Neurologists' understanding of concussion has expanded greatly in the past few decades, as has interest among the general public. This is what makes Navigating the Challenges of Concussion (Oxford University Press, 2023) so timely. The newest addition to the American Academy of Neurology's Brain & Life Book series combines the latest research and information from a neurologic, psychological, and rehabilitative perspective.
Navigating the Challenges of Concussion is organized into four sections. The first part defines concussion, describes the causes, outlines the symptoms and treatment options, and details a typical recovery. The second part explains what to do if symptoms persist. Section three delves into various categories of those who experience concussion, including athletes, military personnel, and older people. The final part recaps what we know about concussion and where current research might lead us.
Brain & Life spoke with Michael S. Jaffee, MD, FAAN, director of the Brain Injury, Rehabilitation, and Neuroresilience Center at the University of Florida in Gainesville, about the book, which he co-authored with Donna K. Broshek, PhD, professor and neuro-psychologist at University of Virginia Health in Charlottesville, and Adrian M. Svingos, PhD, a neuropsychologist at the Kennedy Krieger Institute in Baltimore.
How does this book differ from others on the subject?
It covers the spectrum of concussion, from typical recovery to persisting symptoms, different contexts of injury, and considerations across the lifespan. The book reflects the most up-to-date knowledge and advances in our understanding of concussion. In addition, each chapter features vignettes from people who've had a concussion.
What is a common misconception about concussion?
That someone must black out or lose consciousness. Now we know that in the majority of cases, people do not black out. People also thought you had to be hit on the head to have a concussion, but concussions can be caused by whiplash or by being hit in other places, like the shoulders or torso.
How has treatment changed?
We used to recommend that people stay in a dark room, avoid stimulation, and not do anything. It was called cocooning. Research has shown that cocooning can actually prolong recovery. Today, physicians recommend gradually resuming normal school, work, and physical activity, using symptoms as a guide for pacing.
Are some groups more at risk for a slower recovery?
Having attention deficit hyperactivity disorder (ADHD) or a learning disability can complicate recovery. In the past, doctors would take people off ADHD medication, believing it was overstimulating. In fact, the medication is essential to healing. In addition, children with ADHD may be more prone to concussion because they may be more impulsive or take more risks. It's important for doctors to determine whether patients have learning disabilities or ADHD in order to tailor treatment. Another group of people who face a long recovery are those who are misdiagnosed or not diagnosed at all. Their symptoms are more likely to persist and even worsen.
What are typical symptoms of a concussion?
The physical symptoms include headache, dizziness and balance problems, sleep disturbances, and fatigue. The emotional symptoms can be irritability, depression, anxiety, and post-traumatic stress disorder. Cognitive symptoms may include trouble concentrating; memory, language, and processing problems; and learning difficulties.
How long is the recovery process?
Many people recover in days or weeks and don't experience any long-lasting problems. If symptoms like having trouble staying alert or problems with speech or language persist, people should seek an evaluation from a doctor who specializes in traumatic brain injury, if possible.
As a specialist in concussion, how do you treat patients with persistent symptoms?
I run a concussion and traumatic brain injury clinic, and we have a multidisciplinary approach that includes evaluations by a neurologist, neuropsychologist, and neuro-occupational and physical therapists [professionals who work with people who have neurologic impairments to improve their day-to-day function]. Based on these evaluations, we create an individualized plan for each patient that addresses the physical, emotional, and cognitive aspects of concussion.
What is your goal with this book?
My co-authors and I want to raise awareness of concussion and improve the quality of care. We provide solid, evidence-based education to the people who need it so they can make informed decisions that are right for them.
Navigating the Challenges of Concussion is available at all major booksellers.
