Grade 3 concussion recovery

How Long Do Concussions Last?

Treating a concussion quickly and effectively is critically important. Misdiagnosing the problem or allowing someone with a concussion to put themselves in harm’s way too soon can lead to further injury and long-term complications. Proper post-concussion care can help you heal more quickly.

If you’ve experienced a concussion:

  • See a doctor immediately to have your injury and symptoms evaluated. Even if they don’t seem serious, symptoms following any type of head injury should be treated as an emergency.
  • Rest during the day and try to get a good night’s sleep. It’s the key to helping the brain heal.
  • Stay inside in an area without a lot of bright light.
  • Apply ice packs for headaches.
  • Keep family or friends around you 24 hours a day for the first two days at least.
  • Take only the medications your doctor has approved. Acetaminophen (Tylenol) for headache pain may be OK, but aspirin and ibuprofen (Advil) may cause bleeding problems in the brain.
  • Focus on doing one thing at a time. Multitasking, like watching television while doing homework or cooking, can make you feel more distracted and lightheaded.
  • Eat a light but healthy diet, especially if you are feeling nauseous.
  • See your doctor for all follow-up appointments. If you are experiencing new symptoms during your recovery, see a doctor immediately.

Likewise, there are several things you should avoid doing in the days and weeks immediately after a concussion:

  • Avoid returning to work or school too quickly. Refrain from doing most of your normal activities until your symptoms subside.
  • Avoid activities, such as contact sports, that put you at higher risk for another head injury.
  • Don’t ignore symptoms or lie about them to a trainer or doctor.
  • Avoid alcohol, as it might slow your recovery.
  • Don’t spend much time in front of a computer screen or television. Playing video games or even watching television that features bright lights, noise, and rapidly changing images may cause headaches and other symptoms.
  • Avoid airplane travel if possible. Some people have complained of worsened concussion symptoms after a plane flight.

An accident that causes a concussion can only take a second. A head injury of any kind can be serious, especially if it is not properly treated. You may appear to look and act the same, but there may be damage on the inside that affects your ability to think and focus clearly.

That is where our team of practiced concussion attorneys can help. We can help fight for the compensation you deserve.

  • What is a Concussion?
  • Common Causes
  • Signs and Symptoms
  • Classifications
  • Treatment
  • Recovery Time
  • Other Types
  • Attorney

What is a Concussion?

A concussion is a mild traumatic brain injury (MTBI) that affects brain function. Concussions are caused when an external force strikes the head, or when the skull and brain shake back and forth rapidly. Concussions can happen even after a minor bump or ding to the head.

Some concussions may involve unconsciousness, but not always. Typically, concussions are not life-threatening, although serious symptoms can occur. Any concussion, or suspicion of concussion, should be approached with care and involve seeking medical treatment.

Common Causes of Concussions

Concussions are most likely to happen during a:

  • Motor vehicle accident – car makers are constantly improving the design of their vehicles to make them safer, including minimizing the incidence of head injuries during a collision. Still, a severe accident or not using a safety belt during a minor accident are situations that put individuals at high risk for a concussion.
  • Trip and fall – even a stumble while on your own feet can lead to a concussion, if your head hits the ground or another hard object on your way down. The elderly and younger children are at particular risk for a trip and fall that ends in a mild traumatic brain injury.
  • Recreational or sports event – most of us engage in recreational or sports activities, whether regularly or just on occasion. It is a great way to stay active and healthy. The down side is that activities, especially high-contact sports, can lead to bumps on the head during practice or competition. Some sports that have higher-than-average concussion rates are: football, soccer, lacrosse, boxing, ice hockey, rugby, and bicycling.

Signs and Symptoms of a Concussion

During a head trauma that causes a concussion, the brain moves out of its normal positioning for a brief period of time. This movement disrupts the routine electrical activities of the brain, triggering concussion symptoms, such as:

  • Headache
  • Confusion
  • Dizziness
  • Problems with balance or coordination
  • Memory problems
  • Difficulty speaking
  • Difficulty concentrating
  • Feeling sluggish or groggy
  • Behavior changes
  • Insomnia or other sleep problems
  • Blurred vision
  • Sensitivity to noise or light
  • Ringing in the ears
  • Nausea or vomiting

It’s important to keep in mind that signs of a concussion might show up days or weeks after the accident. If you or someone you love has experienced a bump to the head, or a blow to the body that has rattled the head, please stay vigilant for any of the above concussion signs.

Classifications of Concussions

The symptoms of a concussion will depend on how severely the head was struck or rattled. The severity of a concussion is classified by grade:

Grade 1 (mild concussion)

Grade 1 concussions are characterized by brief memory loss, confusion, headache, dizziness, nausea, but no loss of consciousness. Symptoms usually last less than an hour, but can linger for days. Most commonly, grade 1 concussions occur in minor car accidents, athletic events, or at-home mishaps.

Grade 2 (moderate concussion)

Signs of a grade 2 concussion are similar to grade 1 symptoms, although symptoms typically last from a half an hour to an entire day. Some medical experts argue that grade 2 concussions can include lost consciousness for several minutes.

Grade 3 (severe concussion)

A grade 3 concussion is characterized by unconsciousness and the lasting presence of concussion symptoms. In serious cases, victims may experience amnesia, and can have difficulty with language. Professional treatment and observation are required since this grade of concussion can be a sign of mild brain damage.

Simple vs. Complex

In 2004, a group of professionals attending the Second International Conference on Concussion in Sports in Prague, introduced the categorization system of simple vs. complex concussions. A simple concussion was deemed to last less than 10 days, while complex concussions were characterized by at least 10 days of severe concussion symptoms, such as cognitive impairment or concussive convulsions.

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Concussion Treatment

After suffering a concussion, be sure to seek medical attention right away. During the first 24 hours, you should have a loved one monitor your condition. In general, rest is the best treatment for a concussion, even after symptoms have disappeared. If symptoms persist after you have received medical care, be sure to contact your healthcare provider. Be persistent. You may want to reach out to a medical professional who specializes in treating concussions. Also, do not return to any activities that might put you at risk for another concussion until cleared by your doctor.

Concussion Recovery Time

The severity of your concussion will determine how long it takes to be symptom-free and feeling back to normal. You can speed up the recovery process by cutting back on your cognitive load. This basically means doing as little thinking as you can. Try to reduce or entirely cut-out reading, texting, playing on the computer, or even watching TV. The more mental rest you get at the beginning, the faster you can return to your everyday life.

Short-Term Effects

Short term concussions last several hours to a few weeks. Symptoms can appear immediately after the accident, or can show up days or weeks later.

Long-Term Effects

People who experience concussion symptoms more than several weeks after their accident typically have had multiple concussions. There can be a compounding effect with consecutive concussions, especially if the individual has not fully recovered from one concussion before experiencing another. This is another reason why it is so important to properly heal from a concussion and follow your doctor’s advice.

Some long-term symptoms that can last months or years include:

  • Problems with long-term memory
  • Slowing of certain body movements
  • Emotional distress
  • Depression

Other Types of Concussions

Post-Concussion Syndrome

Post-concussion syndrome is a disorder that is characterized by symptoms that last for weeks or months. The risk of getting this syndrome is not necessarily connected with the severity of the initial injury. For most post-concussion syndrome victims, symptoms show up within the first week. Usually they will subside within three months, although symptoms can persist for a year or more.

Second Impact Syndrome

This is a rare condition that occurs when an individual sustains a concussion before a previous concussion has properly healed. The syndrome involves rapid and severe brain swelling that can have serious and even life-threatening results.

Our Attorneys Specialize in Brain Injuries

Our lawyers have extensive experience in going after people who are responsible for an accident that causes a concussion. We can hold the at-fault party accountable and get you the compensation you need to move on with your life.

Concussions are unpredictable. You may need to be under the doctor’s care for weeks or months. Medical bills can add up. Let us help you recover the costs related to your accident.
Reach out to us today.

Facts About Concussion and Brain Injury

Keep talking with your doctor, family members, and loved ones about how you are feeling, both physically and emotionally. If you do not think you are getting better, tell your doctor.

For more information, see the resources listed below.

Help for Families and Caregivers

“My husband used to be so calm. But after his injury, he started to explode over the littlest things. He didn’t even know that he had changed.”

When someone close to you has a concussion or a more serious brain injury, it can be hard to know how best to help. They may say that they are “fine” but you can tell from how they are acting that something has changed.

If you notice that your family member or friend has symptoms of a concussion that are getting worse, talk to them and their doctor about getting help. They may need help if you can answer YES to any of the following questions:

  • Are any of the concussion symptoms substantially affecting their life activities (such as feeling restricted in their activities due to symptoms, performance in school or at work has changed, unhappy with life changes)?
  • Has their personality changed?
  • Do they get angry for no reason?
  • Do they get lost or easily confused?
  • Do they have more trouble than usual making decisions?

You might want to talk with people who share your experience. The Brain Injury Association of America can put you in contact with people who can help (listed in the resource section below).

Resources for Getting Help

“I thought I was all alone, but I’m not. There are lots of people out there who understand what I’ve been through.”

Several groups help people and their families deal with concussion and more serious brain injuries. They provide information and put people in touch with local resources, such as support groups, rehabilitation services, and a variety of health care professionals.

  • CDC’s Injury Center has created resources and conducts research to help prevent concussion and more serious brain injuries and improve outcomes for survivors. For more information contact CDC toll-free at 1-800-CDC-INFO (1-800-232-4636) or visit CDC’s Injury Center on the Web at www.cdc.gov/TraumaticBrainInjury.
  • The Brain Injury Association of America (BIAA) has a national network of many state affiliates and hundreds of local chapters and support groups across the country that provide help in your community.

    You can reach BIAA by calling the toll-free National Brain Injury Information Center at 1-800-444-6443.

    You can also get information through their website at www.biausa.org. Both the help line and the website can provide you with information about the BIAA affiliate closest to you.

  • The Defense and Veterans Brain Injury Center (DVBIC) works to ensure that active duty military and veterans with brain injury receive the best evaluation, treatment, and follow-up. You can reach DVBIC by calling toll-free at 1-800-870-9244 or by visiting their website at www.dvbic.org.

    For more information about TBI in the military, including an interactive website for service members, veterans, and families and caregivers, please visit: www.TraumaticBrainInjuryatoz.org.

From the Centers for Disease Control and Prevention. www.cdc.gov.
Disclaimer: This information is not meant to be a substitute for professional medical advice. The reader is advised to always seek the advice of a physician prior to changing any treatment or to receive answers to questions regarding a specific medical condition.

Concussion Grading Scales Abandoned

Historically, concussions were “graded.” The three most commonly used concussion grading systems were the Cantu,1 Colorado Medical Society (CMS),2 and the American Academy of Neurology (AAN)3 guidelines.4

The CMS and AAN measured concussion severity and assigned a “grade” to the concussion at the time of injury. Both emphasized loss of consciousness (LOC) and post-traumatic amnesia (PTA) over other post-concussion symptoms.

The Cantu Grading System, developed by MomsTeam concussion expert emeritus, Robert C. Cantu, M.D., placed less weight on LOC as a potential predictor of subsequent impairment and additional weight on the overall persistence of post-concussion symptoms, assigning a grade to the injury only after the athlete is symptom-free.

Here’s how the three concussion grading scales compared:

Concussion Grade Cantu Grading System (2001 Revision) 1991 Colorado Medical Society Guidelines 1997 American Academy of Neurology (AAN) Guidelines
Grade 1 (mild)
  • No (LOC)
  • Either PTA or post-concussion signs and symptoms that clear in less than 30 minutes
  • Transient mental confusion
  • No PTA
  • No LOC
  • No LOC
  • Transient confusion
  • Post-concussion symptoms clear in less than 15 minutes
Grade 2 (moderate)
  • LOC lasting less than 1 minute and PTA or
  • Post-concussion symptoms lasting longer than 30 minutes but less than 24 hours
  • No LOC
  • Confusion with PTA
  • No LOC
  • Post-concussion symptoms last more than 15 minutes
Grade 3 (severe)
  • LOC lasting more than 1 minute or
  • PTA lasting longer than 24 hours or
  • Post-concussion signs or symptoms lasting longer than 7 days
  • Any LOC, however brief
  • Any LOC, either brief (seconds) or prolonged (minutes)

No same-day return to play

Historically, LOC was thought to be a hallmark of a more serious, severe concussion, with athletes who lost consciousness at the time of their concussion receiving a higher “grade” under these grading systems than those that did not, and athletes who were knocked unconscious for longer periods of time receiving higher grades than those who were unconscious for shorter periods of time. These grades were used to determine how long an athlete should be removed from sports after sustaining a concussion.

A decade ago, young athletes who suffered what the old grading scales would have considered “mild” or Grade 1 concussions would have been routinely allowed return to sports in as little as 15 minutes (Cantu) to 30-minutes (AAN) after his or her symptoms were thought to have cleared.

Individualized concussion assessment

Extensive research on sport-related concussion since 1999, however, has provided medical professionals with a much better understanding of the symptomatic course and risk of potential long-term complications, even death, from allowing a youth athlete to return before his concussion has been fully evaluated away from the sports sideline.

Clinicians involved in the assessment and management of sport-related concussions began to notice that athletes who were knocked unconscious for brief periods of time often recovered more quickly than those who did not lose consciousness at all. Therefore, it seemed inaccurate to diagnose those who did not lose consciousness with a lower grade of concussion. Furthermore, grades were used to determine the period of time that an athlete was removed from sports. It did not make sense to keep those who recovered more quickly out of sports for longer periods of time than those who recovered more slowly.

For this and for several other reasons, the use of these grading systems has been abandoned in favor of a symptom-based, “multi-faceted approach to concussion management that emphasizes the use of objective assessment tools aimed at capturing the spectrum of clinical signs and symptoms, cognitive dysfunction and physical deficits,”10 and a symptom-limited, graduated exercise protocol leading to a return to play.5,6,8

Nowadays, when making decisions to return an athlete back to play after he or she has recovered from a sport-related concusion, doctors consider each case individually, taking all factors into consideration in helping to determine the amount of time an athlete is asked to remain symptom free before returning to contact, although prolonged LOC and anterograde amnesia are still considered red flags for concussion and factors that may modify concussion management) under recent international consensus statements.5,6,8

The universal trend (including, as of March 2013, the American Academy of Neurology9) has thus been strongly against alllowing athletes to return to the same game or practice no matter how quickly their symptoms appear to clear, and in favor of a conservative and gradual return of an athlete to sports only when symptoms have cleared not only at rest but with exertion and their neurocognitive function and balance have returned to its pre-injury baseline, and any academic accomodations for the concussed athlete have been discontinued. The no same-day-return-to-play rule is now reflected in laws enacted in 48 of the 50 states and the District of Columbia.

Grading systems had value

“While grading systems have been abandoned in favor of more individualized management,” writes Dr. William P. Meehan III, MomsTeam concussion expert and Director of the Sport Concussion Clinic at Children’s Hospital Boston in his 2011 book, Kids, Sports, and Concussion,7 “they were extremely beneficial during their time. When the first grading systems were developed,” he notes, “few medical professionals took concussions seriously. Athletes were often sent straight back into play after sustaining a concussion, without another thought.” Thus, Dr. Meehan writes, “these grading systems were instrumental in drawing much need attention to the issue of concussive brain injury in sports. They allowed many athletes to recover from their injuries, prior to sustaining an additional concussion.”

1. Cantu RC. Posttraumatic retrograde and anterograde amnesia, pathophysiology and implications in grading and safe return to play. J Athl Train. 2001;36(1):244-248.

2. Colorado Medical Society. Report of the Sports Medicine Committee: Guidelines for the Management of Concussions in Sport (Revised). Denver, CO: Colorado Medical Society; 1991.

3. American Academy of Neurology. Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1997;48(3):581-585.

5. McCrory P, Johnston K, Meeuwisse W, et al. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br J Sports Med 2005;39(4):196-2004.

6. McCrory P, Meeuwisse W, Johnston K. et al. Consensus statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Br J Sports Med 2009: 43:i76-i84.

7. Meehan WP. Kids, Sports, and Concussion (Praeger 2011) at 26.

8. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013;47:250-258.

9. Giza C, Kutcher J, Ashwal S et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. (published online ahead of print, March 18, 2013); DOI:10.1212/WNL.ob013e31828d57dd (accessed March 24, 2013).

10. Guskiewicz K, et al. Evidence-based approach to revising the SCAT2: introducing the SCAT3. Br J Sports Med 2013;47:289-293.

Updated and revised July 12, 2014

The Challenges of Gauging Concussion Severity

Once upon a time, and not that long ago, concussions were categorized on a scale of severity: grade 1 (mild), grade 2 (moderate), or grade 3 (severe). The trouble was, there were numerous concussion classification systems —from the Colorado Medical Society, the American Academy of Neurology, and other organizations — and it wasn’t clear whether one was better than the others.

“We’ve learned that each concussion acts differently, so trying to use a template just doesn’t work for individual patients,” says Andrew Gregory, MD, an associate professor of orthopedics, neurosurgery, and pediatrics at the Vanderbilt University School of Medicine in Nashville, Tennessee. “Usually it’s only in retrospect that you can say how severe a concussion is.”

Even the level of impact in a head injury or the location of the impact can’t predict symptom severity or recovery time, according to a study of collegiate football players’ concussions published in February 2018 in the Journal of Neurotrauma. In fact, the researchers concluded that biomechanical forces that are associated with blows to the head produce different injury presentations in different people. Complicating matters, “it seems the more concussions you have, the longer it takes you to recover and the less injury it takes to cause concussion,” Dr. Gregory says.

There is, however, a consensus on the nature of a concussive head injury, according to a statement by the Concussion in Sport Group, published in May 2017 in the British Journal of Sports Medicine:

  • Concussions can be caused by a direct blow to the head, face, neck, or an impact to another part of the body if it transmits an impulsive force to the head.
  • Concussion typically leads to a rapid onset of temporary impairment of neurological function, one that resolves naturally over time.
  • The acute signs and symptoms of concussion reflect a functional disturbance, not a structural injury.
  • These signs and symptoms may or may not involve loss of consciousness.

The benefit of the grading system was that “it made it clear to clinicians that concussion was something to be taken seriously,” says Prin Amorapanth, MD, a clinical instructor of rehabilitation medicine at the Rusk Rehabilitation Center at New York University’s Langone Medical Center. “But at the end of the day, it turned out not to have a lot of prognostic value.”

Since use of the classification systems was cast aside in 2013, concussion is now categorized as a type of mild traumatic brain injury (TBI), and it’s up to a clinician to gauge its severity.

Current Practices for Diagnosing a Concussion

Today, Dr. Amorapanth explains, doctors typically assess concussion severity with a symptom inventory such as the SCAT5 (Sport Concussion Assessment Tool), which asks patients to rate 22 symptoms on a scale from 0 to 6 (with 6 being severe), or the Acute Concussion Evaluation (ACE), which tracks the presence of symptoms and whether they worsen with physical or cognitive activity, as well as risk factors for protracted recovery.

“Then, we can generate a total score of severity and count the domains in which the person has symptoms,” Amorapanth says.

Concussion symptoms generally fall into four categories:

  1. Somatic (headache, dizziness, visual disturbances, nausea, and the like)
  2. Cognitive (confusion, loss of consciousness, inability to concentrate, and memory problems)
  3. Affective (emotional lability, anxiety, sadness, and irritability)
  4. Sleep changes (trouble falling asleep, or sleeping more or less than usual)

“The greater the number of symptoms and the more severe they are might predict how long recovery takes,” Gregory says, but there aren’t clear cut-offs or boundaries for this, either.

The combination of symptoms reported by the patient and a neurological exam — in which the doctor evaluates the patient’s vital signs, visual performance, balance, memory and cognitive functioning — guides how the patient’s concussion is treated. If there’s concern about a skull fracture or bleeding inside the skull, a CT or MRI scan may be recommended. Red flag symptoms that warrant more extensive evaluation include:

  • Neck pain or tenderness
  • Double vision
  • Weakness or tingling in the arms or legs
  • Vomiting
  • Severe headache
  • Seizure or convulsions
  • Loss of consciousness
  • Altered mental status

Otherwise, for an acute blow to the head that results in mild to moderate symptoms, “we might watch to see if the symptoms are time limited,” Amorapanth says. The mainstay of treatment for concussions is physical and cognitive rest for 48 hours, followed by a gradual return to activities or a graded aerobic exercise regimen under clinical supervision, he notes.

Until the person is symptom-free, “we recommend avoiding triggers — such as bright lights, loud noises, physical or mental exertion — that make symptoms worse,” Gregory says. ”But some light activity, such as going for a walk or riding a stationary bike, can be good for recovery. It decreases symptoms and helps people feel better,” thanks largely to the exercise-induced release of endorphins. If symptoms worsen during physical activity, patients are instructed to stop what they’re doing.

If your concussion symptoms are not getting better after three to four weeks, “we may be more aggressive with interventions to facilitate recovery,” Gregory says. For example, if you have ongoing vision impairment or light sensitivity, you may be referred for ocular or occupational therapy. If balance problems persist, vestibular therapy may be warranted. If cognitive problems persist, cognitive therapy may be in order. The goal is to help you get back to full functionality as soon as possible.

Concussion

What to do if you think you might have concussion

Treat a minor head injury at home

You don’t usually need to get immediate medical advice if you only have mild symptoms that don’t last long after a head injury, such as:

  • a headache that goes away on its own or is relieved by painkillers
  • slight dizziness
  • feeling sick
  • being a bit dazed

You probably don’t have concussion, and can follow the advice about treating a minor head injury at home.

Call NHS 111 for advice if you’re not sure if you need medical help.

When to go to hospital

Go to your nearest accident and emergency (A&E) department if you’ve injured your head and have:

  • woken up after being knocked out
  • problems with your memory
  • a headache that doesn’t go away
  • been vomiting since the injury
  • changes in your behaviour, such as becoming more irritable
  • had an operation on your brain in the past or are taking blood-thinning medicine such as warfarin
  • been drinking alcohol or taking recreational drugs

In these cases, you should be checked by a health professional trained in assessing head injuries. They’ll decide if you need a brain scan to rule out a serious brain injury.

When to call 999

Call 999 for an ambulance if someone has injured their head and has:

  • been knocked out and hasn’t woken up
  • difficulty staying awake
  • problems with understanding, speaking, writing, walking or balance
  • numbness or weakness in part of their body
  • problems with their vision
  • clear fluid coming from their ears or nose
  • bleeding from their ears or bruising behind one or both ears
  • a black eye with no obvious damage around the eyes
  • a fit (seizure)
  • hit their head in a serious accident, such as a car crash

Also call for an ambulance if someone needs to go to hospital but you can’t get them there safely.

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