[scribbling]
Hi, my name is Dr. Mike Evans,
and this is a quick review of concussions –
what they are and what they do.
Now, you might have watched our concussions 101 video,
and this is just an updated version that covers even more.
Concussions have got a lot of press.
I think we can all now name a player or, or a friend that has had one,
and I think we tend to hear about the bad cases,
but I think it's also important to know that a concussion can be well managed
by you and your family, your school, and your care team.
The first thing you need to know about concussions
is that they are like your other injuries,
and yet completely different. [buzzer sound effect]
When you injure your knee, you rest it initially
and you, and you see how it feels after a few days.
You probably get it looked at, sometimes it's something more serious,
but most get better, a- and you slowly resume activity.
Well, all that's true for concussions –
it's, it's estimated that 80 to 90 percent of concussions
resolve within 3 weeks.
The big difference is that most people aren't used to resting their brain.
There are no crutches, no ice pack, no injury that people can see.
If you go right back to school, physical activity, work, digital life,
it's, it's like going for a run on your injured knee.
Let's start with what a concussion is.
A concussion is a blow to the head,
or elsewhere on the body that shakes your head,
[spring noise] where you have some other stuff going on.
These other things tell us that your brain has been affected.
Now, your brain is Mission Control and responsible for so many things.
So, there are a lot of different ways a concussion can feel.
We generally think of four categories.
So, physical problems like headaches, poor balance, being more tired,
blurry vision, dizziness, sensitivity to light or noise, [horn]
and so on.
Next are thinking problems
such as feeling mentally foggy or, or slowed down
with difficulties remembering or concentrating.
Then there are emotional symptoms
like feeling sad or, or less control over your emotions.
You might feel more worried or irritable.
And finally, there are sleep issues which can work both ways.
You might feel you're drowsy or, or sleeping more,
or the reverse – you may have trouble falling asleep
or are sleeping less.
These symptoms can appear immediately or take 24 to 48 hours to happen.
It's also important to step back
and wonder if any of these symptoms get worse when you're working harder,
either physically or cognitively, when you're using your brain.
Concussions can be scary at the beginning,
so it might be helpful to start
by making sure there isn't something more serious going on.
If things take a sudden turn for the worse,
for example, an unusual worsening of a headache
or repeated vomiting, seizures, weakness in your arms or legs,
or you seem way more out of it –
slurred speech, confusion, drowsiness, or you can't be woken up.
This needs to be urgently assessed.
The two key words here are sudden change.
Concussions don't show up on CT or MRI scanners in the Emergency Room,
but these tests can be useful when there is a sudden worsening
to look for brain injuries other than a concussion.
The reality is most concussions can be managed without going to the ER,
but, but check with your doctor just to be sure.
My advice is to take the first week after concussion in 24 hour chunks.
Things might get a bit worse or better in the first 24 hours
[screeching] and we tend to err on the side of caution
and focus on resting the brain.
This means taking time off from screens, taking it easy, no sports,
and getting lots of sleep.
Sleep is good for a concussion.
Again, if you injured your knee,
you would probably still make it to school or work,
but with a concussion, you need to rest that brain.
So, you may have to take a few days or even a week off.
This seems like a lot, but it may pay off down the road.
So, speaking of the road of recovery,
this is hard to predict at the time of injury.
Usually things get better in days or weeks,
but it can also take months.
There are some factors that may make your recovery
stretch out a bit longer
and that you need to consider in your "get better" strategy.
For example, have you had a previous concussion?
Especially a recent one or, or one that lasted a long time.
Or is there a story of multiple concussions
where it took less force to cause symptoms?
[zapping] If you have a history of headaches or migraines,
these can worsen.
If you have had some learning or mental health issues
such as ADHD, anxiety, depression,
a sleep disorder, a learning disability, and so on,
these conditions may or may not become more of a challenge
when you injure your brain. [book shuts]
Now, as I've said, helping your brain self-repair is different. [sound effect]
[receiving signal] It might be helpful to imagine your brain like a cell phone.
When you get a concussion,
it's as if your baseline battery life goes down.
It's just harder to recharge to 100 percent,
as a lot of your power goes to healing your brain.
If we try to do all of the activities we normally do,
chances are we'll run out of power quickly,
and this is when we feel run down [sound effect]
and our post-concussion symptoms get worse.
One way to conserve energy is to use the four P's.
So, the first P is to prioritize our activities each day –
we only wanna use up our limited charge
on the activities that are most important to us.
The second P is to plan out which activities we are gonna to do
and when to do them.
It is best to plan difficult or important activities
when you have more of a charge – so after a rest
or on a day you don't have many other activities to do,
or at a time when you feel best – [sound effect] could be the morning.
The third P is to pace yourself.
Instead of reading a full chapter of your textbook,
try reading a few pages at a time
with breaks to allow your battery to recharge.
And the fourth P is to position yourself
in environments that won't use up extra battery.
Just being in noisy and distracting environments,
or feeling stressed, drains your charge.
So, with the four P's in mind,
let's talk about return to learn and return to physical activity.
[bell] Both these strategies can be modified
by your unique situation, school, and/or your healthcare professional,
but they're a great starting point.
Being at school makes the brain work hard
and so you wanna return gradually.
Perspective is important here.
Each of us are different in how we respond to a concussion,
so your recovery plan is unique and needs to be individualized.
[deep breath] [blows] Sometimes, this means taking more time,
and it's important for you and your family
to see this as a smart response that will get you better sooner,
not a failure.
We generally begin by starting with no school for a few days,
and getting lots of rest at home.
Next is a small increase in home, cognitive, and physical activity,
with light walking, easy reading, and some screen time.
A diary of your planned activities and what happened can be helpful.
If you can do 30 minutes with no symptoms,
you can start school-specific activity like homework
in 30 minute chunks.
When you can tolerate 30 minutes of school-type activity
without your symptoms getting worse, with breaks to help your symptoms,
then you are ready to go back to school part-time
for one to three hours a day
with realistic productivity expectations.
When you can do four to five hours of school activity
with two to three rest breaks,
you can consider a return to full time school
with supports that acknowledge the four P’s.
This might mean extra help, more breaks,
limited testing in a day, preferential seating, and so on.
When you have no active symptoms and no problems with exertion,
you can return to your regular school schedule.
To make all this happen,
I think it is very important to have a contact person at the school
who can make staff and volunteers aware,
assist in scaling your activity up or, or down,
and individualizing your supports to get better.
This means facilitating a collaborative team approach
involving the family, doctor, school, coaches.
It means education, and I think it also means paying attention,
and reacting to subtle signs,
and check-in meetings to discuss strategies
around homework, testing, breaks, distraction-free environments,
seating, access to class notes, phys. ed., and playground planning.
Returning to physical activity when you are symptom free
is a similar stage-based approach,
and having the team on the same page is key.
Step one is no activity at all.
In step two, we try light aerobic exercise, like a jog.
If you can do that with no symptoms,
then step three is returning to your sport in a low risk setting.
So, going for a skate, kicking a soccer ball, [sound effect]
shooting some hoops, but just by yourself or with a partner.
This makes the activity more predictable
and less likely you will be hit by an object or a person.
Monitor yourself and see how you do.
If all good, and you wanna return to team play,
step four is being "yellow shirted" for practices.
Now, the yellow shirt tells the other players
that they cannot come into contact with you.
If you remain symptom-free with this high level of activity,
then you can go to step five, which is full-contact practice.
We usually try and stretch out this stage out a bit
to really test for symptoms,
but I think also to help the player feel confident
that she or he is back to normal.
If all goes well, then step six is you return to competition.
[cheering]
Each step must take at least a day,
and so, depending on how the person does,
this process can take a week, a month, or even a year.
All this can take time and be frustrating. [sound effect]
It's hard to slow down and it's easy to feel down.
Talking is key.
It, it's so important that you are open with your parents, teachers,
coaches, family, and friends because it's hard to see concussions.
People presume you're okay,
so you need to be up front about how you're feeling.
Things like being in a fog or being anxious
can be hard to put a finger on.
So, you don't need to dwell on it, [sound effect]
but, but you do need to be clear and honest about how you're feeling.
The good news is that I think the world is much more accepting of concussions.
The reality is that we are still figuring out
exactly the best way for each person to come back from a concussion.
The data thus far suggests that people who don't let their brains rest
tend to do worse,
especially if they expose themselves to re-injury before they are ready.
What we're still figuring out is the right balance
between challenging yourself and overdoing it.
We don't want you do too much,
but we also don't want you do too little.
It seems that, you know, as with other injuries,
people who increase their activity gradually
without triggering problems seem to do well.
[scribbling]
So, take care of yourself if you have a concussion.
You know, your brain is you.
Everything you've got good at –
your memories, how you figure things out –
all that is sitting inside your brain.
So keep positive, share any concerns with the people that care about you.
You can solve this together.
And take care of that fantastic brain of yours.
Thanks for listening.