by Joe Etherton, PhD
Concussion is a relatively common injury that may be considered synonymous with the milder end of “mild traumatic brain injury” (mTBI). Concussion often involves temporary symptoms such as headache, light sensitivity, dizziness, problems with concentration and memory, and irritability. Impairment of cognitive performance resolves within hours-to-days for most injured workers. Even when research studies include mild TBI patients who have lost consciousness up to 30 minutes, there is no statistically significant difference between pre- and post-injury neuropsychological test performance observed by 3 months after the injury.
Unfortunately, some injured workers become convinced that the effects of their concussion remain months or even years later, and some perceive themselves as too disabled to work. “Post-concussion syndrome” is a term originally used for patients with symptoms that lasted longer than expected (say, 3 months), but in practice, some clinicians use this term for concussion-like symptoms whenever they occur. Multiple studies have found that subjective symptoms commonly associated with post-concussion syndrome (like fatigue, headache, concentration problems, irritability) are not specific to concussion and occur at essentially the same frequency in people with and without a history of concussion. In addition, scores on self-reported, post-concussion measures are more strongly related to measures of psychological distress, including anxiety, depression, and stress, than to the presence or absence of prior concussion. In other words, many of the sensations and experiences that people associate with concussion are actually features of normal life, and they are experienced to a greater degree when levels of anxiety or depressed mood are elevated.
Unfortunately, when injured workers and physicians misattribute these subjective complaints to a concussion, this often promotes sedentary behaviours and deconditioning. This lack of engagement in fulfilling or enjoyable activities further promotes depressive symptoms.
So, when you hear the word, “concussion”, remember this:
· A concussion has not occurred every time a person’s head comes into contact with another surface (e.g., whether bumping the head on a shelf when standing up or playing sports or even in an auto accident).
· The objective deficits associated with concussion usually resolve within hours-to-days. They might last for weeks, but subjective symptoms (like self-reported forgetfulness, concentration problems, or headaches) are so common in people with no history of concussion that the symptoms do not serve as a reliable indicator of whether the effects of a concussion have resolved.
· Several studies have demonstrated a “good old days” bias in which patients may significantly overestimate their pre-concussion cognitive abilities and overall health.
· Carefully consider that the wrong concussion information provided by medical professionals and claim adjusters can shape an injured workers’ mindset into a self-fulfilling prophecy, resulting in delayed recovery.
