Video: ReThinking Concussions – Injury Overview (Part 1)
According to research by the UPMC Sports Medicine Concussion program, one in 10 high school athletes in the U.S. who play contact sports will suffer a concussion this year. In this video, Hannah Storm and Dr. Micky Collins, clinical and executive director, discuss the six different types of concussion, as well as common misconceptions about the injury.
Read the full transcript from ReThinking Concussions: Injury Overview, with Hannah Storm and Micky Collins, PhD:
Dr. Collins: I feel the biggest misconception is that you need to retreat to a dark room to get better from this injury. The reality is this is a fully treatable injury. The great, great majority of the time, we can get athletes fully healthy after a concussion if we target our treatments the right way and get them back to sports they love.
Hannah Storm: Does it matter when they seek treatment? Do they have to seek treatment immediately after a concussion, or if time passes, what are the implications of that?
Dr. Collins: We can treat either of those situations. However, the earlier we see someone, the quicker we can target what’s actually happening with the right therapy and get them better quicker. But we see patients all the time that come here, year or two, three years out, that we can still help in a considerable way.
Hannah Storm: And not all concussions are created equal, correct?
Dr. Collins: Correct. If there’s 30 different types of knee injuries, why do we think there’s one type of concussion? We’ve actually, here at UPMC, we’ve been able to identify now that we know there’s at least six different types of concussions, essentially. And for each of those types, we have different symptoms. We have different findings in the testing we do. We have different exam findings, but most importantly, we have different treatments for those different types of concussions. Concussions is a really heterogeneous injury. It presents differently in different people with different risk factors, but once you identify what type of concussion and you match the right treatment to that problem, we can see our outcomes improve greatly.
Hannah Storm: So when you’re analyzing what type of concussion a person has, what is the process like?
Dr. Collins: So, one of the biggest issues is understanding that there’s different risk factors in people going down these roads of having different concussions. For example, people that have a history of car sickness are more likely to have vestibular problems after a concussion. People with a history of migraine are more likely to get migraine. People with a history of anxiety are more likely to get anxiety. People with a history of lazy eye are more likely to have ocular problems. So, understanding what people bring to the table is your first clue. And we actually find that less force causes concussion in those types of patients. So if you lined up 100 people and hit them in the head, the people with those risk factors are going to have a concussion a lot more easily.
Hannah Storm: Some people are more vulnerable than others.
Dr. Collins: Correct.
Hannah Storm: From the outset.
Dr. Collins: Absolutely, and then once you identify what risk factors they have, understanding the different symptoms they experience. For example, if they become dizzy in a busy hallway or a cafeteria, that’s probably a vestibular problem. If they get a headache doing their math, it’s probably an ocular problem. If they have a hard time with light and noise sensitivity and really severe headaches, it’s more likely migraine. So, you have to listen to your patient and understand what symptoms are occurring, and then we have tools that we can actually use objectively to measure what type of concussion a patient has, so our tools guide us. Like neurocognitive testing, for example, there’s different profiles of data that support whether it’s vestibular, ocular, migraine, anxiety, cognitive, et cetera. And so, once we combine our tools with the right questions, with the right exam, with the right understanding of risk factors, I call it the chessboard, once we understand the chessboard, then we can understand how to treat it.
Hannah Storm: Can you name the six types of concussions?
Dr. Collins: Cognitive, or thinking problems. The second type is called a vestibular problem, so that’s the part of the brain that allows us to coordinate our head and eye movements, allows us to balance, allows us to interpret motion. The third type is ocular, so our eyes have to work together as a team. It’s a very complex neurological process, and if you have any problem with the eyes working as a team, either moving your eyes, following a target, converging your vision, diverging your vision, accommodating your vision, then we can see problems in that system. The fourth type of concussion is migraine, which is what it sounds like. The fifth type is neck. We can see neck problems that can cause some of the symptoms. And then the sixth subtype is mood or anxiety. These are not mutually exclusive, you know?
Hannah Storm: So you could have two or three categories of concussions as—
Dr. Collins: I saw a patient this morning that came in from somewhere that has all six of those things going on. They’re not doing well. They don’t feel well. It affects them across a lot of different domains, but we’ll still be able to treat them. We have treatments for all those problems. Getting back to your first question, Hannah, that what’s the biggest misconception? We have treatments. We have things we can do to get people better, and I don’t think that story’s been told extensively. And the other misconception is the fact that rest helps. It actually doesn’t in some of those types of concussion. It actually can make the problem worse. So, for example, when you have a vestibular problem, people will get dizzy in busy environments. They’ll have a hard time with their balance. They’ll feel overwhelmed in cafeterias, grocery stores, car rides, that kind of stuff. The way you treat a vestibular problem is actually by exposure. It’s not by rest. So we actually have to retrain the system. When we put fighter pilots up in the air, we expose them to g-forces so they don’t throw up in the cockpit. What we’re doing there is training their vestibular system. That’s the only way out of that is by rehabilitating or retraining the system. And so people that get put in dark rooms and they have that type of concussion, it’s not going to go well.
Hannah Storm: Makes it worse.
Dr. Collins: Correct. Now, there’s other types, like migraine. If you’re in the middle of a migraine, we’re not going to be able to push through that. Once you kind of come out of that migraine phase, we can start to increase activity, but that’s an example of where we do need maybe some rest. I’ve never recommended naps. I’ve never recommended dark rooms. I’ve never recommended not going to school, for example In some cases, rarely, will I take a kid out of school, very rarely.
Hannah Storm: And some kids are out of school for weeks because of concussions.
Dr. Collins: That doesn’t happen in our clinic, and the reason why is, for example, migraine. People that nap are at risk for migraine. People that don’t exercise are at risk for migraine. People that are stressed out are at risk for migraine. So you think about a kid napping all day, out of school, not eating at the same times, not being regulated and then falling behind in math class. Well, you have kids; I have kids. I know if my daughter falls behind in her calculus, there’s going to be a lot of stress, and stress will produce migraines. So, you can see how you got to be really careful about how we behaviorally manage these kids. And unfortunately, the information that parents get is rest, rest, rest, rest, rest. And we end up cleaning up a lot of messes we didn’t need to clean up if the right prescription of activity was recommended.