Understanding the NCAA Concussion Protocol: Complete Concussions’ Review
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Memory is central to human flourishing. Not only is it essential for our survival, but it also helps shape who we are. When we are healthy, our short- and long-term memories all fit together snugly to form a self-narrative that moves, instructs, intrigues, provokes, inspires, and ultimately unveils us to ourselves. And it is so easy to take it for granted.
Unfortunately, a common symptom of concussion is memory difficulty. This article will help you understand how a concussion may impact your memory and provide evidence-based strategies to ensure a quick and complete recovery.
A Case of Memory Loss.
When I was about eight years old, another student knocked my friend Travis backward off the playground equipment during recess. He hit his head on the ground. After a few moments, he got up, dusted himself off, and started playing again until the bell rang to go inside. Not long after class started, Travis leaned over and asked me in a panicked tone, “Where am I?” I laughed, thinking he was joking around—but he wasn’t. It didn’t take long for the teacher to recognize there was a problem. When we told her that he had hit his head while playing during recess, he was immediately taken to the hospital across the street from our school. There, he was diagnosed by the attending physician with a concussion.
The kind of post-traumatic memory loss that Travis experienced is called anterograde amnesia and involves the inability to form new memories right after a head injury. Someone who experiences this kind of memory loss will often ask the same questions over and over again concerning the immediate past. They may ask, “What happened?” or “Where am I?” or other questions indicating a deep confusion about their immediate circumstances.
On the other hand, they will have no difficulty remembering things like who they are and where they live. Retrograde amnesia occurs in a minority of concussions (under 30% of cases).
Retrograde amnesia is even more uncommon and involves the temporary loss of memories before injury. For example, I’ve had a patient fall onto the concrete while long-boarding on vacation – he forgot that he was long-boarding and wondered why he was in Hawaii for approximately 30 minutes.
It is even possible to experience both anterograde and retrograde amnesia simultaneously. Both kinds of amnesia should resolve in less than an hour following injury, but they may persist in some cases for several hours.
Amnesia after concussion is considered a “red flag” symptom. The presence of any kind of amnesia following a head injury warrants immediate removal from play (if occurring during sport) andpresentation to an emergency room for assessment.
Memory Loss vs. Difficulty Remembering.
However, not all concussions result in memory loss. Amnesia is relatively rare following a concussion.
Memory difficulties are far more common.
Such difficulties do not result from true memory loss (like with amnesia), although they may feel like it sometimes. Post-concussion memory difficulties might present as:
Forgetting meetings or appointments
Forgetting the names of friends, family, colleagues, or acquaintances
Struggling to remember information from past conversations
Difficulty retaining new information
Misplacing items like your wallet, keys, or clothes
Feeling mentally foggy, confused, or disoriented
Losing track of time and events
These memory difficulties can significantly impact daily life, and, to be sure, they can be psychologically taxing. The mental health burden of memory difficulties can further lead to:
Irritability or agitation
Anxiety or depression
Fear of being in work, school, or other social settings
Before looking at recovery strategies, let’s next consider the potential causes of memory problems following concussion.
Causes of Memory Problems.
A concussion results in a functional disturbance in the brain. Because the brain is something like the central processing unit for the entire body and its systems, impairment of brain function can have many downstream effects on other bodily systems. Your symptoms may be caused by:
dysregulation of blood flow to your brain
increased inflammation in the brain and gut
post-traumatic hormonal changes
cervical spine dysfunction
eye dysfunction
inner ear dysfunction
These changes can cause symptoms like headache, nausea, dizziness, and brain fog (to name a few). It’s not hard to see how someone suffering from these symptoms might have difficulty remembering things!
Thepsychological effects of concussion can also affect your memory. Head injuries often have some degree of impact on one’s ability to go to school or work, socialize with family and friends, and do hobbies and other activities that ordinarily bring pleasure in life.
Following a concussion, it is common for individuals to experience fear, anxiety, and even depression. These states of mind can present genuine barriers to memory and overall cognitive function.
How Long Will This Last?
It’s important to remember that memory problems associated with concussions are often temporary. In many people, symptoms reach their worst severity around day 3-5 following concussion and will begin to taper down afterward. Most concussions will be resolved entirely within four weeks, primarily if managed adequately early on.
Sometimes, concussion symptoms can be prolonged for a variety of reasons. Although about30% of concussions will take longer than one month to heal, when managed by atrained clinicianspecializing in up-to-date concussion management, even cases of prolonged symptoms (lasting longer than 30 days) will often fully resolve.
Prolonged concussion symptomsoften include memory difficulties and attention difficulties, headache, dizziness, and sleep disturbance, among others. But as we have noted, symptoms such as these—even if not strictly “memory difficulties”—may result in memory difficulties. Many concussion symptoms can be precursors to memory problems.
Of course, every human being experiences lapses in memory from time to time.
Thus, it is worth noting a tendency sometimes experienced by patients who have suffered a concussion that may complicate the recovery process if gone unrecognized. It’s called the“Good Old Days” bias. This occurs when concussion sufferers overestimate their pre-injury physical or cognitive functioning. The “Good Old Days” bias skews the perception of one’s condition and recovery.
For example, everyone—even the healthiest among us—will occasionally walk into a room and forget their reason for being there. But after sustaining a concussion, you may too quickly attribute that momentary forgetfulness to post-injury memory loss when, in fact, it is just ordinary human error. “Good Old Days” bias is especially notable in those who suffer from persistent concussion symptoms, but it may affect people at any time during the recovery process.
Baseline testing is one way to prevent this bias, as it provides an objective record of your pre-injury physical and cognitive performance. However, in reality, not everyone will havebaseline testing when they are injured. Thus, it is essential to be aware of this propensity to confuse ordinary forgetfulness with concussion-related memory difficulties, and it’s equally important to find a good clinician to help you discern which of your experiences are injury-related and which are not.
Healing Your Memory.
Memory problems are often only a tiny part of a more comprehensive symptom profile in concussion sufferers. Often, the symptoms of concussion aremultiple and diverse. Thus, the best way to heal your brain and body is to address all your symptoms in one comprehensive treatment plan, which should be managed by a clinician trained in concussion care.
The essential components of a well-crafted concussion recovery plan should include:
Step 1: Find a Trained Clinician and Get Assessed Immediately. Research has consistently confirmed the importance ofearly assessment after concussion.Earlier assessment is often correlated with faster recovery.
Step 2: Eat an Anti-Inflammatory Diet. Optimized gut health is linked with more excellent cognitive performance and improved memory. Poor gut health is connected with brain fog and other symptoms that can be barriers to memory and other aspects of cognition.
Step 3: Get Daily Exercise. The days of prolonged “absolute rest” after concussion are over. It has become increasingly clear to clinicians and researchers thatexercise—even very early on in the concussion recovery process (within 1-2 days post-injury)—is very beneficial for resolution of concussion symptoms and overall recovery. Your clinician will guide you through this process and help you decide which exercises and intensities are best for you as you progress through the stages of recovery.
Step 4: Address your Neck Pain. Every concussion results in an associated neck injury (often a whiplash injury). This is easy to understand when considering the close anatomical relationship between the “heavy” head and the relatively slender neck to which the head attaches – and the mechanism of concussions. Many of the symptoms of whiplash—headache, dizziness, fogginess, nausea, and cognitive impairments like memory difficulties—are identical to concussion. To address the inevitable neck component of concussion, it is critical to see a chiropractor, physiotherapist, athletic therapist, or other trained professional who can ensure the speedy resolution of a concussion-related neck disorder.
Step 5: Maintain a Positive Outlook. Don’t underestimatethe importance of your mental health through all stages of your recovery. The psychological component of concussion recovery is just as important as the physiological component—both are linked! It is important to remember that your memory will eventually return to normal. Concussions, if they are appropriately managed, rarely result in permanent changes to memory and other cognitive functions. You will get better!
Conclusion.
In conclusion, memory difficulties are a common symptom of concussions. However, with proper management from a trained clinician and a comprehensive treatment plan, acute and chronic symptoms should fully resolve. Remember that addressing both the physical and psychological components of concussion recovery is essential for optimal results. There is no doubt that with adequate time and appropriate care, it is possible to resolve memory difficulties associated with concussions.
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Dr. Matthew Nelson is a graduate of the University of Regina (Physical Education, 2007) and the Canadian Memorial Chiropractic College (2014) where he graduated with Clinic Honours and was the recipient of the Istrati Family Memorial Award. He is currently pursuing an MA in Philosophy at Holy Apostles College and Seminary.
Matt played football for the University of Regina Rams for four seasons. Following his time with the Rams, he trained for one year in Bobsleigh Canada Skeleton’s development program. He is owner and clinician at Core Health + Performance in Shaunavon, Saskatchewan. He is married and the father of four children.