23 - Concussion

Abstract

Concussion is one of the most common neurological conditions in the world. Due to the frequency at which individuals sustain concussions and the detrimental effect concussion can have on function, the Centers for Disease Control and Prevention (CDC) has labeled concussion a major public health issue. Concussion, also referred to as mild traumatic brain injury (mTBI), has been defined by the International Consensus Conference of the Concussion in Sport Group (CISG) as a complex pathophysiological process affecting the brain, induced by biomechanical forces. Whether concussion results in structural damage or a functional injury is unclear and has been debated over centuries. What is clear is that concussion may cause a variety of short-lived neurological signs and symptoms that, in most cases, resolve spontaneously. However, in a minority of concussive events, symptoms will evolve and persist over a number of days or weeks leading to a slow, prolonged recovery, which can impact an individual’s ability to return to meaningful activities. Unfortunately, despite the recent boom in research in the last 25 years related to concussion, there continues to be disheartening evidence, both empirical and anecdotal, which suggests continued mismanagement in the care of patients who sustain a concussion. This chapter was developed to provide a review of the information at all stages of care following a concussion with an emphasis on topics for the rehabilitation specialist who provides services to children, young adults, and older adults. In this way, the rehabilitation specialist is provided information to better understand who is affected, who is at increased risk, in what ways individuals may be impacted, the level of evidence and current recommendations for management of concussion, and effective prevention programs to inform local, state, and federal policies to address this critical topic.