Traumatic Brain Injury and Post Concussion Syndrome For traumatic brain injury (TBI) and post concussion syndrome (PCS).


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Old 01-20-2022, 05:44 PM #1
DrewDigital DrewDigital is offline
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Lightbulb Is Overdoing-It the cause of Post-Concussion Syndrome?

Is Overdoing-It the cause of Post-Concussion Syndrome? I think so because overdoing-it triggers an over-active neuro-inflammatory response which leads to prolonged inflammation and related symptoms.

People should not have to suffer with concussion symptoms for months after a head injury. Most concussions heal within 7-10 days. When people have symptoms that last longer than that, it's probably because they didn't rest enough in the beginning.

Let me give an example of what I mean by overdoing-it. Many years ago, I had a bout of PCS. I fell out of a chair and hit my head. The next morning, I felt ok, and it was a holiday weekend, so we went to the Wild Animal Park. All the people and noise and activity really made my head hurt. I tried to stick it out for a few hours but finally said we had to leave. Then my symptoms persisted for 6 months.

If I had stayed home and rested, my concussion would have healed within a week, and I would have been fine. But because I pushed through the pain, I suffered for many months.

Let me clarify, some cognitive activity is ok. It's the high-level intense cognitive activity that is detrimental and should be avoided. But that includes activities like computer work, academic work, school homework, or going to theme parks, activities we want to do every day. So, to put it in other words, don't overdo-it. Find a balance between resting and activity such that you don't exacerbate symptoms.

There are two injuries that occur during a concussion. First there is the impact force and then there is the inflammation that the brain produces in response to the impact. Inflammation has a beneficial role in the beginning, but prolonged inflammation is bad. It has a damaging effect and can cause more symptoms than the initial impact.

If we examine head injuries that result in PCS, in most cases, the impact force is not enough to cause long-term symptoms. Anxiety alone is not enough to cause long-term symptoms. So that means inflammation is the culprit. (There are other factors that contribute, like structural damage, vascular disruptions, signaling disruptions, but those are out of our control, whereas overdoing-it is something we can avoid.)

There has been talk about how anxiety can cause concussion-like symptoms without a forceful impact, and how people with a history of anxiety are more prone to PCS. That's because anxiety is linked to brain inflammation. If anxiety can do that, then overdoing-it can also cause brain inflammation.

The brain's inflammation response system is on high alert after a blow to the head and stressors can trigger it to pump out inflammatory compounds to look for and repair damaged cells even if there is no damage. Intense cognitive activity can trigger this over-active neuro-inflammatory response. Then it takes a long time for the brain to clean up the inflammation and learn to stop over-reacting, hence Post-Concussion Syndrome.

This research study suggests that after a concussion, adolescents with the highest level of mental activities — such as reading, doing homework and playing video games — take the longest to recover.
Cognitive Rest After a Concussion Speeds Recovery | Psychology Today

If we have a better understanding of what causes Post-Concussion Syndrome, then we can prevent it and provide better treatment.
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Old 01-21-2022, 03:42 AM #2
Mark in Idaho Mark in Idaho is offline
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Drew, You appear to confuse PCS, which is symptom that persist after 6 to 8 weeks and basic concussion symptoms.


[People should not have to suffer with concussion symptoms for months after a head injury. Most concussions heal within 7-10 days. When people have symptoms that last longer than that, it's probably because they didn't rest enough in the beginning.]

The research shows 85% of concussions recover (heal is the wrong term) within 6 to 8 weeks with most recovering within 2 weeks and some within just a few days.

The study you link did to not differentiate reading and homework from video gaming and social media/texting. Video gaming, online activity, and social media/texting are well known over-stimulating and fatigue inducing. It is disappointing that the study did not make that differentiation. It could be that the participants did not understand that differential. The category 0 was complete rest. That has been shown to be of no value except in severe cases.

Boston Childrens' is one of the best in the world for concussion. Dr Robert Cantu was one of the early researchers and he and Chris Nowinski and the Concussion Legacy Foundation were instrumental in getting this research started in Boston. Odd that Meehan did not suggest this other category of moderated reading and school work with no computer action. Maybe it is more challenging to exclude the computer stresses in today's youth.

A prior study indicated that returning to moderated cognitive activity that does not trigger an increase in symptoms at 24 hours is beneficial.

Another study indicated that prior depression and anxiety contributed to prolonged PCS. Anxiety/stress inducing video gaming, social media, streaming, and the fast finger flipping of smartphone screens contribute to this.

[If I had stayed home and rested, my concussion would have healed within a week, and I would have been fine. But because I pushed through the pain, I suffered for many months.]

You can surmise this but it is not a given fact.

Remember, If you have seen one brain injury, you have only seen one brain injury. Every brain injury is different.

What people need to understand is self-discipline. They must moderate activities based on real time effect. Are they struggling to read a line of text? If yes, Stop reading and change activities and environment. Go walk the dog.... Pushing cognitive efforts when those same cognitive efforts did not require pushing previously means, Stop the cognitive effort.

Meehan indicated continuing to make enough effort to maintain grades is acceptable. Wow. That opens all kinds of stress into the recovery period.

There is nothing that can't be learned at a later date.

I would have loved to see Meehan state that teachers need to allow students to delay any schoolwork until they have recovered adequately.

The school calendar should not rule over the students' recovery and success. Would a semester off allow a student to return to the AP courses that are so prized?

So, self-discipline to moderating activity based on immediate and even next day effect is best.

If one broke their leg badly requiring extensive healing, they would take the time to let healing happen.

Just because the rest of the body works fine does not mean returning to activity is OK.
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Old 01-24-2022, 11:05 PM #3
DrewDigital DrewDigital is offline
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I agree that high level cognitive activity should be moderated and self discipline is required.

The example I gave happened in 2005. I had seven more similar falls after that and I recovered within a week each time with adequate rest. Except for this last one where I overdid-it. And I had many falls before that. So the conclusion I am making is based on many head injuries, unfortunately.

One of the reasons I brought up overdoing-it is because it is so easy to do. Most people don't realize the difference between low-level and high-level cognitive activity. Even if they do understand, people have responsibilities and obligations that are hard to get out of. Or teens may be too stubborn to admit they might have injured their head. So preventing PCS requires more awareness.
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