March is Concussion Awareness Month! Concussion awareness has progressed significantly in past decade. Research continues, but there is still so much more to know about injury prevention, accurate testing, symptom variety and severity, recovery, and best healing practices. The more we know, the better we can treat, and most importantly, reduce impairments in people who have sustained a concussion.
But perhaps we need to start with the basics; what is a "concussion"?
From the 2015 article Concussion is confusing us all (David J Sharp):
"It is time to stop using the term concussion as it has no clear definition and no pathological meaning. This confusion is increasingly problematic as the management of 'concussed' individuals is a pressing concern. Historically, it has been used to describe patients briefly disabled following a head injury, with the assumption that this was due to a transient disorder of brain function without long-term sequelae. However, the symptoms of concussion are highly variable in duration, and can persist for many years with no reliable early predictors of outcome. Using vague terminology for post-traumatic problems leads to misconceptions and biases in the diagnostic process, producing uninterpretable science, poor clinical guidelines and confused policy. We propose that the term concussion should be avoided. Instead neurologists and other healthcare professionals should classify the severity of traumatic brain injury and then attempt to precisely diagnose the underlying cause of post-traumatic symptoms."
In the 6 years since this article was published, the use of mild traumatic brain injury (mTBI) has increased. It is common to see the terms "mTBI" and "concussion" used interchangeably in the research, media, and clinic. In regards to physiology, mTBI likely captures the injury state more accurately. But telling a patient "you have a brain injury", can be traumatic. When providing a diagnosis to someone in pain, words matter.
From the article Nocebo Effects and Negative Suggestions in Daily Clinical Practice – Forms, Impact and Approaches to Avoid Them (Ernil Hansen)
"Medical situations are hot spots in the life of a patient with potentially long lasting effects arising from the use of either negative expressions or encouraging statements, or the lack of empathy or a positive physician-patient relationship. Health care personnel should be aware of and evaluate what patients are exposed to, hear and see. Knowing more about the effects of nocebos and negative suggestions, combined with increased attention to these matters, provides the basis for better recognition of detrimental influences in their own clinical environment and to be able to avoid, stop or neutralize them."
Providers are responsible for communicating their evaluation, diagnosis, treatment, and prognosis findings in a thorough and understanding manner. How providers choose to communicate effects trust, patient satisfaction, compliance, and healing.
What is your option - should we use the term "concussion" or the phrase "mild traumatic brain injury"?