Table Of ContentNavigating the Challenges
of Concussion
David C. Spencer, MD, FAAN
Editor, Brain & Life® Books Series
Professor of Neurology
Oregon Health and Science University
Portland, OR
Other Titles in the Brain & Life® Books Series
Navigating Life with a Brain Tumor
Lynne P. Taylor, MD, FAAN; Alyx B. Porter Umphrey, MD; and Diane Richard
Navigating the Complexities of Stroke
Louis R. Caplan, MD, FAAN
Navigating Life with Multiple Sclerosis
Kathleen Costello, MS, ANP- BC, MSCN; Ben W. Thrower, MD; and Barbara
S. Giesser, MD
Navigating Life with Epilepsy
David C. Spencer, MD, FAAN
Navigating Life with Amyotrophic Lateral Sclerosis
Mark B. Bromberg, MD, PhD, FAAN and Diane Banks Bromberg, JD
Navigating Life with Migraine and Other Headaches
William B. Young, MD, FAAN, FANA, FAHS and Stephen D. Silberstein, MD,
FAHS, FAAN, FACP
Navigating Life with Chronic Pain
Robert A. Lavin, MD, MS; Sara Clayton, PhD; and Lindsay Zilliox, MD
Navigating Life with Parkinson’s Disease, Second Edition
Sotirios A. Parashos, MD and Rose Wichmann, PT
Navigating Life with Dementia
James M. Noble, MD, MS, CPH, FAAN
Navigating
the Challenges
of Concussion
Michael S. Jaffee, MD, FAAN, FANA
Professor and Vice-Chair, Department of Neurology
Director, Brain Injury, Rehabilitation, and Neuroresilience (BRAIN) Center
Bob Paul Family Endowed Professor of Neurology
University of Florida
Donna K. Broshek, PhD, ABPP- CN
John Edward Fowler Professor of Psychology
Director, Neuropsychology Assessment Clinic
Co-Director, Acute Concussion Evaluation Clinic, Neurology
University of Virginia Health
Adrian M. Svingos, PhD
Neuropsychologist and Research Scientist
Brain Injury Clinical Research Center
Kennedy Krieger Institute
Baltimore, MD
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Library of Congress Cataloging-in-Publication Data
Names: Jaffee, Michael S., author. | Broshek, Donna K., author. |
Svingos, Adrian M., author.
Title: Navigating the challenges of concussion / Michael S. Jaffee, Donna K. Broshek,
and Adrian M. Svingos.
Other titles: Brain & life® books series.
Description: New York, NY : Oxford University Press, [2023] |
Series: Brain & life books series | Includes bibliographical references and index.
Identifiers: LCCN 2022037295 (print) | LCCN 2022037296 (ebook) |
ISBN 9780190630119 (paperback) | ISBN 9780190630133 (epub) |
ISBN 9780197500033
Subjects: MESH: Brain Concussion—diagnosis |
Brain Concussion—therapy | Popular Work
Classification: LCC RC 394.C7 (print) | LCC RC 394.C7 (ebook) |
NLM WL 354 | DDC 617.4/81044—dc23/eng/20221109
LC record available at https://lccn.loc.gov/2022037295
LC ebook record available at https://lccn.loc.gov/2022037296
DOI: 10.1093/ med/9 780190630119.001.0001
This material is not intended to be, and should not be considered, a substitute for medical or
other professional advice. Treatment for the conditions described in this material is highly
dependent on individual circumstances. And, while this material is designed to offer accurate
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Printed by Sheridan Books, Inc., United States of America
CONTENTS
About the Brain & Life® Books Series | vii
List of Figures | ix
Preface | xi
Acknowledgments | xv
Section 1: Concussion and Typical Recovery
1. What Is a Concussion? | 3
2. Assessing and Managing Your Concussion: The Initial
Evaluation | 13
3. Early Physical Symptoms of Concussion | 23
4. Early Emotional Symptoms of Concussion | 37
5. Early Cognitive Symptoms of Concussion | 47
6. Setting the Stage for Recovery | 57
Section 2: What to Do If Your Symptoms Are
Persisting After Concussion
7. Assessment and Management of Persisting Physical Symptoms
After Concussion | 67
v
vi Contents
8. Assessment and Management of Persisting Emotional and
Cognitive Symptoms After Concussion | 87
9. Later Complications: Chronic Traumatic Encephalopathy and
Neurodegenerative Conditions | 97
Section 3: Special Considerations
10. Concussions in School- Age Children and Adolescents | 109
11. Can Having Attention- Deficit/ Hyperactivity Disorder
or a Learning Disorder Complicate Recovery from
Concussion? | 127
12. Athletes and Sport- Related Concussions | 135
13. Occupational and Work Issues Related to Concussion | 151
14. Military Concussions | 159
15. Concussions in Older Adults | 169
Section 4: Conclusion and What’s Next
16. Where Have We Been and Where Are We Going? | 183
17. Conclusion | 189
GLOSSARY | 191
ABOUT BRAIN & LIFE® AND THE AMERICAN ACADEMY
OF NEUROLOGY | 211
INDEX | 213
ABOUT THE BRAIN & LIFE ®
BOOKS SERIES
What was the first thing you thought when you learned you or a family
member had a neurologic condition? Perhaps you were confused, un-
certain, afraid, or maybe even in denial. A common thread is often the
realization that life has changed and may continue to change, but also
uncertainty about exactly what that means or what to expect. And
yet, neurologic conditions themselves inevitably change— sometimes
quickly, in a matter of seconds or minutes, and sometimes gradually
over months or even years.
With any new diagnosis— especially one that is potentially life-
changing— you may not be prepared to take in and process large amounts
of new information on the spot. And even under the best circumstances,
each condition comes with the need to learn a new language and under-
stand the necessary tests, underlying causes, and right treatments. It
may be difficult to wrap your arms around a great deal of information
in what are often time- limited appointments with your neurologist.
Understanding your new diagnosis and how to manage it is a gradual
process, and you will inevitably have questions with the passage of time
and reflection. Learning about your condition can help you understand
what the most useful and accurate information is to share with your
neurology team, allowing you to fully participate in treatment decisions.
But facts and information are only part of the picture. You may
have questions about how to manage your day- to- day life with a
vii
viii aBout the Brain & life® Books series
neurologic condition: whether in terms of your career, your home,
your relationships, or, in some instances, long- term planning and
care. We designed the Brain & Life Books series to help you address
some of the fears, concerns, and difficult emotions you may feel, such
as grief and worry, by harnessing the power of accurate and timely
information to help guide you and your family through the change
brought about by a neurologic diagnosis. The books share stories of
others who have traveled down paths like the one you are on to re-
inforce the fact that you are not alone.
We selected the authors of the series carefully with these goals in
mind. First and foremost, all authors are respected experts in their field,
and the information in the Brain & Life Books series is accurate, up-
to-d ate, and written to be understandable to someone with no medical
background. Experts from the premier neurology organization in the
world—t he American Academy of Neurology—a nd the oldest and lar-
gest university press in the world— Oxford University Press— carefully
review each book to ensure the highest quality. But we also chose our
authors because of their experience and ability to connect with patients
and their families. The experiences and feelings you are having now
have been dealt with and managed successfully by our authors and their
patients. Our authors will share with you best practices, stories, and
pearls of advice that will leave you with a feeling that your diagnosis is
manageable—y ou can do this. We have highlighted all key terms that
you and your family should know when first used, and we have in-
cluded them in a comprehensive glossary at the back of the book.
The Brain & Life Books series was written with you in mind,
whether you have been diagnosed yourself or are a family member,
caregiver, or friend of someone who has been, as a resource for suc-
cessfully navigating life with a neurologic condition.
David Spencer, MD, FAAN
Editor, Brain & Life® Books
Professor of Neurology
Oregon Health and Science University, Portland, OR
LIST OF FIGURES
2.1. A typical CT scanner | 17
3.1. A typical MRI scanner | 25
3.2. Diagram of the inner ear | 30
3.3. Dix- Hallpike maneuver | 32
3.4. Balance Error Scoring System | 33
7.1. Postconcussion syndrome | 68
7.2. Preexisting conditions and persisting symptoms following
concussion | 70
7.3. Pencil pushup | 81
7.4. Palm press | 82
8.1. Virtual reality apparatus: head- mounted display with
embedded motion tracker | 91
8.2. Factors associated with persisting symptoms following
concussion | 94
14.1. Blast injury modalities | 161
ix
