Despite a greater recognition of the danger of concussions, particularly in athletes, much about the condition remains unknown. Effective treatment options still elude doctors, even as unproven approaches like hyperbaric chambers become common.
In the majority of cases, rest will lead to a full recovery, but sometimes symptoms linger. When they do, patients can experience long-term, debilitating symptoms like pain or vertigo. What is the historical understanding of concussion, and its treatment?
Much of the literature surrounding concussions in JSTOR was published during war years, between 1915 and 1919, with another surge in 1943-1944. By 1915, for example, two years of brutal combat brought the first important lesson in concussion treatment, that sometimes less is more. Medics and battlefield surgeons came to the then-outlandish conclusion that radical brain surgery was not always wise.
It was not until 1944, with another war underway, that the true nature of concussion became understood. Writing in the British Medical Journal, Geoffrey Jefferson correctly realized that the symptoms of concussion were caused by “commotion” (movement) of the brain, and the severity depended on how much shaking the brain endured. An extensive correspondence developed in regards to Jefferson’s paper played out in the pages of the British Medical Journal, hotly debating the nature of consciousness. It seems a strange avenue to pursue, given the urgent need for effective treatment of brain injuries.
By the 1970s, efforts to treat concussion became more systematic. A 1972 study came to the surprisingly progressive conclusion that active treatment, e.g. therapy, should be determined on a case by case basis, considering age and other factors. The doctors sometimes considered the psychology of treatment, prescribing physical therapy less because it was useful than to alleviate the fears of older patients.
The authors also stressed the value of consistency, especially the need for one doctor to follow a patient for the duration of their recovery. Perhaps the biggest surprise, in our age of managed care organizations and defensive medicine, is the consideration given to the patient’s financial needs. The extra effort and expense of more active care was justified because it allowed patients to return to work much earlier!
Treatment of concussion has not progressed much further in 2015. Some things are clear, i.e. rest is good and multiple concussions are very bad, but surefire treatments still don’t exist. T
he U.S. military has taken a particular interest in concussion research, as once again brain injuries afflict combat veterans. Effective treatment is further complicated by extensive overlap between concussions and PTSD. Hopefully the renewed interest in concussion will bear fruit.