Concussions are a problem that must be tackled.
We must not only prevent them better, but also treat them better.
To discuss this, we welcome Dr. Philippe Fait, Scientific Director of the Cortex clinic and co-founder of the Pier-Yves Bouchard Foundation.
Daniel : What is a concussion and what is the difference between a concussion and a head injury?
Philippe : We define a craniocerebral trauma by a trauma, therefore an accident, which will affect the brain in the cranial box.
Trauma has several grades: mild trauma will be qualified as a concussion while the most serious will be considered as head trauma.
Trauma is qualified as mild when no abnormality will be detected on medical imaging. The symptoms are still present and they are functional in nature.
Moderate to severe trauma, on the other hand, is likely to cause sequelae that will last over the long term.
Daniel : What are the risks that these traumas have repercussions in the long term precisely?
Philippe : Lots of factors actually.
The 1st factor would be the extent of the damage. If it's a concussion and it's taken care of properly, the chances of long-term sequelae are quite low.
This is also the case for a first concussion or even concussions very far apart in time. The more concussions are multiplied, the greater the concussion suffered and the greater the risk of long-term sequelae.
Daniel : What are the symptoms of a concussion?
Philippe : There are 4 main categories of symptoms related to concussions.
First of all, there is the physiological category which includes symptoms such as headache, dizziness, etc.
Then there are cognitive symptoms such as difficulty in paying attention and concentrating.
As a third category, we talk about emotional symptoms that can have an impact on the level of irritability for example.
Finally, sleep disorders represent the last category and will result in insomnia or drowsiness for example.
Daniel : What are the main stages in the return to sport after a concussion?
Philippe : We must first of all take into consideration that each person is different and that there is no one and only one winning formula for all.
The first thing to do is to withdraw from risky activities. One must at all costs avoid another movement in the cranium following the concussion. Rest of 24 to 48 hours is therefore necessary and is of a physical and cognitive nature, ie no reading, homework, video games, etc.
It should be understood that a concussion is in fact a boil in the brain and that rest is necessary for healing.
Subsequently, if the symptoms have disappeared, one can resume very light physical activities such as walking, stationary cycling, etc. We then wait 24 hours and if no increase in symptoms occurs as a result of the activity, we can increase the intensity while evaluating the symptoms.
Then, we can think of reintegrating contactless practices into our activities and finally, if all goes well, reintegrating normal practices and ultimately, a return to the game.
The same goes for the cognitive: we go there gradually with short reading, then homework, to finally return to school.
Daniel : How long should you plan to recover from a head injury?
Philippe : Each person is different but we must count at least 10 to 14 days for an adult and 1 month for a child.
When we go beyond 3 months, we unfortunately fall into more chronic phases and it is important to consult in order to prevent the symptoms from remaining.
Daniel : I myself am a client of your clinic for mild concussions: I had the feeling that concussions are treated a bit like a physical injury, ie increasing the load gradually. Am I wrong?
Philippe : I really like your analogy and you are right on some points.
On the other hand, the difference is that a concussion is hardly tangible for the patient. That is, despite the symptoms, no medical imaging can prove the condition. People, believing their trauma to be trivial, continue their activities despite the headaches.
Conversely, an ankle pain for example, can prevent you from walking so it forces you, in a way, to deal with the problem rather quickly. Managing a concussion is therefore more difficult and less intuitive.
It is important to point out that, as it is the brain that manages all the functions of the human body, trauma can have impacts on our thoughts and our decision-making which are sometimes ideal. This may explain why some people put themselves at risk following a concussion.
Daniel : Who will we see when we have a concussion?
Philippe : The ideal is to start with your family doctor since she is, in a way, the conductor for the future. Chances are, they'll refer you to an interdisciplinary team to target needs.
For example, for physical symptoms, one can go to a physiotherapist, a kinesiologist, etc.
For cognitive disorders, we can think of neuropsychologists or occupational therapists, while for affective disorders, a psychologist is quite appropriate.
La Cortex clinic is also an excellent point of service with its multiple interdisciplinary specialists.
Daniel : I imagine that the ideal is to prevent concussions. What should we work on to prevent them as much as possible?
Philippe : There are indeed many aspects that help prevent concussions.
We can think of the sport environment such as adapted equipment: the fit of a helmet is a good example. Still in the sports environment, we can think of the placement of equipment near play areas such as walls, garbage cans, etc.
Then there are the rules in sports that must be set in order to limit hits to the head and encourage Fairplay.
Another method would be individual prevention through the practice of muscle strengthening exercises in the neck to increase the absorption of energy, etc.
Finally, we are trying to make young people more aware of concussions so that they are able to quickly detect the signs in their teammates, for example.
Daniel : Do micro-concussions exist?
Philippe : Despite the fact that many specialists are studying the question, it is currently difficult for us to answer this question in 2021.
It has in fact been detected that certain sports, such as soccer and football for example, create thousands of repeated blows to the head of players without however causing concussions. On the other hand, it would be the accumulation of these micro-shocks that would cause dysfunctions later in their life.
That being said, no results can prove this theory yet.
Daniel : To finish, can you tell us a bit about the Pier-Yves Bouchard Foundation?
Philippe : Pier-Yves was a 21-year-old soccer player when he lost his life following a major shock during an indoor soccer tournament.
I was playing soccer at the time with his father and we had the idea of founding a foundation that would help people with a concussion either for consultations with professionals or for the purchase of various equipment. We have helped a host of sports teams to buy protective helmets, for example.
Our mission is therefore to help people who have suffered concussions in a sports context.
