Concussions – Part 3 – Persistent Concussion Symptoms
What is PCS?
Persistent Concussion Symptoms, or post-concussion syndrome as it was previously known, is the presence of at least 3 of the following symptoms, 14 days after injury for adults or 4-weeks after injury for children:
- Sleep problems
- Concentration problems
- Memory problems
- Problems tolerating stress, emotion, alcohol
Research shows that >30% of all concussions that aren’t treated will go on to have long-standing symptoms. This is an incredibly large proportion of injuries that result in persistent and often life-altering symptoms. There are a number of reasons why people can experience PCS, including altered blood flow to the brain, chronic inflammation, visual and vestibular dysfunction, a concurrent neck injury and psychological involvement. As you can see, there are a lot of possible contributors to PCS which is why it is imperative that you see a specialist healthcare practitioner trained in concussion management for accurate assessment and treatment. Even if it is later down the line after your concussion, it doesn’t mean we can’t help both identify the contributing factors and treat these issues until your symptoms resolve and you’re back to 100%.
What is the difference in rehab for acute concussions and PCS?
Where acute management is focused on graded exposure to mental and physical activity, PCS management differs slightly in that it is centred around the identification and treatment of the contributing factors to the persistent symptoms. PCS can be complicated and we know there are a number of possible contributing factors therefore it is important that these are either identified and appropriate treatment is implemented. It may be there are underlying blood flow issues, there may be cervicogenic symptoms related to concurrent neck trauma, there may be visual or vestibular elements or there could be a combination of these factors involved. Whatever is found to be a contributing factor in your assessment is addressed with a tailored treatment plan.
What is CTE?
Chronic Traumatic Encephalopathy (CTE) is thought to be a progressive neurodegenerative disease associated with repetitive brain trauma. CTE can result in significant cognitive and behavioural symptoms such as memory impairment, concentration difficulties, impulse control problems and ‘explosivity’ among others.
Research on CTE is still emerging and the body of evidence is somewhat conflicting. This is due to many things, mainly the fact that diagnosis can only be made post-mortem (once the person has passed) and that there are other neurodegenerative diseases that share signs, symptoms and pathology with CTE so it is hard to distinguish. This is not to say that CTE isn’t a major issue, but to highlight that we can’t conclusively say that it is strictly as a result of repetitive head trauma – due to this it is important to note that just because you have played contact sport your whole life and you have a history of concussions doesn’t mean you are automatically going to develop CTE. However, with the direction the evidence is trending, we need to take precautions in order to reduce our risk of potentially developing this disease.
What is clear in the literature is that age of contact sport involvement correlated to earlier cognitive and behavioural symptom onset in those who have been diagnosed with CTE. Evidence further suggests that contact sport involvement before the age of 12 predicted earlier cognitive and behavioural symptom onset by ~13 years – in those who had been diagnosed with CTE. Since this evidence has come to light, some sports in the U.S. (ice hockey, gridiron) have changed the rules in order to remove contact from the early age groups as a possible preventative measure to developing CTE.
CTE is a complex issue that requires further research in order to conclusively show that repetitive head trauma is a factor in its development. Improving diagnostic methods to allow for early detection and identifying all contributing factors will help to reduce the risk of developing this disease. While the body of evidence is becoming more robust, it is important that we take all steps necessary to avoid any type of brain trauma, in particular in the young age groups with developing brains.