Sub Concussion - Understanding the Risks and Consequences

Introduction:

Concussions are severe injuries to the brain caused by a blow or hit to the brain. A blow or hit to the skull can cause injury to the blood vessels and nerves in the brain and also chemical changes to the brain cells. The impact of sub-concussion does not cause severe symptoms of concussion. They cause milder symptoms compared to concussions. A concussion is a traumatic event that causes temporary headaches. But later on, they can cause problems with memory, concentration, vision, perception, and consciousness.

What Is Sub Concussion?

Sub concussion is an injury that impacts the head but does not lead to severe symptoms caused by a concussion.

• It is an impulsive force transmitted to the head and neck. Sub concussive trauma includes bumps, blows, or jolts to the head.

• Unlike concussions that have severe symptoms, sub-concussive cause mild symptoms. A collision while playing sports is one way a person can get an injury due to a traumatic event, such as a blow to the head or a biomechanical force that impacts the head. Usually, the symptoms are short-lived and resolve spontaneously.

• The impact does not have a sufficient threshold to produce concussion symptoms. When the sub-concussion impact repeats many times, it can reach a noticeable threshold to causes concussion symptoms.

• Collectively all these repetitive impacts of sub-concussions can lead to functional and microstructural changes in the brain cells. Sub concussive repetitive traumatic injuries can cause chronic traumatic encephalopathy (CTE or brain degeneration due to traumatic injury).

• Long-term effects of the sub concussions include dementia (a group of symptoms that disturbs memory and thinking).

• Studies suggest that affected individuals have a 5.8 times more chance of sustaining concussion symptoms.

• Several studies suggest a previous history of concussion is linked with subsequent concussions.

What Are the Risk Factors for Concussion and Sub Concussion?

The potential risk factors include:

• Playing a contact sport such as football.

• Non-contact sports, such as cricket and tennis.

• Not using safety gear for the game, such as a helmet.

• The collision between the players.

• Being hit by a ball or object during the game.

• Bike or car or bicycle accidents.

• Environmental impacts like hitting with ice or board, unexpected accidents, or clashes.

• Happens in non-players in the playground.

What Are the Signs and Symptoms of a Concussion and Sub Concussion?

There is a more functional disturbance of the brain than structural disturbance. The signs and symptoms can take several days to appear. The signs and symptoms of concussion are:

• Bleeding or bruise.

• Headaches.

• Nausea or vomiting.

• Vision problems.

• Dizziness or fatigue.

• Depression.

• Anxiety.

• Irregular periods.

• Confusion.

• Lack of concentration and memory.

• Insomnia (difficulty in sleeping at night).

• Problems with taste or smell.

• Easily irritable.

• Sensitivity to light.

How Does Concussion Cause Chronic Traumatic Encephalopathy?

The causes of chronic traumatic encephalopathy are explained below:

• Chronic traumatic encephalopathy (CTE) causes brain degeneration due to repeated head trauma. Persistent head traumas cause this condition.

• Repetitive head trauma, the severity of the impact, and the number of concussions are the contributing factors for CTE.

• They develop years after the trauma has occurred.

• Concussions are a common type of brain injury. Traumatic brain injury caused by cumulative sub-concussions is more common.

• Traumatic brain injuries can cause death. 30 percent of all injury-related death is attributed to traumatic brain injuries. The cost of the treatment of concussions is also expensive. Concussions and sub-concussions are fast-paced injuries due to a fall, a blow in the head while playing contact sports, or motor vehicle or bicycle accidents.

• The blow to the head or skull causes damaging effects such as chemical changes in the brain cells.

• Concussion leads to neurometabolic changes in the brain. They cause cognitive impairment and cellular damage to the brain.

• The affected individuals have significantly low memory two days post the injury. CTE is diagnosed by taking an autopsy of a section of the brain.

How Does Sub-Concussion Cause Cognitive Impairment?

The sub-concussion causes cognitive impairment, as explained below:

• Cognitive impairment causes a decline in mental abilities such as memory and thinking. Their mental abilities become low compared to others of the same chronological age.

• The changes can be mild or severe. The mild symptoms do not interfere much with the normal functioning of life.

• Cognitive depression is characterized by the inability to learn new things, slow mental processing, and getting easily distracted by external factors. The acute effects of concussion cause neurocognitive problems such as distraction, low cognitive efficiency, and low verbal fluency.

• The affected individuals return to their normal cognitive states five days after the concussion.

• Neurocognitive testing helps detect long-term and short-term cognitive effects after a concussion.

What Are the Diagnostic Tests Done for Sub Concussion?

The physician evaluates the signs and symptoms. A neurological examination is conducted. A neurological examination, imaging tests, and cognitive testing are recommended.

• Neurological Examination - It evaluates vision, hearing, strength and sensation, balance, and coordination.

• Cognitive Testing - It involves the evaluation of memory and concentration.

• Computerized Tomography (CT) - It is a standard test to examine the brain after injury. The cross-sectional images of the skull and brain are taken for evaluation.

• Computerized Neurocognitive Test Batteries - It measures mild to severe degrees of cognitive decline and general cognitive well-being in children and adults. The online cognitive test evaluates the affected individual’s cognitive functions, such as reasoning, memory, attention, planning, and coordination. Neurocognitive testing batteries are used to find the factors influencing an individual's cognitive ability. Recently neurocognitive testing has played a significant role in treating sports-related sub-concussions. It is considered the cornerstone of concussion treatment. Because paper and pencil tests are time-consuming, these computerized neurocognitive test batteries are better used to find recovery progress and neurocognitive impairments. It helps make decisions significantly when the person has delayed response and decision-making. The cognitive test is taken on a phone or computer. It takes around 30 to 40 minutes to complete. The results are generated in the user’s profile. It represents the cognitive skills of the person. It is not a substitute for clinical diagnosis. It is used in addition to professional diagnosis.

The sports-related concussions are accessed through computerized neuropsychological test batteries like:

• Immediate post-concussion assessment and cognitive testing (ImPACT)

• CogSport.

• Automated neuropsychological assessment metrics (ANAM).

• HeadMinder (concussion resolution index: CRI).

How Do Mouthguards Prevent Sub Concussions?

Mouthguards have shock absorption capability. Wearing a custom-made, properly fitted mouthguard can reduce the rate of concussion. The immediate impact on the brain and the beginning of the spinal cord causes a concussion. It is also caused by the lower jaw being driven against the skull where the joints are located. It helps absorb shock and stabilize the head and neck. It also limits the movements caused by a direct hit to the jaws. A custom mouthguard is more effective than a standard mouthguard in reducing concussions.

What Is the Treatment for Sub-Concussion?

Physical rest and mental rest is very essential for quick recovery. Slow-sensitive activities can be carried out because too much rest can slow the process of recovery. Physical activity, playing video games, reading books, and watching television can help. Gradually increasing the activities day by day helps in speedy recovery.

Conclusion:

Sub-concussions are mild injuries to the brain. Many people recover smoothly without long-term complications. But any mild injury to the head should be evaluated by the doctor to prevent future complications. Repetitive concussions can be dangerous. Usually, the sub-concussion symptoms persist for a few days, and they disappear. But the reoccurrence of symptoms can be pretty dangerous.