Dr Debbie Snell
Everyone is talking about the new study that was recently published in The Lancet by a group of New Zealand researchers about how many people sustain a concussion in New Zealand every year. Up until this study was published we did not have any recent high quality local data to help us understand just how many people sustain such injuries in this country. The study demonstrated that previous information we relied on from overseas research substantially underestimated how many people sustain concussions in New Zealand. In fact their study suggested that as many as 33,000 New Zealanders may sustain a concussion every year.
So why is this a big deal? The reason this information is so important is that having more reliable and recent data helps health providers and funders plan services and identify needs. As far as concussion goes most people completely recover and many within the first few weeks of their injury. However we do know that there is a proportion of people (around 15%) who take longer than this to recover and a smaller number (around 5%) who demonstrate difficulties after their concussion injuries for many years. These are findings that have been shown time and time again in research here and overseas and that are widely discussed and debated by health services and funders, clinicians and researchers alike. Based on the recent study findings this means up to about 5000 people could be slow to recover or recover incompletely from a concussion every year, meaning this group becomes very large and significant over time. In fact this is a group that is attracting increasing attention in New Zealand as insurance funders like the Accident Compensation Corporation (ACC) question the basis of such persisting difficulties and therefore eligibility for ACC compensation.
The big question then is why is it that most people recover but some don’t. Unfortunately we are not entirely clear about why this is. Some reasons that have been suggested include that having an injury (any injury) can be stressful and distressing. It is argued by many that this stress response interacts with the concussion injury and creates longer term problems and difficulties. These difficulties experienced by many after concussions include headaches, fatigue, changes in concentration and attention, and changes in mood. The argument that stress influences injury recovery is based on the understanding that we all respond in different ways to stress and some of us may be more vulnerable than others, and thus take longer to recover from a concussion. Others argue that there are physiological changes that occur as a result of the concussion that form the basis of persisting difficulties and symptoms. Proponents of this argument point to recent advances in brain scanning that have identified small (microscopic) brain changes in a small number of cases. However these kinds of positioned arguments are generally unhelpful and we think it is more helpful to consider that recovery after a concussion injury can be a complicated affair, most likely involving an interaction between many factors both physiological and psychological, that also includes individual variation in how people respond to and cope with stress, pain, fatigue, inability to work and loss of income, that can all be consequences of concussion, fortunately temporary consequences for most.
This is indeed a contentious issue. Whether we are clinicians assisting people recover from a concussion, a funder of treatment and injury compensation, the person with the injury, their family or employer, we all need to be aware of this individual variation in outcome and the large number of factors that impact on recovery. It never helps to blame the person with the injury for not recovering, rather we need to keep working together on improving our understanding of what helps, what doesn’t and the basis of persisting problems for some after concussion injuries.
