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Protect the head: how to avoid, identify and deal with concussions

Your brain is your body's command center. Its soft, sensitive tissues float in a cushioning fluid within the hard and sturdy skull. But a swift blow to the head or violent shaking can override these protections and lead to a mild type of brain injury known as a concussion.

More than 1 million mild traumatic brain injuries occur nationwide each year. These injuries can be caused by falls, car crashes or recreational activities like bike riding, skateboarding, skiing or even playing at the playground. More than half of concussions occur in children-often when playing organized sports such as football and soccer.

Though concussions might be categorized as mild brain injuries, they can have long-term effects and should be taken seriously. A single concussion is also known to raise your risk for having another concussion-and a second concussion may be more severe. It's important to learn to recognize the causes and symptoms of concussion so you can take steps to prevent or treat these head injuries.

Concussions usually come about as a result of the brain moving rapidly back and forth or from banging against the side of the skull. While the skull may be designed to prevent most traumas to the brain, it's not built to sustain significant moving that occurs within the skull. This sudden movement can stretch and damage brain tissue and trigger a chain of harmful changes within the brain that interfere with normal brain activities.

More serious brain injuries that involve skull fracture, bleeding in the brain or swelling of the brain can be detected with X-rays or other imaging methods. Unfortunately, concussions can be more difficult to identify because they're not visible from the outside with standard imaging tools like MRI and CAT scans. Instead, concussions are usually suspected when certain signs and symptoms are evident. Common symptoms include nausea, headache, confusion, dizziness and memory problems. Loss of consciousness occurs in about 1 in 10 concussions, and a person with a concussion might also have trouble answering basic questions and move in an awkward, clumsy way.

For about 9 in 10 people with concussions, symptoms disappear within 7 to 10 days. Scientists have been working to learn more about those who take longer to recover. In one recent study, 8- to 15-year-olds treated in an emergency room for mild traumatic brain injuries were observed. While most kids recovered quickly, a small group of about 10-20% of the group developed more intense symptoms following the concussion that lasted for as long as one year for certain individuals.

Body-related symptoms, such as headache and dizziness, tended to fade fairly quickly, the researchers found. But thinking-related symptoms, including problems with memory and paying attention, tended to linger in some kids throughout the year-long study. Children who had lost consciousness or had some additional abnormality that showed up on MRI scans after the injury had an increased risk for lasting problems such as a reduced overall quality of life and even academic problems.

Based on these shocking findings, researchers continue to explore ways to predict a person's response to a concussion, as much remains unknown about the underlying biology and outcomes of mild head injuries. Some studies are looking at how injury and recovery processes differ in immature and adult brains, while other scientists are examining the problems that can arise from repeated injuries to the brain.

Researchers know that immediately after a concussion, the brain is especially vulnerable to having a second, more serious injury, but it's not clear why-or how long that vulnerable period lasts. One study found that a single mild injury reduces the brain's use of the sugar glucose as a fuel, at least in rats. A second mild injury 24 hours later leads to an even steeper drop in glucose use and memory problems that last longer. But when the brain has several days to recover, and the use of glucose returns to normal, a second mild brain injury seems to be no worse than the first.

Studies have found that the risk for a second injury is greatest in the 10 days following an initial concussion. If you suspect that someone has a concussion, make sure they stop whatever activity they're doing, especially if they're involved in a sport. Their brain dysfunction might not only cloud their thinking, and can also slow reaction times and affect their balance so they become more likely to have another injury.

You should also take the following steps to avoid concussions. Wear helmets when appropriate, such as when bicycling, skateboarding or riding a horse. Athletes can decrease their risk of concussion by wearing proper headgear and following the rules of good sportsmanship. Make living areas safer for seniors by removing tripping hazards such as throw rugs and clutter in walkways, and install handrails on both sides of stairways.

This is an ongoing process that requires a conscious effort to better understand, prevent and treat concussions. While this research continues, do what you can to prevent concussions. Learn to recognize the symptoms, and make sure that people with signs of concussion stop their activities and seek medical attention.

For any other sports injuries, be sure to see your physical therapist fast and first, since the best outcomes usually result from a program that starts as early as possible.

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