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Every concussion -- and patient -- is different than the next

NFL Evolution will feature a guest columnist every Tuesday, each with a different viewpoint of player health and safety from the youth level to pro football.

By Dr. Joseph F. Waeckerle, NFL Evolution columnist

People who sustain a concussion and their families are often given conflicting advice regarding diagnosis and management. Only in the last decade or so brain injury specialists have begun to use sophisticated technology to better define what is happening to the brain and nervous system after a head injury produces symptoms consistent with a concussion.

However, there are still misconceptions about what is the "best practice" approach to diagnosis and management that require our consideration.

A concussion is a brain injury and should be taken seriously. While the severity of a concussion may vary in an injured person, they all have a brain injury that requires skillful medical evaluation and proper management. The potential for short- or long-term complications after a brain injury demand medical care by competent health care professionals experienced in concussion care.

All concussions are different. No two are the same. And, even in the same person, a repeat concussion may present a different picture. Each person is unique, each brain is unique, and the brain is very dynamic and constantly changing over time.

As a result, the person who suffers from a brain injury displays symptoms and signs that are characteristic for that individual at that time. There are common symptoms and signs suggesting a concussion, but a complete concussion exam provides valuable information leading to the proper diagnosis and management of the brain injury.

Just as no two concussions present the same, the management plans must necessarily be individualized to the concussed patient. There are no standard approaches to management and recovery such as "two weeks of rest for a mild concussion." Each concussed person is carefully monitored and advised by the health care specialist regarding the best approach to complete recovery.

Short-term complications such as prolonged symptoms like a headache or prolonged signs like balance problems must be addressed and managed carefully. Potential long-term complications, while controversial as to who is at risk, can best be avoided by proper conservative care.

Standardized concussion classification schemes with their management recommendations, such as "mild, moderate and severe" based on loss of consciousness or presence of memory loss, are no longer valid. With the development of sophisticated technology -- including brain imaging techniques that can detail functions at the cellular and subcellular level -- medical researchers have provided a clearer picture of the initial injury, subsequent injury and healing response.

Also, factors that promote proper healing and recovery have been better defined. While much remains to be discovered, concussion specialists can now provide a more tailored management plan to each individual patient.

All concussions initially require brain and body rest as a first-line treatment. The brain requires a significant amount of energy, oxygen and blood supply to function properly. A brain injury limits the availability of these three essential components for brain function. Therefore, any mental activities that increase brain cell work requiring more energy, oxygen or blood supply might further stress the already injured brain, complicating the injury or healing response.

So too, any physical activity that results in energy, oxygen, or blood supply to be shunted to another part of the body limits the availability of these requirements for the brain resulting in decrease availability to the injured brain. The overall principle is maintain supply and do not increase demand.

On a specific note, once a concussed person has been properly medically evaluated, the patient profits from sleep and rest. Authorities do not recommend waking up the patient with a concussion to check them, as their sleep is important to their recovery.

Dr. Joseph F. Waeckerle is clinical professor of emergency medicine at the University of Missouri-Kansas City School of Medicine. He also is editor emeritus of Annals of Emergency Medicine. He has practiced Emergency Medicine and Sports Medicine and has been a team physician at the grade school, high school, college, and profession level for over 30 years. He currently serves on the NFL Head, Neck, and Spine Injury Committee and the Mackey White Brain Injury Committee of the NFL Players Association.

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