Divide and Conquer – Why separate #concussion from #TBI?

The two-part article I finished on Saturday was pretty lengthy — nearly 5,000 words in all — so I’m not sure if it’s going to get a lot of readers. People tend to like shorter pieces they can pause to read for a few minutes… and then get on with their day.

I’m like that, myself.

But I got very caught up in the piece. I’d started it on Friday night in a flurry of inspiration, and when I woke up early on Saturday morning, all I could think about was finishing it. As I wrote, more ideas came to me that really got the juices flowing, and it really pulled me right along.

I also came across a great article in The Irish Times ‘It’s traumatic brain injury, not concussion’ which talks about how we need to stop whitewashing brain injury issues and stop referring to traumatic brain injuries as “concussions”. There’s a lot of really great food for thought in that article about how we understand brain injury, as well as how we talk about it. It’s a great read! Check it out

Some of my favorite excerpts:

At issue is, what is concussion? Popular definitions talk of a “functional” disturbance in the brain, implying or stating there is no physical damage to the brain. This is incorrect. The brain is damaged in concussion in a number of ways, perhaps the most significant injury being to the fine “wires” or axons coursing through the white matter of the brain.

…

4. What is the difference between a head injury and a concussion?

BOD: A head injury may be a laceration which may not necessarily lead to suspected concussion. A concussion does not necessarily have to be caused by a head injury; it can for example just be caused by a tackle. Concussion may be caused either by a direct blow to the neck or face or elsewhere on the body with an impulsive force that is transmitted to the head. This is because concussion is due to the acceleration, deceleration and rotational forces on the brain – a soft mass surrounded by fluid inside a rigid casing (the sponge in a bucket effect).

WS: In common, they are both unhelpful terms. And neither tells the story of the diagnosis. A bit like the chest pain analogy above. Chest pain could be anything from insignificant indigestion to life threatening myocardial infarction. We need to move away from “concussion” to what it is: “traumatic brain injury”.

So, that fueled my fire.

Yes, the term”concussion” is all wrong.

We need to move away from it.

But yet, it’s so common.

What to do? What to do?

I brainstormed a bunch of ideas which might actually work, if we gave them a chance… or developed them further with logic and common sense, rather than personal preferences or professional/commercial agendas. (There’s a ton of money to be made from concussions, so that complicates things.)

By midday, I posted the last of the piece… and almost immediately started fielding expert objections to my suggestion that we should use the term “concussion” exclusively for an impact that damages and alters your brain function.

A number of times, I was told in social media that “Concussion is not an event, it’s a process.” (Though, if that’s the case, then logically, there is no such thing as Post-Concussion Syndrome. Without a distinct event set in time, there is no “post”. There is only Concussion Syndrome. So, you see the logical quandary.)

And I had to step away to think about that. Ultimately, though, I came back to my original thought:

We need to stop using the current term and concept of “concussion”. We need a better terminology that calls it what it is — a brain injury. We also need to  conceptually distinguish the concussive event of getting slammed, from the brain injury that follows, so that we can more effectively address each aspect as separate parts of a continuous whole.

My rationale is:

1. Concussion is a commonly understood term which has massive investments behind it. Nobody in their right mind is going to flush all that time, money, awareness, etc. down the proverbial toilet. I foresee major push-back on that point.
2. Designers and manufacturers of protective gear and concussion testing equipment need to change how they position themselves. They can certainly do some good at a certain stage of the concussive process. However, they currently overreach and promise the moon, claiming to do things they frankly can never, ever do (e.g., prevent brain injury that comes from concussion). What they can prevent and mitigate is the impact itself. They should focus on that, and quit running the risk of brain-injury-related lawsuits arising from their exaggerated claims.
3. Our ability to realistically discuss risks, diagnose injuries, and treat brain-based deficits post-concussion is limited, because we don’t think about it properly. The brain is rarely, if ever mentioned when we talk about “concussion”. Using a term which specifically avoids mention of the core issue — brain injury — doesn’t help us understand, assess, or address the real issues at hand. Including the term “brain injury” forces us to get real. Real quick.
4. Lumping everything together under one poorly understood (and easily misinterpreted) umbrella term makes it very difficult for injured individuals and their caregivers/guardians to understand the issues they’re facing. It also encourages specialists to encroach on each others’ territory. This promotes needless conflict and jockeying for position between complementary practitioners who can and should be working closely together, each in their own respective area of expertise. This muddying of the waters helps no one. It hurts all of us.
5. Changing the terminology from “concussion” to “concussive brain injury” is not terribly difficult to do, when it comes to information resources. All the pamphlets, PDFs, websites, booklets, and PowerPoint slides out there can be updated with this new terminology without completely rewriting all the copy. As a former technical writer who produced massive sets of documentation for software on multiple operating systems, I know that search-and-replace pain all too well. Having terminology which is additive, rather than completely revisionist, is a plus.
6. If ever there was a time to do this, it is now. The movie Concussion has raised public awareness — opening the chance for discussion at a national and international level. Experts may understand the various stages of concussive brain injury, but the general population doesn’t. And having a single blanket term does a great job of confusing an already anxious society. If we’re going to help the general public fully understand, appreciate, and address this profoundly disruptive issue which affects every part of our lives, we need to change the way we talk about it — and the way we name it.

Despite objections, I truly believe we need a sea change in how we talk about concussive brain injury. And that includes the name we give it. The term “Concussive Brain Injury — CBI” could suit us nicely — and tick all the boxes for public awareness. More to come…