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. 

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BIST’s summer fun + water safety reminder

Nothing beats hanging out by the water during hot, lazy summer days.

young family sitting in a lake
SOURCE: BLOGSPOT

It’s easy to feel free and relaxed. And you should.

But it’s also important to remember the hard facts, that more people die from drowning in Ontario than anywhere else in Canada. Certain groups are at increased risk, especially two to four-year-olds, adults 60 and over, people who have lived in Canada for five years or less and men 18 to 49-years-old.

As most people connected with BIST know, surviving a near-drowning doesn’t guarantee things will be easy from then on. Brain damage can occur after the body has been deprived of oxygen for four to five minutes, which makes water safety a crucial component of summer-fun.

Here are some tips to remember when you’re out:

  • Two to four-year-olds are the highest risk group for drowning in the under-five age bracket, and these drownings usually occur near the water. The problem: curious little ones fall into water (such as an outdoor pool) they’ve wandered into in the brief moments their parents aren’t looking. Adults aren’t paying attention, because no one is actually swimming, they’re just near the water. Lack of adult supervision is the biggest risk factor that leads to young children drowning.
  • Young and mid-life men are at increased risk of drowning, particularly due to these at-risk behaviours: consuming alcohol while out in the water, not using a PFD (personal flotation device) when boating, going out in cold, rough waters and being out after dark. Another risk factor: going out on the water alone.
people swimming in an outdoor pool
PHOTO: BLOGSPOT
  • New Canadians, especially folks who have been in the country for five years or less are four times more likely to be unable to swim than people born in Canada. Meanwhile, most people in this group consider swimming to be a very safe activity for themselves and their children.
  • Older adults can be at-risk of drowning if they suffer a medical condition while in the water, such as a heart attack. They may also be at risk if they do not modify activities they did when they were younger,  such as swimming across a small lake, that they’re no longer able to do. At the same time, not wearing a PFD, consuming alcohol while out on the water and going out alone are all risk factors which lead to drowning.
man and girl in a boat wearing life jackets
PHOTO: FLICKR

It’s important to reminder that drowning is a quiet, hard-to-notice event.

A young child can silently slip under the water in the bath, something a parent in another room wouldn’t notice. And most drowning victims can’t call out for help.

This video shows someone drowning in a crowded swimming area, while no one but the lifeguard notices:

 Here’s how to stay safe:

  • Watch kids all the time – especially when you’re near water but not necessarily swimming. That means if there’s a party at the beach or a pool, someone should be ‘assigned’ to watch the young children at all times. Take shifts, so everyone can have grown up fun and keep the kids safe.
  • Don’t swim or boat alone.
  • Wear a life jacket every time you’re in a boat.
  • If you’ve consumed drugs or alcohol, don’t go in the water.
  • Little kids who are not strong swimmers should wear PDFs.
  • Kids under five should not be further away than an arm’s reach from an adult.

Learn how to swim!

Learning how to swim is one of the best things you can do to keep you and your family safe in the water. Free or low-cost lessons are available from the City of Toronto – including lessons for adults. So dive in (safely) and have fun!

Sources: Life Saving Society + Ontario Medical Association