Traumatic brain injury treatment evolves

There isn’t an organ more complex than the brain – that wrinkly lump of electrified tissue responsible for every thought, action and emotion. Yet rarely do we pay it any attention, content to let it labour away on our behalf – that is, unless something goes wrong.  

Whether it’s a slip on an icy driveway or a tumble off a bicycle, the result could be the same: a traumatic brain injury. Suddenly, that hard-working brain can’t keep up, and those injured are left dealing with the consequences. 

A TBI can occur when there is a forceful bump, blow, or jolt to the head or body, or when an object pierces the skull and enters the brain. The most common form of TBI is a mild TBI, also known as concussion or mTBI. 

Earlier this year, the McMaster Students for the Concussion Legacy Foundation spoke with Dr. Angela Carol, a physician with the Hamilton Urban Core Community Health Centre who specializes in treating chronic illnesses, including post-concussion syndrome. We asked Dr. Carol how concussion management has evolved and the challenges she faces when treating them.  

With more research and knowledge, Dr. Carol informed us that medical professionals have changed how they treat concussions. In the past, the accepted protocol was to keep children who hit their heads awake throughout the night to mitigate their risk of dying while asleep. Physicians now know that disrupting a child’s sleep during a key recovery period is not only unnecessary but likely harmful. 

Historically, a strict rest protocol was followed when treating concussions. Physicians instructed patients to sit in a dark room until their symptoms improved. Sheltering patients from overly stimulating environments was believed to prevent the worsening of symptoms while allowing the brain to recover. Doing so also limited the risk of incurring secondary concussions, symptoms of which are often worse than the initial injury. 

New research shows that prolonged periods of strict rest can delay the recovery process. Clinicians now advise patients to adopt a step-wise approach, including a gradual return to activities, so long as symptoms don’t worsen. For adults, research suggests that slow, controlled physical activity below the symptom threshold may aid recovery, such as walking or riding a stationary bike. Incorporating exercise 24 to 48 hours after the injury is believed to speed up recovery. 

Dr. Carol also explained that concussions have long been without objective diagnostic tests. Instead, physicians relied on patient symptoms alone to guide their treatment plans.  

In recent years, physicians have implemented more objective testing for concussions, including the Buffalo Concussion Treadmill Test, a graded exercise protocol for adults. The test begins with walking on a treadmill at a low speed before gradually increasing the speed and incline. At regular intervals, the patient's heart rate is recorded, and neurocognitive tests are administered to assess memory and reaction time. When athletes complete the BCTT without symptom exacerbation, they can begin a gradual return to sport. They will first introduce sport-specific activities. If these activities do not induce concussion symptoms, they can return to non-contact play during practice. Eventually, after many progressive steps, the athlete can return to play. In addition to BCTT, Dr. Carol said that physicians have begun using concussion imaging to guide treatment. Return to activity guidelines suggest that if a child has positive neuroimaging findings, such as a brain bleed detected on MRI, they should not participate in contact sports for at least three months. 

Perhaps the most effective tool to combat the burden of TBIs is also the simplest: awareness and education. Knowing what TBIs are, who they affect, and how they present in patients ensures that they are adequately treated. Data reveals an increasing prevalence of TBIs in Canada, warranting dedicated efforts to quell what some have referred to as a silent epidemic. 

The MSCLF hopes to be a part of the solution by leveraging its members’ medical training and community connections to increase TBI awareness amongst the McMaster student population and the broader Hamilton area. Connect with MSCLF by emailing concussionmac@gmail.com.