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Evolution in the Understanding of Concussion – Non-Athletes are At Much Higher Risk of Disability

Continuing on with the discussion of my Concussion Clinic videos, today’s topic is Non-Athletes are at Far Greater Risk of Disability. Today’s video is here:

Sport is an ideal laboratory to study concussion. First, almost all sport concussions get witnessed and in today’s world, most get videotaped. Second, a very significant percentage of them happen on university campuses where scientists and medical researchers are looking around for things to study. Three, they are predictable, happen in a confined space and to a subset of people who we can control. The predictability and control means we can actually study and test their cognitive abilities before they have the concussion. And then because we know they will have repeated concussions, we can study that as well.

The problem with sports as the laboratory is that we are studying those people who tell us the least about what might happen to average people who suffer accidental concussions. In the sport laboratory we are studying those people who are most likely to get better, to have an “apparent full recovery”. Thus, the sport and concussion literature has done an excellent job of dealing with the primary issue which they care about, determining when it is safe to expose our football players to another concussion. But the truly important issue, of what disability is likely to come from a concussion and how can we best diagnose and treat that disability, the sport laboratory tells us very little.

In fact, the dark side of neuropsychology is trying to use sports concussion research as evidence that concussion does not cause permanent damage. Anyone who has worked with Post Concussion Syndrome survivors knows that concussion or mild traumatic brain injury, can disable. The young male athlete’s apparent full recovery does not tell us very much about how someone older, someone not in extraordinary shape, someone who was not expecting to get hit, will recover.

Here is the reality of the real world of concussions: If you are significant at 24 hours, and you are female and you are over 40, you need to go see the doctor every couple of days until you get better. You need to see a doctor who is going to test your memory. You need a doctor who is not just to test your memory for things you know about your life, but what you have been doing in the 24 hours before that examination. And you need a doctor who is not going to just ask you those questions, but also ask the people you live with.

Obviously, disability happens to those who are not 40, not female, but the more vulnerable your brain is because of age, because of prior concussions, because of emotional challengers you have had in your life, the more likely you will have a bad result. If you are at risk for a bad result, you must be followed and diagnosed in that first week. If you don’t get that type of evaluation we will have no way of predicting whether this concussion will give you a few bad days, a few bad weeks or keep you disabled the rest of your life.

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