain during a concussion they utilized a mouth guard equipped with sensors and a gyroscope, which most experts believe can tell us what happens to the brain during a concussion. When someone is struck in the head, the mouth guard records how the skull moves at a thousand samples per second.

The study’s laboratory is the Stanford football team, young men who regularly go out and hit their heads.  This allows for rich information to be obtained when the researchers extract the data out of the mouth guard.

When the data from the mouth guard, was combined with a finite element model of the brain, developed by Svein Kleiven in Sweden, it showed that the brain of football players, who have suffered a concussion does not smash around in the skull, as current thinking would lead us to believe, but rather twists and contorts. The data shows that the greatest amount of stretching occurs very close to the centre of the brain.

What’s there? The corpus callosum, the wiring which connects the left and right hemispheres of your brain. Camarillo believes that this might be one of the most common mechanisms of concussion, the wiring is being disrupted, which causes a disassociation between your right and left brain and could explain a lot of the symptoms one sees in concussion. This is consistent with what researchers see with Chronic Traumatic Encephalopathy (CTE) – when the corpus callosum of a middle aged, former football player is viewed, and compared to an individual who does not have CTE, his corpus callosum is greatly atrophied.

Although there is a rapid transmission of forces down to the corpus callosum when the head is struck, it does take a certain amount of time. What Camarillo and his team believe is that if we can slow the head down just enough so that the brain does not lag behind the skull, but instead moves in synchrony with the skull, then we might be able to prevent this mechanism of concussion.

How can we slow the head down?

The most currently used bicycle helmet is constructed of expanded polystyrene (EPS) foam within a thin plastic shell. The EPS liner absorbs the force of an impact by deforming, while the outer shell increases the area over which the force is dissipates. The main considerations when designing a bike helmet is the size and stiffness of the helmet, which impacts how efficiently energy is absorbed. As a result of the materials used in constructing an EPS helmet, the size of the helmet has been limited to a few inches. This does not slow down the head enough to enable the brain to move in synchrony with the skull, rather than lag behind the skull. It turns out that air, in an expandable helmet would be the ideal mechanism for slowing the head down enough during impact, so that the brain moves in synchrony with the skull, rather than lagging behind.

woman wearing a skirt standing with her bike

It turns out that a company in Sweden called Hovding, is using the principle of air to give the wearer of their ‘helmet’ some extra space to prevent concussion. Hovding has created what is essentially the world’s first airbag for cyclists. The Hovding is a collar, worn around the cyclist’s neck, that uses advanced sensors, similar to the sensors used in the mouth guards described in Camarillo’s research above, that can sense the cyclist’s movement patterns and will react in case of an accident. The airbag will then inflate, fixate your neck and provide a shock absorption. In experiments conducted by Camarillo and his team they have found that the Hovding collar can greatly reduce the risk of concussion in some scenarios, compared to a standard EPS bike helmet. The Hovding is currently for sale in Europe and Japan, and is CE labelled, which means it complies with European Union safety standards, but not for sale in the United States, and alas, Canada.

In the US, bike helmets are federally regulated by The Consumer Product Safety Commission. The Commission has jurisdiction over the type of helmets they approve. The test they use in order to grant approval to a bike helmet is testing the helmets capacity to prevent skull fractures, not whether the helmet is likely to prevent concussion. In Canada, The Canadian Standards Association accredits organizations to certify that bicycle helmets meet certain standards, such as CPSC bicycle helmet standard, which uses the tests described above by Camarillo.

I contacted Hovding and asked about the availability of their helmet in Canada – alas, it is not available here. They replied that, at this time, they have not investigated helmet certification in Canada. So it might take some time to get my head into one!

Even so, any helmet is better than no helmet, so keep wearing whatever helmet you have, and wear it properly.

 Resources

Modelling and Optimization of Airbag Helmets for Preventing Head Injuries,  published in The Annals of Biomedical Engineering in September 2016.


Since her TBI in 2011, Sophia has educated herself about TBI. She is interested in making research into TBI accessible to other survivors.

Goal setting after a brain injury

BY: ALISON

Before my concussion, I was always busy.

I worked long hours, travelled three times a year, hosted parties, played sports, volunteered and maintained a blog. I had one-year fitness goals, five-year career goals, 10-year family goals, and 30-year financial goals. After my injury, my symptoms were so debilitating and unpredictable that I couldn’t even make plans for 10 minutes in the future. I was close to giving up entirely, until I changed my perspective and approach to goal-setting.

women standing in running shoes
photo credit: 2012Vegas 676 via photopin (license)

How to Set Goals After a Brain Injury

Step 1: Change Your Perspective and Set Your Goal(s).

First you have to decide what you want your goal to be. It is imperative you don’t set yourself up for failure by having unfair expectations. If you set an unrealistic goal, you will de-motivate yourself and give up. Through accomplishing a series of challenging, yet do-able goals, you will achieve the once seemingly impossible ones.

Set simple goals that are achievable in the short term (i.e. daily and/or weekly). Then gradually work your way up to more difficult goals.

After my injury, just lifting my head off the bed to drink water was exhausting, so my first goal was to perform one task every three days. Tasks included taking a shower, folding clothes, or going to an appointment. Once I could do that, I slowly increased the frequency and difficulty of the tasks.

I then added outings to my goals, which later included running errands. Eventually, I was performing multiple tasks each day, having outings a few times per week, and running multiple errands per outing.

As my energy levels improved, I also set my first fitness goal, to walk for at least 10 minutes each day. Over time, this evolved to taking longer walks and faster-paced walks. Once I had more confidence in my capabilities, I focused on social goals. I started with phone conversations and one-on-one meetings, before working my way up to group dinners at bustling restaurants. Finally, I started hosting parties in my home.

Exercise is well-known to improve brain function, depression, anxiety, and sleeping problems. Furthermore, recent studies indicate that moderate exercise is the best treatment for concussions.

a freshly made bed
photo credit: Mazzali bedroom via photopin (license)

Step 2: Plan Out Your Goals and Take One Tiny Step at a Time.

Now that you’ve set your goal, the next step towards achieving it is to make a plan. Write your plan down on a piece of paper so you can follow it easily and cross things off as you complete them.

The best approach to planning (and executing that plan), is to take things one tiny step at a time. Break down each goal into as many small, manageable components as you can, then tackle one component at a time. The definition of ‘manageable’ is different for everyone and will change as you recover.

For example, these were the tiny, manageable steps that I planned for my goal of going for a walk:

  1. Stand up (you could break this step down further. e.g. lift head off bed, then lift head and shoulders off bed, then sit up, then sit on the side of the bed, then stand up.)
  2. Drink some water
  3. Change my clothes
  4. Gather my cell phone, keys, and health card
  5. Put walking/running shoes on
  6. Leave the house (i.e. simply step outside)
  7. Start walking (even if it’s just a few feet) and rest as needed
  8. Walk home and rest as needed
  9. Stretch
  10. Drink some water

When you start executing your plan, the most important thing to remember is to focus only on the task. Don’t even think about how you’re going to tackle the next step until you’ve completed the current one. That means, not worrying about whether or not you’ll be able to complete all of the steps, and not counting the number of steps you have left.

Taking one tiny step at a time will earn you little wins, keep you motivated, and make your goal seem less daunting. Take breaks when you need them and try again later.

It helps to have someone else’s support when you’re working towards a goal, but only if they understand the importance of taking things one step at a time. I remember one night in the winter, my partner wanted to take me to the mall to help me achieve my daily walking goal. I was fatigued and dizzy and convinced that I wouldn’t be able to do it. But he talked me through one step at a time. He said, we’re just going to get in the car and we’re just going to drive to the mall. If you’re still not feeling well when we get there, you don’t have to get out of the car, we’ll come straight home. So he helped me up off the couch and into the car. He drove me to the mall, turned the engine off, and asked if I was able to get out of the car. I was, and in that moment, we set a goal of walking to the mall entrance and back. When I got to the entrance, I felt okay, so we went inside. That night, I ended up walking for longer than my daily goal.

drinking a glass of water
photo credit: Denise via photopin (license)

So when you’re faced with a particularly daunting moment, keep repeating to yourself, “I’m just going to do this tiny task. That’s not too hard.” One and a half years of tiny steps later, I jogged 5 km in the BIST Run, Walk & Roll. I’m working towards running a 10 km race next year.

Step 3: Be Flexible and Be Kind to Yourself.

Celebrate each tiny success and never criticize or punish yourself for set-backs. Goal-setting after a brain injury requires time and practice through trial and error, so be patient with yourself, do what you can, and be flexible with changes to your plans. If something’s not working for you, try again and then try something different. You might need to re-evaluate your goals, revisit them at a later time, or break certain steps into smaller components. Don’t be afraid to ask someone for help.

Step 4: Set New Goals and Keep Challenging Yourself.

As your symptoms improve, you’ll be able to accomplish more each day. When you’re further along in your recovery process, gradually increase the breadth and difficulty of your steps. Soon, you’ll be working on various goals (e.g. fitness, cognitive, financial and social) simultaneously.

Eventually, your goals will become more and more challenging, complex, and long-term. No matter what your physical barriers are, there’s always something to learn, something to improve, and new ways to challenge yourself. As long as you take things one step at a time, you’ll look back one day and surprise yourself with how far you’ve come.


‘Mind Yourself with Alison’ is a collection of self-help tips, research, and personal experiences dedicated to helping people thrive after brain injury (or other trauma). Check out Alison’s other BIST Blog articles Women and Brain Injury: What you need to know and How to be a Good Friend to a Survivor.

 

 

Concussions: the missing piece of the puzzle

BY: KAROLINA URBAN

Its been over two years since my last concussion, which I got while playing hockey. I still have difficulty focusing and remembering small details. I have anxiety and, at times, I feel down.

Although I no longer have a concussion, I don’t feel exactly the same as I did before my brain injury, and that is exactly what has captivated me for over the past several years as a researcher.

hockey skates on ice
photo credit: Week One:Skate via photopin (license)

I continually ask myself, why is it that we can’t fully understand what is going on after a concussion? What is the piece of the puzzle we are missing and how do we get people recovered to a point where they can get back to doing what they love without any consequences? How can we find a way to assess concussions that don’t rely on subjective symptom reporting? More importantly, how do we educate people about brain injuries so they make an informed decision?

These are just some of questions that go through my head.

I think most athletes can say they have lied about aches or pains they have had occur in games or practices. Many have played through broken bones, torn or sprained muscles or joints.

This is part of the team-first culture, where blocking shots, taking a hit to make the play, or playing through an injury is idolized. However, there is a huge difference between injuries to the body and injuries and injuries to the brain.

Injured hockey player
photo credit: Learning the hard way via photopin (license)

The brain is truly extraordinary. It makes it possible for us to do the things we love, such as communicate, learn, share joy and many other things. How we achieve tasks such as skating, or how we understand situations and make decisions involves complex processes with many thousands of connections, millions of neurons firing, tens of millions support cells and all of this is completed at an incredible speed.

And yet sometimes we treat the brain as just another tool in our body, a sacrifice to the team.

When I think of it from another perspective I realize this is the wrong way to look at it!

The brain is what gives us the team-first attitude, what helps us make the correct decisions, and to achieve specific skills. Without it functioning properly we can not be the best we can be. And this is the perspective I know have taken on when I talk to young athletes who have sustained a mild traumatic brain injury. But is this enough to keep them from playing is yet to be seen.

Recently I became an assistant coach for a competitive female hockey team. One of the players was tripped up and hit her head on the end boards. She came off upset, emotional, in pain and clearly could have sustained a concussion. After the ice clean she came back out and wanted to play. Despite all my knowledge about brain injuries, I found it extremely difficult to tell her she needed to sit out the rest of the game.

It is hard to tell an athlete they can’t go back out there and that they need to rests especially when its all they have known their whole life.

16447977753_17dffab6b1
photo credit: Young Athletes via photopin (license)

“Get knocked down, get back up.”

“No pain, no gain.”

“Sacrifice your body to win the game.”

But how can we change this? How can we ensure our trainers, who are responsible for pulling the players out of the game, feel comfortable and believe that it is the right decision? Or can we make the athletes realize they need to be more accountable for their own health and long-term development? Maybe it’s the combination of both?

I can’t say I have the answer, but I can touch on some ways to change this problem.

Mentors

We need mentors, we need people such as Sidney Crosby or Jennifer Botterill speaking about their injuries and what they could have done or should have done to prevent those months of symptoms.

We all know that players are more likely to listen to those who have gone through similar situations, especially when their idols. I can  say I probably wouldn’t have thought about the injury any differently if a doctor, teacher came up and told me not to do something or to be honest about the injury. I mean they told me not to play through a torn tendon in my knee in playoffs, which I completely ignored.

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photo credit: Jordan Reed via photopin (license)

Education

Despite the media constantly speaking about concussions, there is a lack of knowledge about the injury, symptoms, possible long term impact, what to do when you have a concussion, and what resources are available.

One example of a recent partnership is between the Greater Toronto Hockey League (GTHL) and Holland Bloorview Kids Rehab Hospital Concussion Centre. This partnership is an example of how leagues are hoping to educate their players, parents, referees and coaches.

The brain is one of the most complex systems in our body, yet there is little time allocated to teaching about the brain, diagnosis, and rehabilitation.

Many medical schools only spend about an hour or so covering concussions. Physiotherapists have limited education on the subject, which is concerning as they deal with many athletes.

We need to develop supports and education for all stakeholders – parents, coaches and trainers.

 Karolina Urban is a former University of Toronto and Canadian Women’s Hockey League player. Currently she is a PhD student at the Concussion Centre in Holland Bloorview Kids Rehab Hospital

Exploring Concussions with Dr. Anne W. Hunt of the Concussion Centre at Holland Bloorview

On April 7th, BIST is hosting a FREE talk on Exploring Concussions:
Concussion Facts & Myths AND The latest Research Findings
 – featuring speakers Dr. Lesley Ruttan of Main St. Psychological Centre and Toronto Rehab; Dr. Carmela Tartaglia, Assistant Professor at the University of Toronto Tanz Centre for Research in Neurodegenerative Disease and Dr. Anne W. Hunt, Manager, On TRACK concussion program Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital.
Our writer Karolina Urban spoke to Dr. Hunt about her upcoming talk with BIST.

KU:  What are some of the pieces of advice you have for those who have sustained a brain injury in terms of recovery?

AH:  Work as hard as your body and brain will let you; be open to doing things differently; keep in mind that recovery may continue for many years. I’ve seen survivors make significant changes many years after injury.

Dr. Anne W. Hunt
Dr. Anne W. Hunt

KU:  Can you tell me about the importance of time management and prioritization and how to best manage every day life? How important is goal setting? exercise? Doing the things you love?

AH: All of these things are important! It’s important for health and well-being in general to be engaged in activities every day that have purpose and meaning to each person.

Time management and prioritization are important skills that can help us to find time to do activities we need and want to do. Using calendars to schedule activities, using ‘to do’ lists, setting alarm reminders are strategies that may be helpful in managing time. Goal setting is helpful for some people, it is important to set goals that are specific, meaningful and relevant. Setting time frames for goal achievement can be tricky as sometimes following brain injury it can be challenging to know how long it might take to do something. Instead, think about what you might accomplish today and consider how you will accomplish that-make plans and then do it!

Exercise is good for health overall and contributes to optimal brain function. I encourage people with brain injury to participate in exercise that they enjoy, but to do this in a way that doesn’t make symptoms worse. This may mean doing the activity at a less intense level, for a shorter period of time or in a less stimulating environment.

BIST Exploring Concussions Talk
KU: In terms of mental health and dealing with the accident itself, can you speak to some of the tips and/or advice you have for someone who is dealing with persistent issues?

AH: Good mental health is important for well-being. Following brain injury, people may feel more emotional, this may include feeling sad, anxious, scared, angry, overwhelmed, and less confident to name a few. It’s important to develop a support network to help you through difficult times. Consider who your network is-who can you turn to for support-this might be a professional (e.g. therapist), a family member, or friend. If you are uncertain, community organizations like BIST may be able to provide some direction.

KU: Dr. Hunt can you tell me about some of your current or recent research and outcomes?

AH: As an occupational therapist by profession, I’m most interested in developing interventions to enable individuals with brain injury to participate optimally in meaningful activities.

Recently, I’ve been studying how self-management problem solving interventions can help adults and youth with mild traumatic brain injuries. Results from our initial work are very positive. People like these interventions and they are useful in helping people get back to doing activities as well as improving their mood. Our work is in very early stages though so more research is needed.

I’ve also been investigating how vision is affected following brain injury. Visual issues are not uncommon following brain injury. We think that in some people visual issues may be contributing to symptoms like headache and fatigue. Currently we are focusing on understanding and identifying these visual changes in youth following concussion.

KU: Where do you see research fitting in to rehabilitation and assisting recovery or helping to get people back to their daily lives?

AH: Research is very important in brain injury rehabilitation. We need to develop evidence to help us understand what interventions work for specific individuals-no two people with brain injury are alike! Participating in research may have benefits for brain injury survivors. By participating in an intervention study for example, there is the potential to benefit from the intervention itself, plus research participants typically feel good about participating in general because they are contributing to research and ultimately helping others with brain injury.

Although intervention studies may be hard to find, I encourage anyone who may have an interest to contact their local hospital’s research program. Being a research participant can be a very rewarding experience.

Find out more about BIST’s Exploring Concussions Speaker Series HERE

Register by March 31st at info@bist.ca

BIST Exploring Concussions Talk


 Karolina Urban is a former University of Toronto and Canadian Women’s Hockey League player. Currently she is a PhD student at the Concussion Centre in Holland Bloorview Kids Rehab Hospital

What my personal experience with concussion has taught me

BY: KAROLINA URBAN

Summer is here and with it comes the inevitable concern for safety and injury prevention. From organized sports such as soccer and rugby, to recreational activities such as wakeboarding, tubing, biking or your friendly match of volleyball, there is always a risk of a concussion.

Concussions are not limited to a direct hit to the head. They can also be the result of a large biomechanical force, known as a acceleration-deceleration injury, which causes the brain to move within the skull.

The rate of concussions occur in 754 per 100 000 for boys and 440 per 100 000 for girls. Nearly one-third of these injuries are the result of falls, while skating and hockey account for the greatest number of sports related concussions in Canada.

photo credit: UPEI Panthers at Saint Mary's Huskies (Nov 27 2010, Halifax NS) via photopin (license)
photo credit: UPEI Panthers at Saint Mary’s Huskies (Nov 27 2010, Halifax NS) via photopin (license)

The difficulty with assessing or recognizing a concussion is the wide range of symptoms that vary as a result of the heterogeneity of injury. These symptoms can range from being physical in nature (i.e. headaches or dizziness), to cognitive (i.e. difficulty concentrating), to behavioral (i.e. depression, anxiety) or sleep-related (i.e. difficulty falling asleep or sleeping too much.)

80  per cent of adults recover from a concussion within two weeks. For children, the recovery process tends to be slower, but despite the longer recovery period, it has been shown that most of the pediatric population does not continue to have long-term difficulties. However, around 14 per cent of the children who sustain a concussion continue to have symptoms beyond three months after injury. As a parent, guardian, coach or friend it is critical to recognize the impact of concussions, know how to prevent them and how to promote recovery.

Throughout my hockey career I always had this willingness to do whatever it took to win. In the face of injury I would shrug off the pain and continue to compete. In my second year of hockey at the University of Toronto I sustained a concussion in the last season game. From what I recall, the puck came out of a scrum in the neutral zone and the next thing I can remember is sitting on the bench feeling ‘out of it.’ My line-mate asked whether I was okay and I simply responded, “Oh yeah, lets go.”

Image via Facebook
Rowan Stringer; Image via Facebook

Luckily there were only few minutes left in the game as I continued to play. That evening I began to feel worse, more anxious, dizzy and fatigued. But as I had always done, I continued on until the next evening, I went to class, wrote an exam (which I did horribly on) and continued onto practice. As we began to do skating drills, I began to feel nauseous and dizzy and finally agreed to get an official diagnosis. Although I took this step, I quickly got cleared to play again as game one of playoffs was eight days later.

It was quite evident I was no were near ready to return to play. I missed the puck several times, my reaction times were slower, my head was hurting and I was dizzy every time I turned. To be honest I probably hurt my team more than helped. I was, however, extremely lucky to have not sustained another hit to my head. This is called ‘second impact syndrome’ where you undergo another hit to the head when you haven’t given your brain time to recover from the first injury. Impact to the brain during this vulnerable period may result in devastating consequences, such as with the recent death of high school rugby player Rowan Stringer.

If you or someone you know has sustained a concussion, there are return-to-life and play guidelines to help. The Ontario Neurotrauma Foundation has produced pediatric concussion guidelines and has information on persistent concussion symptoms. Parachute has return-to-play guidelines which are also a valuable guide for concerned parents and athletes.

These guidelines are the most up to date and based on research. However, I would like to impart some of the things I have learned throughout my career and the few concussions I have had:

  1. Remove yourself from the activity you are doing. I know this is hard but you are probably putting yourself at risk for a longer or more complicated injury. If you want to get back out there as quickly as possible and avoid more serious injuries, it is critical to stop what you are doing. 
  2. Give yourself time to rest – some of the symptoms of concussion can develop up to 24-36 hours after the injury occurred. So jumping right back into a high risk activity can put you at more risk.
  3. If something doesn’t feel good, stop. If you hurt a muscle and felt the pain when you began running you would stop, so don’t treat your brain any differently. I think this is particularly important when you are trying to get back to your life and sport. Monitoring how your brain feels when you are beginning to re-integrate yourself into all your activities is key.
  4. Be patient – For me this was the most difficult one. Some days you begin to feel better and think that you have recovered and then the next you feel worse again. This can be extremely frustrating, especially if you want to get back to school or back to what you love doing. As long as you are aware that it’s not going to be a straight forward recovery, then maybe you can lower that frustration.
  5. Rest, but don’t sleep all day. Previously it was thought that it was important to completely isolate yourself, stay in a dark room until you felt better and your symptoms were gone. However more recent research has shown that full rest can have a negative effect on brain health and recovery. After the suggested 24-hour rest period, begin to get back into what you are doing, slowly. Go for a walk or try cooking dinner, but whatever it is, make sure you’re moving in small steps.
  6. Define your priorities. One common symptom for  people is fatigue and difficulty to concentrate. If you overwhelm yourself you could hinder your recovery.
  7. This so-called ‘invisible injury’ is nothing to hide, nothing to be ashamed of and it is okay to not feel comfortable doing something that everyone else is. All that matters is taking care of your brain and you need to do whatever it takes to take the appropriate steps.

 Karolina Urban is a former University of Toronto and Canadian Women’s Hockey League player. Currently she is a PhD student at the Concussion Centre in Holland Bloorview Kids Rehab Hospital. 

Women and brain injury: What you need to know

BY: ALISON

Men are more likely to acquire a brain injury than women, and are three-times more likely to die from a brain injury. Perhaps because of this, the media tends to pay more attention to men and brain injury. For instance, name a person in Canada who didn’t know about NHL player Sidney Crosby’s struggle with concussions from 2011 to 2012.

But there’s a lot about women and brain injury which needs to be understood. How many people know about award-winning women’s hockey Olympian Meghan Duggan’s struggle with concussion? Or about hockey player Katie Weatherston, who lost her spot in the 2006 Olympics due to concussion symptoms? Or, more recently, Nicole Setterlund, who left professional sports due to TBI?

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photo: Kevin Healy via flickr

Given recent evidence that females are more susceptible to concussions and have greater difficulties with recovery than men, it stands to reason the focus of attention should be shared between men and women equally.  But further research is required to understand how men and women respond to and recover from TBI differently.

Male and female brains: different but equal

Despite decades of jokes on the subject, male and female brains are, infact, different.

In general, male brains are larger than female brains, while female brains have thicker, more convoluted cortexes with more tightly packed neurons (brain cells).

Functionally, male and female brains rely more heavily on different sides of their brains when performing various tasks. Male brains have a higher proportion of gray matter whereas female brains have a higher proportion of white matter. Gray matter is made up of more active neurons which process information. White matter networks information between different areas of the brain and allows thoughts to be intergrated from gray matter, assisting with complex skills such as language.

This suggests that women’s brains are more complex, even though men and women are equally intelligent. Evidence also suggests that the percentage of gray and white matter regions involved in cognition, which are located in the frontal lobes, is drastically larger in women than that in men. Taking into account the specific location of trauma to the brain, this could explain why frontal lobe injuries can be more devasting to females than males.

Women and ABI

Concussions Rates for Men and Women

Although the majority of people who sustain a TBI are male, recent studies indicate that women are actually more susceptible to concussions and experience poorer outcomes than men. Despite the fact that more men play contact sports than women, women suffer significantly higher rates of concussions than men in these sports. Where men have a higher percentage of concussions resulting from player-to-player contact, women have a higher percentage of concussions resulting from player-surface contact and player-equipment contact. A higher incidence rate of sports-related concussions (SRCs) has been documented in females in high school sports (soccer and basketball) and college-level sports (soccer, basketball, and ice hockey). Furthermore, high school girls are more likely to have recurrent concussions than boys.

The gender-specific rates of sports-related concussions have been explained by the fact that women have less neck strength than men. Neck strength is needed to protect the brain from sudden acceleration-deceleration forces. In fact, it is already well-documented that women are more susceptible to whiplash injuries due to sudden acceleration-deceleration. TBI and whiplash are often experienced concurrently and can cause similar symptoms. Besides having stronger neck and back muscles, men also have more cartilage in the facet joints of the spine, resulting in better protection from injury.

A person’s body mass index (BMI) may play a role in transmitting force and contribute to the severity of an injury, since young girls tend to have higher BMIs than boys.

 woman on couch
photo: Tayor Mackenzie via flickr

Here’s what some of the research has found:

Hormonal Changes After TBI

Hormones fluctuate more drastically in women, making women particularly susceptible to migraines and reproductive changes after a TBI. Fluctuations in estradiol are a cause of migraines in women of childbearing ages. Concussed female soccer players report double the rate of migraines compared to the males.

One study followed 104 women with moderate to severe TBI and observed that 46 per cent of those women had amenorrhea (the absence of menstruation) lasting up to 60 months and 68 per cent of them developed irregular menstrual cycles including more skipped menses. The women also reported worsened premenstrual syndrome (PMS) and menopausal symptoms after TBI. Although the study did not see an effect of TBI on fertility, it noted that fewer female TBI survivors had live births than the controls and that those that did had more difficulties in the postpartum period.

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Given the anatomical, hormonal, and psychosocial differences between men and women, it lends to reason that sex should be a factor when planning treatment, support, and return to school/sports/work for TBI survivors. However, further research is needed before sex-specific treatments can be developed and new medical management guidelines established.


 Alison suffered a concussion in 2013 that damaged her mind and body. The injury shook her spirit, but it didn’t take her determination or ultimately her happiness. In fact, she’s certain that she never would have found love, had it not been for her concussion. Although she went from being a workaholic to a homemaker (and a poor one at that), an extrovert to an introvert, and a partier to a hermit, she set new priorities, accomplished new goals, and found new hobbies. Some things haven’t changed about Alison; she still loves dogs, cooking, and helping others. She’s hopeful that she will one day reconnect with her love for traveling. In the meantime, she hopes to help brain injury survivors and their caregivers by sharing her experience and spreading awareness.