There are millions of reasons to not ditch the word “concussion”. It’s simple. It’s easy to remember. It’s in widespread use, with many millions of dollars worth of reading materials, research studies, merchandise, and commercial brands emblazoned with that word. Not to mention the task forces and the organizations devoted to conquering concussion. We can’t just throw it all away. That would cost us dearly.
There are also very practical reasons to hang onto the term. “Concussion” isn’t emotionally charged like “brain injury” is. You can talk about it without implying that somebody is brain-damaged… which is never an inviting prospect. And you can actually have a public and legislative discussion about… well, brain injury… without ever calling it what it is.
From personal experience, I can tell you, people get freaked out when they think and talk about brain injury. If you never call it that, you can have a lively public debate and develop policies around protecting student athletes, while steering clear of the emotional toll taken by imagining someone brain-damaged. You can take steps to prevent their brains from getting damaged, without ever implying that they could get brain damaged by their athletic activities, which offer them so much structure and lessons for life.
And that’s extremely helpful, especially when dealing with a skittish, worried, and wary public, their school administrators, athletic coaches, and their elected officials.
So, how can we possibly get rid of the term “concussion”? It seems an impossible thing.
Of course, we could keep the term “concussion” to refer only to the concussive event that produces the alteration of brain function resulting from axonal shearing and the metabolic cascade that happens after the impact. That would actually be much more accurate.
I know, I know, concussion as we currently understand it is a process. But frankly, I think the science is still too young to be declaring, once and for all, This Is How It Is. Or that This Is What We Should Call It. Cementing policy and terminology at this point, could lock us into trajectories of research and public policy that ultimately backfire on us.
We’re in a dynamic state with our data and our analysis and our public response. It’s all in flux. Once upon a time, we thought that concussive symptoms were caused only by the blow to the head. Now we know there’s rotational elements as well, axonal shearing, a metabolic cascade of biochemical mayhem, and a lot of other internal stuff that goes on to complicate matters further. We also know that concussions aren’t only caused by direct blows to the head. A blow to the body, or really anything that whips you around hard enough to damage the fragile connections in your brain, will do it as well.
So, it’s reasonable to expect we’re going to learn even more as we go along. And as our understanding changes and more facts come to light, our terminology is going to change, as well. It’s inevitable.
It might very well turn out that there are a number of separate and distinct phases to concussive brain injury, each of which has its own characteristics, each of which should be dealt with and addressed in its own way. But for now, I’m focused on two pieces of the puzzle — the concussive impact which damages the brain and kicks off the agents of brain injury… and the resulting injury itself.
But what do we call the whole process? Yes, it is a process, and yes, we need to treat it as such. My proposal is that we have an overarching term that includes elements of both impact and resulting injury.
We could call the whole deal “CBI – Concussive Brain Injury“, because that’s really what it is.
We don’t lose the familiar and popularized concept of “concussion” — the investment in that term “concussion” is massive, and it would be waste to lose it. Excising it would also be technically inaccurate. There is a concussion element — it’s just not the end-to-end phenomenon.
Plus, when you see concussion as a distinct element of the overall process, this limited definition actually gives concussion its rightful place in prevention, mitigation, and research. It’s not being dismissed. It’s being elevated to a distinct component which deserves deeper inquiry. And all the policies, initiatives, companies, and products that are being developed to prevent and mitigate concussion can be kept in place — if in a slightly modified form.
After all, the commercial and organizational efforts to prevent and mitigate brain-altering blows to the head and body are specific to the concussive event. And you can realistically talk about preventing and mitigating damaging impacts through policy and product offerings. Brain injury… not so much.
Re-designating “concussion” to the concussive event itself seems like a positive first step in solving a pressing society-wide problem: how to even begin to think about concussive brain injury in productive, problem-solving ways.