After a car accident or sports injury you may be confused if you have a concussion or not. One doctor may say you have one and another shrugs it off saying you don’t have one because you didn’t lose consciousness. Here is an explanation of what concussions are and how they are diagnosed by health care providers.
What is a Concussion?
A concussion, also referred as a mild Traumatic Brain Injury (MTBI) is an injury to the brain caused by sudden shaking of the head, whipping of the neck or a direct blow to the head. It may involve a loss of consciousness, but concussions do not require loss of consciousness to be diagnosed. Sometimes there is an “altered state of consciousness.” The victim appears awake and may talk or respond, but clearly is not thinking straight or aware of what’s happening.
How Do Concussions Happen?
Concussions are a form of traumatic brain injury. That means some form of trauma must occur. Trauma can be indirect as in a sudden quick jerk of the head an neck when colliding in sports, or a car accident, or physical assaults. The sudden quick acceleration of the brain causes tissue to be injured. Direct trauma head injuries are obvious; a blow to the head by a ball or other player in sports, an industrial injury where an object strike the head, a slip and fall landing on the head or a car accident where the head slaps the headrest or a deployed airbag.
How Does a Doctor Diagnose Concussion?
Making the diagnosis is fairly straight forward. A doctor, therapist or coach will look for a couple of key factors.
Mechanism of injury
Did the player or accident victim suffer a sudden jerk, shake or blow to the head? If yes, then the next items need to be checked.
State of consciousness
Unconsciousness is the person appears to be sleeping and does not respond to questions and cannot be roused awake by gentle contact with their body such as tapping a leg or arm. In altered consciousness they may be roused by voice commands or physical nudges, but do not become fully awake. Their eyes may be closed and they may try to talk or moan. They may appear fully awake but have a dazed look about them or attempt to get up or move or say things that are not appropriate for the situation. If they appear awake, asking someone who has a potential head injury some questions to check their alertness is important. Ask them their name, where they are and what the date is. If they know their full name, exactly where they are and the precise day and date, then they are fully alert and oriented. They may not be fully alert or oriented if they know their name, but when asked where they are they say “in the car,” but cannot tell you where they are such as the freeway or street or city. They may know the year or day of week, but not the exact date if their orientation is off.
There are a host of symptoms associated with a concussion. The most common early ones are:
- Loss of or altered consciousness
- Sleepiness or sluggishness
- Sensitivity to light
- Blurred or double vision
- Mentally foggy
- Difficulty concentrating or remembering
- Altered emotions: weepy, frustrated, angry
Physical signs of concussion
- Balance problems
- Sensitivity to light
- Eyes do not track smoothly when following object
- Difficulty counting
In the field of play when a player goes down with a head injury, or in an ER when a patient is transported in with report of head trauma, a Glasgow Coma Scale (GCS) form will be used to grade the victim.
A doctor or therapist who routinely works with concussions in the office will have patient questionnaires that have been developed to find and grade brain injuries.
Acute Concussion Evaluation form is used for recent reports of concussion (Generally within 30 days of injury). This test is administered by the clinician asking the patient questions.
Rivermead Post-Concussion Symptoms questionnaire is a form the patient completes to subtype their concussion.
These questionnaires are repeated at 1-2 week intervals to monitor progress then if symptoms or signs persist, they are repeated monthly.
Can a Chiropractor Diagnose a Concussion?
After reading an article about concussions written by a chiropractor this may seem like a silly question. Unfortunately, many people who come in contact with head injury victims and who may be “gate keepers” such as school administrators, nurses, or coaches are not up to speed on concussions and the scope of practice of chiropractors and others who treat concussions. Sadly, even automobile and health insurance companies are often ignorant making false claims that only a medical doctor can diagnose a concussion or that all concussions require a neurologist.
So who can diagnose a concussion?
Many different licenses of healthcare providers are trained in diagnosis of concussions.
- Physical therapists with training
- Coaches with training
- School nurses with training
- Parents with training
- Victims may self diagnose with training
Some specialize in brain injuries. What matters most is, does the provider have extensive training and experience treating concussion injuries.
Uncomfortable Truth About Medical Doctors and Concussions
All MDs regardless of their specialty have at one time been trained in recognizing and diagnosing concussions. Unfortunately, many do not see concussions routinely so they either forget or ignore their training and fail to make the diagnosis. Emergency Room doctors and neurologists are the most trained medical doctors in head injury. These are the MDs who should be making most of the diagnoses, but if it is a mild traumatic brain injury with no loss of consciousness or report of direct trauma, they will fail to diagnose quite often.
Professional jealousy and defensiveness
When a non-MD such as a chiropractor, therapist or coach make the diagnosis of MTBI or concussion, and the player or victim has already seen an MD and NOT been diagnosed, problems may arise. It’s not because the non-MD is wrong, because if they are following these guidelines and have mechanism of injury, symptoms and signs and positive questionnaires, it is medically proven. The problem stems from the MD’s lack of bothering to document or examine properly and so they become defensive. Medical professionals are just humans at the end of the day and when they blow a diagnosis they often are slow to admit it and instead impugn others.
Insurance adjusters and school nurses who do not recognize a diagnosis of brain injury from a non-MD is acting out of ignorance and must be made aware of this information.
Recap How to Diagnose a Concussion
Any doctor, therapist, coach, nurse or parent can diagnose a concussion using the information in this article and the checklist below.
- History of direct or indirect trauma
- Physical signs
Upon determining a concussion has occurred, lay persons are urged to consult a qualified health care practitioner who has specialized training in head injuries. This article is for informational purposes and not meant to be diagnose or treat a medical condition. If you think you or a loved one has suffered an injury, you are urged to seek evaluation by a qualified health care provider.