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University of Copenhagen
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A cruel but not so unusual injury

Concussion — An estimated 25,000 people suffer a concussion each year in Denmark. The effects can extend far beyond the immediate symptoms, and no-one can say for sure how long it will take to get better. At uni, our brain is our most important asset. What do we do, then, when we can’t rely on it?

For Maya Plum, the concussion she suffered in 2012 had a profound impact that extended far beyond the involuntary break it required her to take from her studies. “It was a complete and total loss of identity,” Plum, currently a PhD student and a part-time reader in Education with the Department of Media, Cognition and Communication, says.

Plum, in fact, wound up with two concussions in the span of three years. After the first, which she suffered after she banged her head into a metal post, she went on sick leave for 11 months. At that time, her two children were 4 and 6. Plum, though, was so poorly off that she needed to move in with her father for six weeks. When she wasn’t lying down with her eyes closed, she was lying down with them open, staring at the ceiling.

“I had this feeling like there was blank band running from one end of my brain to another,” she says.

They can’t tell you whether you will be better tomorrow or in three weeks or a year.

PhD student Maya Plum

She got better. But, having a concussion had left its mark. She didn’t dare cycle, or wear high-heels. She got nervous around balls. Then, the first time she went to the swimming pool with her kids after she was back on her feet, she got hit in the head by a child’s bucket. For most people, it would have been just a bump in the head. But, for Plum, her brain still not fully healed, it resulted in another concussion. That was 2015. Her second concussion in two years sidelined her for another eight months.

Psychological impact

Today, Plum is fine. But she remembers what it was like: hopelessness as far as she could see.

“They can’t tell you whether you will be better tomorrow or in three weeks or a year. That’s the worst part of having a concussion, all the uncertainty associated with it,” she says.

Another way that concussions keep you guessing is that even though you are getting better, you don’t notice it. It’s a slow process. So slow sometimes that you get the feeling you’re never going to get better.

For academics and university students, the problems associated with a concussion are compound. That, at least, was how Plum and others in her situation say they’ve felt. At uni, we’re used to working our brains overtime from time to time, like when we’ve got an exam or need to finish a paper or when a deadline to submit a grant application is fast approaching.

“You live your life under the assumption that your body was something that you were in control of. You willed it do something. But, all of sudden, you brain shuts down and you can’t even do the simplest things.”

An academic challenge

If you ever suffer a concussion, you’ll be told not to do a lot of the things that are synonymous with uni life: write, read, sit in front of the flickering light of a screen. Even if you can manage do any of that, doing it will just make your symptoms worse.

About 25,000 people in Denmark suffer from a concussion each year. Many of them are back at it after a few weeks, but for about 15% the effects linger. The university doesn’t keep statistics for how many students go on sick leave after suffering a concussion; HR only records work-related injuries, and, by law, they aren’t allowed to record why people call in sick.

I had this feeling like there was a blank band running from one end of my brain to another
PhD student Maja Plum

When it comes to the science of concussions, doctors are almost just as uninformed, for the simple reason that there is little way to tell just what happens when you hit your head. We know the effects: sadness, in some cases bordering on depression, and, occasionally, even suicidal tendencies. And, unlike most medical conditions, the worst prognosis is for people who are young, healthy and well-off.

For people like Plum, being a member of a university faculty becomes a part of who you are. Her concussions took that part of her identity away from her, but they also prevented her from being a mum, a spouse or a friend. She wasn’t anyone.

You need help

Now that she’s back on her feet, Plum considers herself lucky. She had the support of her employers and the people around her.

“At no time did I feel that I was being rushed back to work. That makes a huge difference when you have a concussion. Because, if you go back, you will overdo it. People at universities are known for that,” she says.

Plum’s best advice to someone with a concussion reflects that fact. Talk about it. When Plum started back at work, her boss suggested she send an e-mail to her co-workers to tell them how she was doing. It helped. As an instructor, she herself finds it helpful when students tell her if they are dealing with the effects of a concussion.

“You get over it if you have someone help you get over it,” she says. “That’s probably the most important piece of advice I can give: ask for help right away.”

Plum’s concussion is a part of her past. Even though she can think clearly and act normally today, she’s now aware of the need to take care of herself. She’s able to work 12 hours at a stretch if she has to submit an article, but she doesn’t repeat the effort the next day.

“My actions are no longer the embodiment of my will. I need to listen to what my body tells me.”

Mental relaxation

The Centre for Rehabilitation of Brain Injury treats people suffering from the long-term effects of concussion, what doctors call ‘post-concussion syndrome’.

No-one knows exactly what happens when you get a concussion. Neuroscientists suspect that when you hit your head, the neurons in your brain either get stretched out or they break. Another effect, according to the centre’s Linda Marschner, a neuropsychologist, is that the brain’s chemical balance is upset.

Centre for Rehabilitation of Brain Injury

The Centre for Rehabilitation of Brain Injury was established in 1985 and provides information to the university’s students and employees about concussions.

On November 8-9, the centre will host an international conference focusing on concussions.

 

 

“The membranes that coat neurons are affected, but over a broad area. That could cause them to be stretched in all different directions, with the result that brain’s ion channels don’t function properly. But, because it happens over a broad area, we can’t really identify where the brain is damaged,” Marschner says.

In order for the brain’s neurons to repair themselves, and for its chemical balance to be restored, it needs to rest. Studies, however, suggest that it takes longer for people to recover from concussions than it used to. The reason may be linked to our modern lifestyle. Young people, in particular, live more spontaneously, and that makes it hard for the brain to get the rest it needs, according to Henriette Henriksen, a physiotherapist with the Centre for Rehabilitation of Brain Injury.

“Young people live very spontaneously,” she says. “The don’t plan ahead to meet someone on Friday, 7 November, for example. They say, you up for doing something now? You up for doing something tomorrow? But if your brain is recovering from a concussion, you need to be able to tell others that I can’t do anything today, because I need to do something tomorrow. If I do something today, then I’ll be out of it tomorrow.”

And, if you are used to being kept busy by your studies or your career, then the last thing you want to hear is a doctor tell you that you need to slow down. Then there are the unanswered questions: when I can get back to my former life? Will I ever be able to go back to my former life?

One step forward, ten steps back

Tue Scheel Nielsen knows what that’s like. He was on his way home from a party to welcome new students when he fell off his bike – three days before he was to begin studying for his masters in Information Science and Cultural Communication. He remembers making sure his fresher got home safe and then the next thing he can recall is lying in a hospital bed.

That was three years ago. Nielsen missed six months of school, but the time back has been one long roller-coaster ride.

No-one could have predicted that it would have turned out the way it did. Nielsen himself reckoned he’d be back on his feet after a couple of weeks. That was how long it took most people to get over a concussion. Not him though. His concussion was one of those that just won’t let go.

“I remember one of my classmates coming to visit me not long after I fell. I told her I’d be back next week or something else that today sounds totally naïve.”

I stopped believing in myself and in my future.
Student Tue Scheel Nielsen

Unlike most people who suffer a concussion, Nielsen did take the rest his doctors recommended. For six weeks, all he did was listen to audiobooks and go for walks. He started back at uni after that, but he was allowed to take just one class, and his study group was understanding enough that they let him take it easy while he was recovering.

After six months, he figured he was over his concussion. But, as the semester wore on, his symptoms got worse. It got so bad that he wasn’t able to sit the exam for the class he was taking. The next semester was no better. In the autumn of 2017, he got accepted for an internship and got hired at a good part-time job. But it was all too much. His brain couldn’t handle it.

“By December things were total chaos. When it came time for me to write a summary of what I had done during my internship I couldn’t read my notes or write up my observations. That was when my headaches were at their worst and when I was most tired. It’s still that way from time to time.”

Up against the administration

Nielsen has had a tough year so far. He’s spent most of his time applying for waivers for all the things he was unable to complete, disenrol from classes, and then ask to be permitted not remain in his master’s programme, even though he’d already taken too much time. Eventually he had to ask for a leave of absence and then apply to the council for cash assistance.

“I used the entire summer writing applications of one form or another instead of getting better. It wasn’t until last week that things came together. So now, I can start thinking about taking care of myself,” he says.

I used the entire summer writing applications of one form or another instead of getting better.

Tue Scheel Nielsen

Nielsen is fortunate. His time in student government taught him how the administration works, and he knew people who could help him with his applications. Writing an application for a waiver, he says, is every bit as hard as writing a paper – just a lot less satisfying.

“I completely understand why so many people have to give up filling out applications. It’s also understandable that they put up some requirements, but, without the people I know, and what I know, I would probably have had to give up, too.”

It’ll get better. Really

In a way, Nielsen considers himself lucky that his concussion was as bad as it was. Since it was so bad, he’s got plenty of documentation from the hospital and his doctor to prove that there’s something wrong with him. Even so, suffering from an invisible illness is hard, especially when the symptoms come and go.

“I thought I was better,” he says. “I had a job. I had an internship. Life was good. But when things got bad again, I felt terribly alone. I stopped believing in myself and in my future. That took a lot out of me. It certainly hasn’t been easy.”

Even though it can be exhausting, Nielsen makes sure he does something social a couple of times each week. If he doesn’t, he risks slipping into the depression that can accompany post-concussion syndrome.

His next goal is to return to his studies in six months and finish up his master’s. “Things will get better,” he says, mostly to himself.

Tidal wave of fatigue

Henriksen, the physiotherapist, says Nielsen’s and Plum’s stories are familiar ones.

People who are dealing with the effects of a concussion need to learn what to use their energy on, and what not to. Tiredness, she says, is typically the worst symptom of a concussion, though it might take a few days to kick in.

“It’s like a tidal wave of fatigue washing over you,” she says. “People say their body just shuts down. It’s like they don’t even have the energy to stand up.”

Aside from tiredness, the list of symptoms is long. Dizziness and headaches are two of the physical effects. Mentally, people have trouble thinking, remembering and planning. Some experience problems sleeping. Still others have emotional problems.

The Centre for Rehabilitation of Brain Injury can help. People with concussions need to be told how to avoid provoking their symptoms so they can gradually disappear. Some, though, never quite get over their concussions.

“Their symptoms won’t go away,” Henriksen says. “For them, the only thing they can do is learn how to live in a way that allows them not to be affected by their concussion all time.”

Similar. But very different

There is no evidence of a direct connection between concussions and mental illness, but both have similar symptoms. And having an injury like a concussion that no-one can see evokes the same sort of reactions that mental illness does.

“A lot of the students we treat have been told things like, ‘Oh, you’re just a little depressed, that’s all,’ or ‘Maybe it’s stress.’ It’s understandable; the symptoms are similar. But, no, a concussion is neither depression, not stress,” Henriksen says.

Because of the nature of the injury, and the way that people respond to it, the Centre for Rehabilitation of Brain Injury instead tries to explain to people with concussions why they feel the way they do and to talk to others who feel the same as they do.

“They all know someone who got over their concussion after a few days,” Henriksen says. “So they feel like something is wrong if it takes them four months to be able to do things they were able to do just last week. That’s difficult for them – and those around them – to accept.”

Good advice for students after a concussion

1. Take the time you need to get better

In most instances, you’ll be better off taking time off now, even if it means missing an exam, and focusing on recovering than you will if you rush back before you’re ready and risking a relapse. Taking a little time off now will save you a lot of grief later.

2. Ask permission not to sit your exams

If you suffer a concussion close to an examination period, ask for permission not to sit them. Don’t just skip them. If you miss an exam without permission, you can only sit the make-up. If you’ve been given permission not to sit it, you still have your first try and you’ll also have an easier time of it if you need to apply for a waiver later.

3. Talk to your student counsellor – and bring a friend

Your student counsellor can help you come up with a plan. Take a friend with you if you think you will need someone to take notes for you and to help you remember what you wanted to ask about.

4. Have someone check your KUmail for you

The university normally sends information about exams, activity requirements and waivers to your KUmail address. If you can’t use a screen, then ask a friend or a family member to check your account for you.

5. Contact Special Education Support

If your concussion winds up being a long-term injury, Special Education Support can set you up with any help you might need. Special Education Support can help you get back to your studies sooner and help you get more out of your classes once you do.

Source: Malthe Grindsted Ulrik, student counsellor, Department of Media, Cognition and Communication, Centre for Rehabilitation of Brain Injury

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