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Military neurologist offers advice for care of a head injury after a slip and fall

Plow truck in snow Winter time slips and falls could result in more than just an embarrassing bump to the head. Know how to recognize a concussion.

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Traumatic Brain Injury | Winter Safety

It’s wintertime, and inevitably it seems, you’re going to slip and fall and possibly bang your head on the icy sidewalk. While you might get a bump on the head and end up being more embarrassed than hurt, military doctors caution not to dismiss what could be a dangerous traumatic brain injury (TBI). 

“A lot depends, obviously, on how hard they hit and how old they are,” said Dr. Anthony Panettiere, a clinical neurologist with the National Intrepid Centers of Excellence at Walter Reed National Military Medical Center in Bethesda, Maryland. 

Panettiere said older people, especially those more than 60 years of age, could be more prone to persistent concussive symptoms after hitting their head. He added that some combat veterans who have suffered multiple TBIs can also experience increased susceptibility, because each TBI occurrence can lead to increasing time to recovery, with a lower chance for a full recovery. 

“So, for example, with the first TBI event, you may have gotten better in a couple of weeks. The next time it happens, it might take 1-2 months to get better,” said Panettiere. “Each subsequent event can leave you with mounting deficits that you may never fully recover from, such as headaches, memory issues and sleep disturbances.” 

Many times, the first person to see someone suffer a TBI from a fall will be a nonmedical bystander. Panettiere advised that if you see someone hit their head and lose consciousness, they should be checked out by a medical professional. When there is head trauma but no obvious loss of consciousness, you need to ask cognitive questions to determine the person’s level of brain impairment. 

“The kind of questions we might ask are not simply their name, but pursuing answers to more detailed questions, such as, ‘When is your wife’s birthday?,’ or ‘Where does your child go to college?’” said Panettiere. “Difficulties with correctly answering these types of questions may help observers unveil some cognitive issues that that could suggest more significant brain injury than initially suspected, and should prompt medical evaluation.” 

In cases of documented concussion, some degree of brain rest is recommended, but not full rest. For example, while a student might delay taking a test, that person can still do some light reading. Panettiere said the brain needs to stay engaged, just not in a taxing way. “Studies found that when concussed people were in recovery and given the option to have either no cognitive engagement or full engagement, it took them about 100 days to recover. Those who were lightly engaged improved in 30 to 50 days.” 

Panettiere said there are some common sense measures people can take to avoid a nasty slip and fall and head injuries: make sure you wear proper high-traction footwear, and carry your work dress shoes to your destination; wear sports helmets when participating in winter sports, such as ice skating; and in the car, buckle up and set headrests at the proper height (middle of the headrest should be eye level). 

The bottom lines: don’t blow off too easily what might be a treatable, but attention-needing head injury, and give yourself some time to heal.

"It would not be unusual for people to have problems with their memory, focus, mood and headaches,” said Panettiere. “Most people get better, but it still should be something they monitor for improvement. The brain can heal, but sometimes, it just takes a long time.”

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