This is a great piece written by MATRIX Neurological who have summarised and articulated the new guidance issued on Concussion and the Management of head injuries, well worth a read for anyone but some important insights here for the VCSE sector.

In May 2023, the National Institute for Health and Clinical Excellence (NICE) and the Government in April 2023, have both issued important new guidance on recognising and managing concussions and head injuries.

Both form part of the new Acquired Brain Injury Strategy currently being written by the government to address the neuro-rehabilitation needs of people affected by an acquired brain injury.

The need for this new Strategy has emerged from the growing wealth of national and international research on traumatic brain injuries, and the current media coverage of the life-changing issues being suffered by both amateur and professional sports players who have suffered repeated concussions, and the negative long-term impacts of repeated head injuries and concussions on the brain.

NICE Guidance entitled: Head Injury: assessment and early management, is aimed at all healthcare professionals and people using services to work together to make decisions about treatment and care following a head injury and states the care and treatment you will now receive.

The document also highlights the need for specific training for all healthcare professionals at every level, due to the current lack of understanding of the risk factors and the long-term impacts of concussions and head injuries on a person’s brain.

The UK Governments guidance entitled ‘If in doubt, sit them out’, is aimed at grass root sports organisations and is intended to provide information on how to recognise concussion and on how it should be managed from the time of injury, through to a safe return to education, work and playing sport.  Everyone suspected of sustaining a concussion should be assessed by an appropriate healthcare professional or by accessing the NHS.

It is intended for the general public and for individuals participating in all grassroots sports, from primary school age and upwards, where health professionals are typically not available onsite to manage concussed individuals.

Concussion is such a common injury and it has come to be recognised as a ‘nothing or insignificant injury’.  Whereas, in reality, it is a serious medical condition that causes brain altering microbleeds, that often remain undetected, or cause even larger bleeds on the brain.

Many people do not realise that a head injury or a concussion, can be fatal and/or trigger a range of serious complications that are not immediately evident, but can very quickly become life threatening.

This is now widely recognised for children and young people, and is the reason behind children under the age of 12 no longer being allowed to head a football.  Studies have shown that it causes changes in their brains that affects their cognitive function and their ability to learn at school.

It is therefore important for everyone to recognise that a concussion is actually a traumatic brain injury resulting in a disturbance of brain function and that 90% of concussions occur without a loss of consciousness (being knocked out).

Concussions are caused by a direct blow to the head, but can also occur with other significant injuries, such as:

  • Knocks to other parts of the body
  • injuries to the neck (i.e. whiplash, or being in a car when it has collided with another vehicle, even when you are perceived to have no injuries) or
  • injuries to the face (i.e. facial fractures, punches to the head i.e. with boxing, assaults etc.).

However, anyone who loses consciousness because of a head injury has had a concussion and should also be assessed by an appropriately trained Healthcare Professional within  24 hours of the injury.

Concussion can affect a person in many ways but more commonly as follows.

  • physically – i.e. headaches, balance and dizziness, vision and sensory changes
  • sleep – unable to sleep or sleeping for too long
  • communication – struggling with speech or finding the right words, being slow to respond
  • Cognitively – i.e. fleeing slowed down, memory and attention problems, not thinking clearly
  • Emotions – i.e. short-tempered, sad, emotional
  • Behaviour – i.e. changes in personality, odd behaviour

Concussions can happen at any age, however children and adolescents

  • May be more susceptible to concussion as their brains are still growing and developing
  • Take longer to recover
  • Returning to education too early may exacerbate symptoms and delay or prolong recovery
  • Are more susceptible to rare and dangerous neurological complications, including death caused by a second impact before recovering from a previous concussion.

There are also a number of risks and consequences of a concussion; such as

  • A history of a previous concussion increases the risk of sustaining another concussion, which it then may take longer to recover
  • A history of a recent concussion also increases the risk of other sports related injuries (e.g. musculoskeletal injuries)

Red Flags to be aware of  which require urgent medical assessment include:

  • Any loss of consciousness because of the injury
  • Deteriorating consciousness (more drowsy)
  • Feeling of pressure in the head
  • Dazed or vacant look
  • Amnesia (no memory of the event of events before or after the injury)
  • Increasing confusion or irritability
  • Being more emotional
  • Unusual behaviour change or being combative
  • Any new neurological deficit e.g.
  • Difficulties with understanding, speaking, reading or writing
  • Decreased sensation
  • Loss of balance
  • Weakness
  • Double vision/visual problems/more sensitivity to light
  • Seizure or convulsion/ limb twitching or lying rigid/motionless due to muscle spasm
  • Severe or increasing headache
  • Repeated vomiting
  • Sever neck pain
  • Any suspicion of skull fracture (e.g. cut, bruise, swelling or severe pain at the site of the injury)
  • Previous history of brain surgery or bleeding disorder
  • Current blood thinning therapy
  • Current drug or alcohol intoxication

It is also important to note that symptoms may appear immediately or over a number of days/weeks.  In these cases it is important to bring these symptoms to the attention of a suitably trained Healthcare Professional.

The general public are advised to read and make themselves aware of this new government guidance to ensure that people recognise the symptoms of a concussion or head injury.

Where children and young people are experiencing or also undergoing assessments for learning and behaviour difficulties, i.e. ADHD, Autism etc., it is vital that any previous head injuries or lingering factors are conveyed to the assessing professional, so that the assessment process is not degraded and the correct diagnosis can be made.

Notes:

Acquired brain injuries are the biggest cause of death and disability in the UK following an accident or illness.   Each year, over 1 million people attend emergency departments in England and Wales with a recent head injury caused by an accident.

A recent Freedom of Information Request showed more than 5,000 people attended our A&E departments in James Cook University Hospital, North Tees Hospital and Hartlepool Hospital with a head injury during 2021/22.  The greatest number attended the James Cook University Hospital.  Of the 5,000 plus, 2,019 were children aged below 16 and 619 were aged 16-25.

These numbers are repeated year-on-year meaning that significant numbers of people, are potentially living with the hidden effects of an acquired brain injury they may or may not be aware of.  The majority were children aged below 16.

MATRIX Neurological a lived-experience led, registered charity, that works Tees Valley wide to support children, young people and their families living with the complex and hidden effects of an acquired brain injury caused by an accident or illness.  For more information or specialist support contact MATRIX Neurological on 01642 989116 or see their website: www.matrixneurological.org.uk


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