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Recovery after Concussion or Mild Traumatic Brain Injury

The Glascow Coma Scale (GCS) and Post Traumatic Amnesia (PTA) duration are used to determine the severity of a brain injury.

The GCS is used to determine the severity of a coma. This scale ranges from 3 to 15 and looks at the patient’s ability to open their eyes, to move body parts and to speak after different stimuli. A low number indicates a severe injury.

PTA is the situation in which the patient is conscious however they have no awareness of time, place and the people around them. Health professionals will ask questions such as “what is your name, where are you?” to establish the length of the PTA. PTA is measured in days.

People are diagnosed with a mild traumatic brain injury when they have a GCS between 13-15, and PTA duration of les than 24 hours.

People who have sustained a concussion or mild traumatic brain injury often present with problems such as fatigue, difficulty concentrating, headaches, balance problems and dizziness. These symptoms are caused by damage in the brain and usually disappear after approximately three months. However, some people do not recover within this timeframe and they develop chronic symptoms that can last for a year or more. Research shows that these symptoms are caused by psychological factors and health professionals call this post concussion syndrome.

Silverberg and Iverson (2011) reviewed the literature about post concussion syndrome in people with mild traumatic brain injury. They found that people who had psychological problems before their injury were more likely to develop post concussion syndrome compared to people without these problems. Furthermore, during the first week after the injury, some but not all people experience psychological distress; and early psychological stress is related to later post concussion syndrome in some but not all people. The authors also found that there is not enough evidence to support that psychological distress increases over time in people with post concussion syndrome.

What do these results mean in relation to treatment?

Concussion clinics should provide education and reassurance to patients so that they understand that the symptoms they are experiencing are common and will disappear with time.
Screening for psychological distress can help identifying people who need psychological intervention.
Early intervention targeting psychological distress can help to prevent the development of post concussion syndrome.

Silverberg, N.D. & Iverson, G.L. (2011). Etiology of post-concussion syndrome: Physiogenesis and psychogenesis revisited. NeuroRehabilitation, 29 (4): 317 – 329.

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