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Blue Hill
Originally published in Castine Patriot, March 16, 2017 and Island Ad-Vantages, March 16, 2017 and The Weekly Packet, March 16, 2017
Expert outlines dangers, and changing approach to concussions

BHMH’s Dr. Bruce Hamilton

Dr. Bruce Hamilton-Dick, orthopedic sports medicine, orthopedic surgery and sports medicine specialist at Frenchman Bay Orthopedics, recently spoke on the dangers and changing medical approach to concussions.

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by Anne Berleant

Concussions, their causes, diagnoses, treatment and lasting effects, are a hot talking point around sports. Yet a recent talk by a concussion expert, hosted by Blue Hill Memorial Hospital, brought as many questions regarding car and other accidents.

When talking about concussions, first give up old preconceptions of what a concussion is, according to Dr. Bruce Hamilton-Dick, who specializes in orthopedic sports medicine, orthopedic surgery and sports medicine at Frenchman Bay Orthopedics, which partners with BHHM and Maine Coast Memorial Hospital.

“You don’t need a blow to the head to have a concussion,” he said. “A concussion is your brain accelerating and hitting the side of your skull.”

A direct hit to the face, neck or anywhere on the body, including the head, that causes the head to snap forward can cause a concussion.

But the bigger danger lies in what happens immediately after the concussion, Hamilton-Dick said. A blow to the head after a concussion of any severity, known as a “post-concussive blow,” has a 50- to 60-percent mortality rate, because the brain is in an impaired metabolic state.

“Sending [athletes] back into the game puts them at huge risk,” Hamilton-Dick said.

While immediate symptoms such as dizziness, impaired balance and confusion may not be present or be short-lived—and Hamilton-Dick notes that loss of consciousness is the least common symptom of a concussion—it still takes seven to 10 days for a full recovery with at least 24 hours of complete physical and cognitive rest.

Evolving medical knowledge
Over 40 years ago, a concussion was defined as “an insult to the brain,” and sports concussion were considered minimal on a scale of mild to moderate and severe, Hamilton-Dick said. An athlete would be given five minutes on the bench and then head back into the game.

But a concussion isn’t a “brain bruise,” it’s “a total disruption of neural pathways,” that causes acute metabolic problems.

CT scans and MRIs won’t diagnose a concussion, he continued; there really is no diagnostic test. Doctors look for impaired balance, changes in behavior, sleep disturbances, headaches, dizziness, difficulty concentrating, amnesia, and sensitivity to loud noises and bright lights.

The treatment? Rest, both physical and cognitive. No extensive reading, video games or TV, or physical activity for the first 24 to 48 hours, and be cautious of daytime naps. Once a specialist gives the okay, light aerobic activity can begin, then non-contact training, full contact practice and, finally, a return to play, with 24 hours between each step.

Some of those attending the talk spoke of lingering effects after they or a family member suffered a concussion or, in one case, what appeared to be an undiagnosed one after a car accident where no immediate symptoms were displayed.

Post-concussive syndrome is a different diagnosis, Hamilton-Dick said, where a person is “functioning but not at the level of pre-concussion,” and can occur when the brain has not been given time to recover from the initial concussion.

And while the medical and scientific community is still learning more about concussions, and sports are changing some rules especially at the youth level, Hamilton-Dick said, “I think the only way to prevent concussions is the fundamental aspect of most sports needs to change.”