Making the subjective objective; how technology helps evaluate concussions

 BY: PHIL PALMER, DC AND DONALD D. SCHRUMP JR, DC, MS, CSCS

In the current climate of concussion clinics, many tools are being used to assess this type of serious injury, also known as traumatic brain injury (TBI), or acquired brain injury.

Assessments can include physical and mental status examination, Glasgow Coma Scale, Immediate Post-Concussion and Cognitive Testing (ImPACT) computer-based system, Balance Evaluation Scoring System (BESS), Inertial Sway measuring devices, and Optogait assessments. 1-3

 

Cognitive Symptoms of Concussion: difficulty remembering, feeling slowed down, feeling mentally foggy, difficulty concentrating, confused about recent events

 

Each assessment method is designed to evaluate the different aspects of the complex physical, cognitive and emotional disturbances that can result from a concussion.4

Establishing a ‘baseline’ with patients before a concussion occurs is useful in evaluating a person post-concussion to determine how the injury has affected them.1, 3, 5  This is not always possible given how and when a brain injury can occur.  An Assessment baseline can always be performed when commencing treatment and as an introduction to a rehabilitation program, and to compare against when re-evaluating a patient’s progress throughout their program.

One tool we are using to establish a patient’s baseline is the Optogait, which is considered a ‘gold-standard’ device for measuring gait (how a person walks), balance and movement symmetry.6-9

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The simple 30-60 second test of walking on a treadmill can be recorded by a computer system using lasers to establish the individual characteristics of the patient’s gait, which can then be remeasured throughout the rehabilitation program.  This test gives objective data on all aspects of the gait cycle, as well as stability, balance and movement symmetry.

The amount you move when standing still (your postural sway), can also be measured by 3D accelerometers (which track acceleration), gyroscopes (which track orientation), and magnetometers (which, according to the journal, Karger, ‘measure the’ magnetic fields emitted by the brain, generated by neuronal activity).10 These tools allow a much precise measurement of sway  – up to 1,000 times per second more – compared to the current manual testing.

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We also determine the speed of cognitive processing during walking by testing patients walking while counting backwards.  The movements of the eyes and head together (Vestibular Ocular Reflex) are also tested in order to determine concussive symptoms.

These tests are useful when a patient may feel that their concussion symptoms have resolved, but in fact, their cognitive processing is still poor.

The Gyko component of the protocol also tests sway, which is the movement of the centre of mass, and upper vs. lower body plus compensatory movement patterns made by the brain to return to a normal set point when standing and walking.

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These tests are blended nicely with the Optogait March in Place Tests (eyes open/eyes closed), and Gyko system to determine changes in physical functioning with changes in body position.

Most recently, a validation study was conducted to utilize the Optogait® equipment for evaluation of march-in-place tests traditionally used for vestibular (inner ear) testing, called the Fukuda or Uterberger Stepping Test. 3, 13-15

 

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Using objective physical characteristics of the pathophysiology of TBI, the data collection with the OPTOGAIT equipment cannot be easily altered by the patient, thus you cannot under-estimate your symptoms with testing of gait, postural sway, or marching in place tests with your eyes open or closed.

This testing protocol provides an objective, evidence based protocol for both assessing, documenting and treating acquired brain injury.

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Dr. Philip Palmer is a chiropractor serving Toronto and the surrounding area. He is the clinical director of Genesis Rehabilitation, Physiotherapy and Sports Injury Clinic.

REFERENCES

  1. Hirsch MA, Grafton L, Runyon MS, et al. The Effect of Cognitive Task Complexity on Postural Sway in Adults Following Concussion. Archives of Physical Medicine and Rehabilitation. 2015;96(10):e51.
  2. Gaudet CE, Weyandt LL. Immediate Post-Concussion and Cognitive Testing (ImPACT): a systematic review of the prevalence and assessment of invalid performance. The Clinical neuropsychologist. 2017;31(1):43-58.
  3. Engelson MA, Bruns R, Nightingale CJ, et al. Validation of the OptoGait System for Monitoring Treatment and Recovery of Post-Concussion Athletes. Journal of chiropractic medicine.
  4. Harmon KG, Drezner JA, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. British journal of sports medicine. 2013;47(1):15-26.
  5. Alberts JL, Hirsch JR, Koop MM, et al. Using Accelerometer and Gyroscopic Measures to Quantify Postural Stability. Journal of athletic training. 2015;50(6):578-588.
  6. Lienhard K, Schneider D, Maffiuletti NA. Validity of the Optogait photoelectric system for the assessment of spatiotemporal gait parameters. Medical Engineering & Physics. 2013;35(4):500-504.
  7. Lee MM, Song CH, Lee KJ, Jung SW, Shin DC, Shin SH. Concurrent Validity and Test-retest Reliability of the OPTOGait Photoelectric Cell System for the Assessment of Spatio-temporal Parameters of the Gait of Young Adults. Journal of physical therapy science. 2014;26(1):81-85.
  8. Gomez Bernal A, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME. Reliability of the OptoGait portable photoelectric cell system for the quantification of spatial-temporal parameters of gait in young adults. Gait & Posture. 2016;50:196-200.
  9. Ammann R, Wyss T. Comaparison of Three Gold-Standards to Measure Ground Contact Time in Runners. SPORTWISSENSCHAFTLICHE. 2011.
  10. Neville C, Ludlow C, Rieger B. Measuring postural stability with an inertial sensor: validity and sensitivity. Medical devices (Auckland, NZ). 2015;8:447-455.
  11. Iosa M, Morone G, Bini F, Fusco A, Paolucci S, Marinozzi F. The connection between anthropometry and gait harmony unveiled through the lens of the golden ratio. Neuroscience letters. 2016;612:138-144.
  12. Iosa M, Bini F, Marinozzi F, et al. Stability and Harmony of Gait in Patients with Subacute Stroke. Journal of Medical and Biological Engineering. 2016;36(5):635-643.
  13. Zhang YB, Wang WQ. Reliability of the Fukuda stepping test to determine the side of vestibular dysfunction. The Journal of international medical research. 2011;39(4):1432-1437.
  14. Honaker JA, Boismier TE, Shepard NP, Shepard NT. Fukuda stepping test: sensitivity and specificity. Journal of the American Academy of Audiology. 2009;20(5):311-314; quiz 335.
  15. Grommes C, Conway D. The stepping test: a step back in history. Journal of the history of the neurosciences. 2011;20(1):29-33.
  16. Maerlender AC, Masterson CJ, James TD, et al. Test–retest, retest, and retest: Growth curve models of repeat testing with Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Journal of clinical and experimental neuropsychology. 2016;38(8):869-874.
  17. Schatz P, Glatts C. “Sandbagging” baseline test performance on ImPACT, without detection, is more difficult than it appears. Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists. 2013;28(3):236-244.

PHOTOS: Optogait Technologies Inc.

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How to best return to work following a concussion in the computer driven 21st century

BY: COLIN HARDING

One in five Canadians will experience a concussion from sport in their lifetime. Suffering a concussion can lead to a range of debilitating symptoms such as constant fatigue, changes in mood, headaches and difficulty concentrating.

Returning to work after a concussion can be challenging and if not done properly may slow recovery. There are activities and techniques that allow for the smoothest transition back to normal life and the best chance for a full recovery.

The following are some tips on how to recover from a concussion and return back to work while maintaining your health.

There are good days and bad days and accepting that things will take time is important to maintaining a high level of mental health.

Say yes to help & support

The Centre of Disease Control and Prevention recommends gathering support as an important part of recovery and may help lift the burden of a concussion off an individual’s shoulders. Support can come from many places: a partner, a family member, a healthcare professional or a manager at work.

Having open channels of communication can lead to a greater understanding and empathy during recovery. It is easier for your peers to understand your situation and support you through the process if they know what has happened.

For example, a manager who knows their co-worker has recently experienced a concussion should lessen the workload initially as the individual begins the transition from rest back to work and this may help decrease their symptoms and stress.

Woman at her desk with head in her hands
PHOTO: enerpic.com

Avoid triggers

Once someone has experienced a concussion it is important to recognize what triggers his or her symptoms. Every concussion is different and these triggers may range from person to person. The backlight on a computer screen may cause headaches, exercise may cause nausea, and conversations may cause fatigue.

Every individual has a different set of factors that will influence their symptoms. If an activity makes symptoms worse, then it is important to stop that activity and rest. For instance, if conversations’ are overwhelming, take a break from social engagements.

Manage your energy

It may sound simple, but managing symptoms and energy amongst all of the different aspects in your life can be a real challenge. Once the symptoms are resolved someone may wish to return to work. Returning with a decreased workload, taking scheduled breaks and being cognisant and respecting symptoms are helpful to ensure that transition goes smoothly.

Accepting that an injury has happened, and that it will take some time to recover from, is another important aspect to consider when living with a concussion.

Be patient

There are good days and bad days and accepting that things will take time is important to maintaining a high level of mental health. The recovery process and managing setbacks can be incredibly frustrating, and patience can be one of the most important aspects of a recovery.

A person should focus on the activities that they can control and feel like they are making progress on, as opposed to the activities that are out of their control. Light exercise (As long as a person does not experience worsening symptoms), a balanced diet, and getting enough sleep are part of the foundation to achieve health and could be part of a recovery plan.

Having a concussion can initially be draining and frustrating. Having the support from work and peers, being aware, managing symptoms, and accepting that recovery takes time can go a long way towards making the transition back to normal life successful.

 


Colin Harding is the CEO and founder of Iris Technologiesa Canadian healthcare technology company that is improving the lives of peoplewho have suffered from a mild traumatic brain injury (MTBI) or live with chronic migraines.

A version of this article originally appeared on the Iris Technologies Blog

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

Without action, awareness does little

BY: ALYSON ROGERS

Nine years ago, I walked into an emergency room with very obvious signs of a concussion. Despite glaring symptoms, no one would even utter the word ‘concussion’. Doctors told me I had whiplash, which didn’t even come close to describing the traumatic brain injury diagnosis I was given six months later.

Hospital emergency room entrance

This year, I walked into the same emergency room, with very obvious signs of a concussion. Despite nine years of brain injury awareness in the media, in hospitals, in schools and in sports, my experience was no different.

What good is brain injury awareness if we don’t put it into practice?

April 2017 marked nine years since I acquired my brain injury. I experience symptoms every day and it looks like they are here to stay.  Like many others, I navigated the health care and education systems before brain injury awareness hit the mainstream. My family and I had to research and advocate for every bit of care I received. Even with a CT scan in hand, it was difficult to get doctors to believe, let alone treat my symptoms. This was before Sidney Crosby, NFL lawsuits and head injury protocols; the dark ages of brain injury.

This year, I learned that we are still living in the dark ages. Last month, I was hit in the head with a locker by accident at work. When my symptoms continued to get worse instead of better, I went to the same emergency room I went to nine years ago. It didn’t even cross my mind that I would be treated exactly the same as I was back then, this was the new era of brain injury awareness, right? Wrong.

locker room

There were three of us in the emergency room with concussion symptoms; the doctor barely looked at any of us and sent us on our way.  I returned to my family doctor, who has seen me do this concussion dance with the health care system before, and was sent to another emergency room. The second ER doctor told me what I was experiencing was impossible and seemed shocked when I dared to ask for WSIB forms to be filled out. Despite the blurred vision, noise sensitivity, nausea and fatigue he put a question mark beside the concussion diagnosis on my papers.

June is Brain Injury Awareness month in Canada and it’s a month I’m excited for and take pride in every year. Considering how prevalent concussions / brain injuries are, I think awareness is important for everyone,  but awareness isn’t enough.

Being aware is the first step but it is by no means the only step in preventing and responding to brain injuries. The next step is to put that awareness into action; this action is going to require effort and change by professionals and individuals.

It’s easy to say we are aware and be done for the day but if we don’t put in this effort for people with brain injuries, awareness falls flat and nothing changes. The very people brain injury awareness is supposed to be helping are failed all over again- stuck in the dark ages of brain injury.

The other piece of brain injury awareness that requires action to be effective is prevention. Awareness that leads to policies such as concussion protocols are great (if they are put into action and enforced) but this doesn’t lead to a decrease in people sustaining brain injuries. Brain injury prevention is going to have to come from individual change; with the increase in brain injury awareness, we know that a hit to the head can have lifelong impacts. With that being said, there is no excuse for deliberately hitting someone in the head.

Many brain injuries, especially sports-related brain injuries, are entirely preventable and occur due to individuals decisions. My brain injury stems from a youth athlete’s decision to use physical force instead of skill to win a basketball game. This is similar to Sidney Crosby, during the NHL playoffs he sustained another concussion at the hands of a player on the opposing team. It is very well known that Crosby has a history of concussions and another hit to the head could, at the very least, end his career. With the increase in brain injury awareness, we should be seeing a decrease in these types of injuries simply by individuals changing their behaviour.

Woman playing basketball

My hope for this Brain Injury Awareness Month is to move beyond awareness and towards action.  This includes a decrease in the number of brain injuries and better outcomes for survivors.


Alyson is 25-years-old and acquired her brain injury nine years ago. She graduated from Ryerson University and is a Youth Worker at a homeless shelter. In her spare time, Alyson enjoys writing, rollerblading and reading. Follow her on Twitter @arnr33

 

 

 

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17 activities you can do when you’re recovering from a concussion

BY: ALISON

When I was in the acute phase of my concussion, I couldn’t do anything. I thought the boredom would kill me if my symptoms didn’t (new research suggests I was somewhat right).

I felt even more frustrated when my partner’s online search for fun activities for concussed people turned up countless suggestions that weren’t possible for me. All forms of stimuli were excruciatingly painful. I couldn’t do anything that involved electronic devices, lights, eye strain, sound, or physical activity.

Here is a list of activities that I gradually worked my way up to doing.

Please feel free to write a comment below and share what you did while recovering from your brain injury.

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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?

photo
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.