At adolescence the brain is in an active stage of maturation. It is not a time of growth but a time of increasing connectivity, and becoming more complex and specialised. One of the important things that happens at this time is myelination. Myelination improves the efficiency of brain circuits, therefore the maturity of the adolescent brain. The brain rewiring in puberty is not actually completed to around 25 years of age, and later for males. The prefrontal cortex or frontal lobe is not developed til 25 years of age and is an area of self-regulation and control of thought and action. The other area worth noting in adolescence is the limbic area - this area is deep within the brain and includes the amygdala, hippocampus and hypothalamus. It is hormonally activated during puberty and is involved with emotional processing and the reward process. One of the later areas of development in the brain is the frontal lobe, which is responsible for our thinking, judgement, insight, planning and impulse control. This is another reason not to hit alcohol in a big way as a teenager. Then there is the cerebral cortex which is the outer layer of the brain in which the highest level of neural processing occurs. This includes language, memory, emotion, analysis of sensory information, planning, judgement and organization. The last brain area to mature in adolescence is the high level executive function. Executive function and self-regulation skills are the mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully.
A concussion is when the brain shifts inside the skull. This can cause a sudden, but usually temporary – disruption in a person’s brain function and development. I relate concussion very well to an explanation given in the movie called Concussion made in 2015. In this movie Dr Bennet Omalu tries to convince authorities and create awareness among the public about the presence of the long term effects of American football related head injuries. He uses a Woodpecker in his explanation comparing their skull to ours.
Dr. Bennet Omalu: "All of these animals have shock absorbers built into their bodies. The woodpecker's tongue extends through the back of the mouth out of the nostril, encircling the entire cranium. It is the anatomical equivalent of a safety belt for its brain. Human beings? Not a single piece of our anatomy protects us from those types of collisions. A human being will get concussed at sixty G's. A common head-to-head contact on a football field? One hundred G's."
The skull helps protect the brain from injury and the spinal fluid cushions the brain inside the skull. A blow to the skull or hard jolt can hurt the brain directly or make the brain move around and bang the brain hard up against the skull. Even with a helmut this can still happen because we are not wood peckers. In saying this a helmut can protect against skull fracture and other brain injuries caused from sport.
A concussion is a type of mild traumatic brain injury. It happens when there is a hit to the head with force. This can cause inflammation, pressure, chemical changes in the brain, hormonal disruption if the pituitary or hypothalamus moves and change in brain cells. It is a finely balanced organ that does not like these changes.
Teenage concussions are most likely to happen when playing sport. The highest risks are football, ice hockey, lacrosse, soccer, field hockey, fights, skateboarding, bike accidents, boxing, a fight, a car accident or a fall. One of my biggest concerns is the repeated concussions and the dangers of repeated head injury.
One of the issues here is not being honest and lying to coaches to get back in the game. There is evidence that men are slightly less likely to report concussions. Studies show that both male and female athletes will lie about symptoms after head trauma to stay in the game, men about 79% of the time and women about 70% of the time. Actually, these numbers are really terrifying if athletes are so willing to cover up potentially dangerous symptoms.
Hurrying back to sport and other physical activities puts a teenager at risk of what is called a second impact syndrome. This is when someone gets another head injury before the concussion has healed. Although very rare, second impact syndrome can cause lasting brain damage and even death. Never ignore symptoms or try to ‘tough it out’. Sadly, even though there are many concussions reported there are many that are undiagnosed, or symptoms not mentioned to coaches for fear of missing the game. Therefore it is really important for parents and coaches to be fully aware of any symptoms so the teenager is treated and recovers well.
In most cases the teenager will feel better within a few weeks of the concussion. I had concussion and fractured my head from a fall when I was 12 years of age. In my case I lost consciousness at the time however in many teenage concussions there may not be loss of consciousness.
Like any brain condition the symptoms can vary but here are some of the symptoms felt after a concussion:
Blurred or double vision
Balance problems – even balance for walking
Confusion and saying things that do not make sense
Slow to answer questions
Noise and light sensitive
Nausea and or vomiting
Ringing in the ears
Memory loss or amnesia
Trouble focusing or reading
Feel emotional, upset, angry or nervy
The strange thing is that the concussion symptoms can start straight away but for others it can appear hours or days after the injury.
It is extremely important to seek medical help asap if severe headache or worsening headache, epileptic seizure, pass out or continual vomiting.
It is better to be safe than sorry and head injuries can be serious.
Things that can help:
Relax at home
Try not to read or watch TV or computers. Stay screen free.
Avoid all sport. If up to it, gentle walks only
Sleep and nap as needed
Avoid stimulants like alcohol and caffeine (including Chocolate) or sugar. Even Gluten can be inflammatory in the healing phase.
Reduce sensory congestion- TV, Computers, social media, electronics, too much background noise
Talk to practitioner about natural anti-inflammatories (Probex, Traumeel, Theractiv) and nutrients that help the nervous system recover
NST, cranial osteopathy and remedial massage
Banning sports that use the head for hitting the ball, reassessing some sports to help with prevention, avoiding headstands
Females may be more susceptible to concussion effects.
Interesting to note is that girls are more prone to concussion and effects of concussion than boys. Anatomically female athletes have smaller necks and heads than males. Stronger necks protect the skull more. The girls have an increased movement of the brain within the skull which results in concussion. Secondly hormones are said to play a role in an increased number of concussions. This is very interesting. One study of women who were hospitalised for concussion, looked at women's hormonal status at the time of concussion. Women who were hurt in the early part of their menstrual cycle when there's higher estrogen around, had on average longer times to recovery than women who were in the second half of their cycle or on contraceptive pills. But then again the pill can effect blood flow to the brain which might not help the recovery either, or pregnant, when progesterone hormones were around. This was added to some research in rats that suggested that rats given progesterone, a female hormone, immediately after head trauma, had less adverse brain effects.
This led to an early study of giving head trauma patients, both men and women, progesterone after head trauma to see if the brain was less damaged and recovered faster. The early studies suggested that progesterone was somewhat protective, and that was really exciting to me. That aside, a larger randomized trial of progesterone treatment in head trauma didn't show a difference in outcome.
Women have smaller, more breakable nerve fibres in the brain compared to men that may make them more susceptible to concussions, suggests a new study from Penn Medicine neuroscientists published online in The Journal Experimental Neurology 27, 2017
healthcare university of Utah website
Arain M Haque, M., Johal, L.,Mathur P,Nel,W.,Rais, A.,Sandhu, R, & , Sharma 5 (2013)Maturation of the adolescent brain. Neuropsychiatric disease and treatment, 9, 449-461, DOI: 10.2147/NDTS397776.
Gledd,J (2016). The amazing teen brain. Lecture series:influence of early experience on adult brain organization and function - Kavali institute for brain and mind symposium. University of Californian Television
The Journal Experimental Neurology 27, 2017 - Penn Medicine neuroscientist.