concussion

Bike Crashes and Brain Injuries

A Collaborative Blog Post by Hottman Law Office and Colorado Concussion Clinic

My Own Experience

In May 2017, I was on a group charity ride. We had been riding together for three days at that point, and the group was dialed and very skilled.  As we rounded a bend at mile 90 of a 120-mile day, we were on a slight downhill going at a pretty good clip. Someone in front of me rolled over a stick that was just the right shape and size...it shot out from under their wheel and under my front wheel.  As I rode over it, my bike went out from under me as though I had ridden my road bike over a wet root. I went down before I knew what was happening and crashed hard. Two riders behind me crashed into me/landed on me.

IMG-4617.jpg

My bike broke in eight different places.  As I lay in the road, I had immediate pain to my lower back and, of course, plentiful road rash.  While my helmet showed damage from hitting the ground, I did not have head "pain,” but my neck did become very sore over the next few days.  I did not see a doctor right away or seek medical care, which was a huge mistake. My roommate on the trip pointed out that I was repeating certain things over and over to her.  I was incredibly emotional—crying easily and without provocation.

Instead of being smart by packing it up and going home to rest and recover, I used a neutral support bike to do the last day—a 90-mile ride into the heart of downtown Manhattan, NYC.  The only thing on me that was mine was my sunglasses and shoes—everything else was new/borrowed. I willed myself through the ride feeling not at all like myself, pretty out of my head, and in a great deal of pain.  

Once home, I noticed I could not muscle my way through work, emails, or my daily agenda.  My head felt tired. I wanted to sleep and avoid bright lights. My mental endurance would wear out midmorning. I also noticed on short, easy bike rides that I would "bonk" mentally—similar to the sensation we have all experienced when we do not eat enough calories on a hard bike ride.  Except I was feeling this often and after very easy effort. My first real road ride post-crash stands out. I was still healing up the road rash, my low back still really hurt, but I felt I was ready to ride with friends. On a very fast downhill, my rear wheel rolled over something that caused an immediate and fast flat tire.  I braked carefully but in a very panicked way as the thought of going down again was more than I could bear. I became a sobbing mess and told the group I was riding back home. I cried most of the way and could not get control of myself. When I turned around to see that they had been following me at a distance (worried about me as good friends do), I really fell apart.  

IMG-4483.JPG

I never saw a neurologist or doctor for my head issues and really wish I would have.  Since I pushed so hard to get back to work and riding so soon, I felt the delay of my symptoms for many months.  I did not feel totally like myself again until that November or December. Had I rested, I am sure it would not have taken so long.  

In addition, five weeks after the crash when my low back was still hurting so badly, I was having trouble walking, so I saw a doctor and got an MRI.  This is when we learned that I had fractured my sacrum, the bone on the back of my pelvis. I had also torn the labrum in my right hip. Given the nature and extent of these injuries, there is no doubt in my mind that I had suffered head trauma which impacted me for many months.

As a result of my personal experience, all of the emerging literature out there on concussions, as well as the experiences we have had with clients, (who both have and have not received care for their head injuries), we recommend all of our clients seek help for head trauma as soon as possible after they have been hit by a car.  Too often adrenaline protects us for awhile, and then the ER focuses on orthopedic injuries, and the trauma to our brains goes unnoticed/unaddressed.  That is why we will suggest everyone take the Symptom and Symptom Scale Questionnaires provided by Colorado Concussion Clinic (buttons below) and encourage you to read Sarah Brittain’s article for valuable information on concussions.

Sarah Photo.jpg

Why Concussion Care Matters

Sarah Brittain runs Colorado Concussion Clinic, a venture created to fulfill a need for evidence-based comprehensive concussion care.  Sarah has a Master's Degree in Communication Science Disorders from the MGH Institute of Health Professions. Her clinical work has focused on treating clients’ cognitive deficits secondary to acquired brain injuries. For more information, visit www.healmyconcussion.com.

Any orthopedist will tell you that a broken arm requires four to six weeks in a cast to heal. Heart surgeons give their cardiac patients six weeks to begin to feel better and up to six months to feel the full benefits of the surgery. According to many professionals, an injury to the brain, our most complex organ, should take ten days.

I hope you can appreciate the absurdity of the ten-day timeline given above. I will absolutely concede that a number of people with concussive injuries heal within that ten-day time frame, and that is certainly the hope, but many do not. Symptoms that persist beyond ten days should be addressed by trained professionals to maximize recovery. Early treatment is key for better outcomes.

A common misconception of concussion (a term now synonymous with mild traumatic brain injury - “MTBI”) is that complete rest leads to recovery—a recommendation not based on current scientific data. In fact, research actually shows that complete rest beyond the first 24-48 hours is detrimental to healing. Research shows that moderate activity is imperative to healing from concussion. There is, however, a caveat: too much activity can set you back in your recovery.

Let me take a step back here. What is a concussion? What are the signs and symptoms? The following definition is taken from the American Congress of Rehabilitation Medicine:

A patient with mild traumatic brain injury (aka concussion) is a person who has had a traumatically induced physiological disruption of brain function, as manifested by at least one of the following: 1. any period of loss of consciousness; 2. any loss of memory for events immediately before or after the accident; 3. any alteration in mental state at the time of the accident (e.g. feeling dazed, disoriented, or confused); and 4. focal neurological deficit(s) that may or may not be transient; but where the severity of the injury does not exceed the following:

• loss of consciousness of approximately 30 minutes or less;

• after 30 minutes, an initial Glasgow Coma Scale (GCS) of 13–15; and

• posttraumatic amnesia (PTA) not greater than 24 hours.

In layman's terms, if you don't “feel right” or you feel “out of it”, you likely sustained a concussion. It is important to note that nowhere in the definition does it say you had to have a direct blow to the head. In fact, quite the opposite is true. You can sustain a concussion without hitting your head.

Below are some of the most common real world signs and symptoms of concussion, grouped into the following categories: physical, cognitive, emotional, and sleep.

FullSizeRender.jpg

Alright, so you think you have a concussion. Now that you know you probably should not rest and avoid everything, what should you do? Like I said, a percentage of the concussion population will recover within ten days. If you are one of those people, that is great. You can likely resume your activities, although you should take care to avoid hitting your head again. But if that is not the case, please read on.

I equate concussion treatment to early intervention for school children. Any child that is struggling with learning to read will get some intervention (in most schools), because it is unclear if the child will eventually catch up with his or her peers, or fall further and further behind. Investing time and therapy in early intervention has been shown to lead to better outcomes compared to those who took the “wait and see” approach.

The same is true of concussion. Early intervention goes a long way and the evidence is beginning to show it reduces the chances of having persistent post-concussive syndrome.

What might this intervention look like? Well, it depends on who you are and what your symptoms are. Are you an athlete now having trouble with dizziness and balance? Let's sign you up for some vestibular physical therapy. Are you having trouble at work and keeping up with tasks? A good cognitive therapist can help you with that. The list goes on and on. There are skilled treatments for each of these issues.

Words of caution: With concussion being a hot topic today, many health practitioners are quick to say, “Oh yeah, I can fix that!” Buyer beware—Just as you wouldn’t trust your mechanic to fix both your car and your dishwasher simply because they are both machines, you probably do not want your physical therapist who is treating your shoulder injury to treat your vestibular issues. Physicians and therapists in concussion rehabilitation are specialists, and you may need a team of these experts to get fully better. Do your due diligence and research your providers, and do not be afraid to ask questions! Is there research and are providers using evidence-based practice? If not, then it is likely too good to be true.

Concussions are a serious injury and not something to be ignored. Early treatment is key for improved outcomes and reducing the risk of developing persistent post concussive symptoms. Don’t sit at home in a dark room for days...be proactive in your recovery!

Guest Blog: Sam's Experience and Lessons

We are reposting this Facebook post by former client Sam Doniach (with his permission) because it includes several great lessons and suggestions - and we hope you can benefit from his experience and his advice! 

"With racing season right around the corner, I figured now would be a good time to share my cautionary tale. This is very long, so if you don't want to read the whole thing the main points are: 

1. Get (and wear) a RoadID or something similar.

2. Tell somebody where and when you are riding and when you expect to be home.

3. If something happens, get a lawyer!

The date: April 4, 2014. Also known as the Rockies' home opener. My wife was working and I had the day off, so I decided to go out for a ride and enjoy the nice spring weather. I was heading home, coming out of Cheeseman Park and heading north on Franklin, crossing 14th. A van (not a minivan, but something like a Ford E-150) was coming south on Franklin and turning left onto 14th. Apparently they either didn't see me or they underestimated how fast I was going, Either way, they turned left right in front of me, and I ran straight into the side of the van. I'm not sure how fast I was going but I imagine between 20 and 25 mph.

Somehow my helmet didn't crack, but I was knocked out cold, and got a couple of pretty big lacerations on my cheek and eyebrow. A bystander called 911, the police and paramedics came, and I was taken to Denver Health. Up to this point, I had always kept my driver's license in my jersey pocket when I was out riding, because in my morbid imagination, I figured that if I was hit and killed, they'd be able to identify the body.

When the paramedics got to me, they cut my whole kit off. I know now that this is standard procedure, because they have to be able to see one's whole body to find out the extent of the injuries. The problem was, my clothes (and ID) were all left with the police on scene, and I was rushed to the hospital completely naked. I was in pretty bad shape - I had a GCS of 8, which means I had some pretty serious brain trauma - and they got me to Denver Health as fast as they could. When I got to the hospital, they had no idea who I was. I was a John Doe.

On almost any other day of the year, this mystery probably would have been solved fairly quickly. But remember what day it was: the Rockies' home opener. Denver Health was on divert, which means they weren't accepting any ambulances except for serious traumas, which my accident certainly qualified as. The paramedics and police were spread thin dealing with all the craziness that goes on downtown on opening day. So a John Doe I remained.

I got hit probably around 6 or 6:30pm. My wife got home from work about 7:30pm. I hadn't told her that I was going for a ride, but when she got home and I wasn't there, she saw that my bike wasn't there either and figured it out pretty quickly. It was already starting to get dark when she got home, but she figured that I'd be home soon. I had my cell phone with me, but when she called it I didn't answer, which isn't unusual when I'm out riding. As it got darker and later, she got more and more worried. She kept calling my phone, but it kept ringing and ringing and never got picked up. At some point, PD brought my belongings to the hospital, but it must have been in a bag and nobody answered it. Eventually the battery must have died because it went straight to voicemail.

She called the police, but they said that she couldn't file a missing persons report until I had been missing for 24 hours. So she started calling hospitals. She didn't know I was a John Doe; in fact, she knew I always took my driver's license with me, so she was asking for me by name, and never found me. She called Denver Health at least 3 or 4 times, but they told her to stop calling because they were on divert. Nobody made the connection. I also hadn't told her where I was going, so she had no idea where I could be, or what area I would have been in if something happened.

Eventually, around 11pm or so, she called the police again, and an officer came to our house. She told him what I looked like, showed him a couple pictures, and said that I had been out for a bike ride and hadn't come home. He went out to his cruiser and was on his phone for about 15 minutes; finally he called her from his cruiser and said that I was at Denver Health. She rushed to the hospital, not knowing what she would find - would I be brain dead? Paralyzed? When she finally found me, I was covered in blood, and all doped up on painkillers. She asked if I knew who she was, and I said "my wife".

I still have no memory of the accident, or of anything for about a week after. All of this story comes from what my wife told me and from what I could piece together from the police and ambulance report. I had 2 subdural hematomas, which means my brain was bleeding under my skull. They kept me in the hospital overnight for observation, and discharged me the next day. I give thanks every day that I wasn't more seriously injured, and I consider myself incredibly lucky that I have no long-term deficits (as far as I can tell) from the accident.

There was good and bad luck (or fate, or karma, or the work of God, or whatever it may be) involved that day. I was hit by a car, it was the Rockies' home opener, and my wife had the worst, scariest day of her life - all bad. But it wasn't a hit and run - the driver stayed on scene. And even though it was a very serious accident, I really wasn't injured that badly. I tried dealing with the driver's insurance company, but I was way out of my depth, so I decided to hire a lawyer. We are lucky to live in a place with so many cyclists, and there are lawyers that deal with exactly this type of accident. I think that I hired the best - Megan Hottman, who sponsors the Cyclist Lawyer cycling team. She worked incredibly hard for me and my wife, and things worked out better than I ever could have imagined.

I'm sharing this story not to get sympathy, or to make people feel bad for me. I consider myself incredibly lucky. But cycling on the road is very, very dangerous, and we need to do everything we can to protect not only ourselves, but the people we love and who love us. I failed to do so that day, and I feel terrible for the fear and pain I caused my wife. So there's a few things I want to pass on:

1. Get a RoadID or something similar! If something happens, you want the hospital to know who you are and who to contact. Especially if you have any serious medical problems or drug allergies - they are incredibly important for the doctors to know about.

2. Tell somebody where and when you are riding and when you expect to be home. If my wife had known where I was going and when I was expecting to be home, she might have had a better idea of where to look for me.

3. If something happens, get a lawyer! I can't emphasize enough how helpful this was. Insurance companies are hard to deal with for a reason - they only want to look out for their bottom line, and they're counting on the fact that the average person doesn't know as much as they do.

Thanks for reading my (long!) story. I hope that nobody has to go through what my wife and I did, and hopefully you can all learn from what happened to me without having to go through something like that."

View his original post here