Originally Published in 2016
Consciousness and Concussion
by Ralph B. Lilly, M.D. | Contributor
Of all the body’s organs, the brain is, to me, the most intriguing. It is incredibly complex in certain aspects yet remarkably straightforward in others. Housed within our skulls, the brain is built from billions of neurons. Each neuron is intricately connected through a vast network of thousands of connections to send electrical signals to other neurons. Alongside support cells and blood vessels, the brain harbors all the essential electrolytes and chemicals for the survival of the entire nervous system. These signals influence how we think, move, and engage with our surroundings daily.
What is Consciousness?
The electrical waveforms produced in our brains give rise to the complex functions we refer to as “consciousness.” As children, we learned about the five senses (smell, taste, sight, hearing, and touch), which are parts of the brain’s numerous duties. In truth, there are additional sensations, such as our spatial awareness and three-dimensional perception. Our senses shape our emotions, including fear, happiness, and sadness. Our reactions are based on the continuous stream of information we receive, and our brains must assess and decide on actions to take 24 HOURS A DAY.
Therefore, the brain is the fundamental organ of consciousness. Because each of us is unique, our behaviors are equally distinct. The memories archived in our neural networks are in constant flux. It is akin to an electronic storage system containing all of our prior conscious experiences, as well as our learning, sensory, and motor experiences. All these elements are transformed into our personal responses to outside stimuli. The way your brain processes information and decides how to respond is unique to YOU.
What is Concussion?
Concussion is defined as a temporary disruption of these essential brain functions. Many medical professionals now prefer the term “concussion” over “mild traumatic brain injury” since no brain injury should ever be regarded as “mild,” particularly from the perspective of the victim, their families, friends, employers, and the wider community.
The brain can sustain damage in various ways, yet the dynamics of an impact to the skull or the brain’s collision with the inner skull walls during acceleration and deceleration lead to the physical symptoms patients report. The injury inflicted on the brain alters how the nervous system functions.
When a patient experiences a change in their arousal level, it is referred to as “unconscious.” The injured individual may not even realize it, or it could happen so swiftly that others may not notice. Therefore, a loss of consciousness is not necessary for a concussion diagnosis; however, a “confusional state” is often evident, with impairments in memory, attention, focus, perception, judgment, personality, emotion, and decision-making.
Patients may also experience symptoms such as dizziness, headaches, tinnitus, balance issues, fatigue, challenges in initiating activities, ongoing headaches, and a sensation of “mental fog.” If a combination of these symptoms lasts for over 24 hours, the patient is diagnosed with “post-concussive syndrome.” The cognitive and behavioral changes may persist for varying durations, depending on the nature of the trauma and the individual’s brain condition.
How Do We Manage Concussions?
Considering the brain’s myriad microscopic neuronal connections, damage to the tiniest components may be challenging or impossible to detect on standard MRI or CT scans. Negative results in diagnostic imaging should not always be interpreted as an absence of injury; symptoms must also be carefully considered by the patient and their caregivers.
Medical management of concussion necessitates prompt evaluation by (pediatric) neurologists, pediatricians, physiatrists, and neuropsychologists. Diagnostic assessments should encompass both imaging and neuropsychiatric evaluations. Collaboration with the patient’s school or workplace, along with family members and caregivers, is crucial.
Some patients may need adjustments to their academic or work schedules. Speech, occupational, cognitive, vocational, and recreational therapies can address specific needs. These therapists and physicians should offer advice regarding sleep, diet, exercise, and especially—how to prevent further cranial injury.
Concussion should be treated as a serious brain injury. While not always directly life-threatening, it frequently leads to significant changes in the injured person’s daily life. With appropriate care and intervention, the prognosis is generally favorable.
The Centers for Disease Control and Prevention estimated around 1.7 million traumatic brain injuries occur annually in the U.S. between 2002 and 2006. Of these injuries, approximately 45,000 to 50,000 individuals do not survive. About 50% of those who survive may return to normal functioning within six months. After one year post-injury, approximately 85% return to their pre-traumatic state; however, around 10%-15% of brain injury survivors will experience residual issues to varying degrees. These issues may include memory deficits, uncontrollable anger, personality changes, and negative effects on day-to-day functioning. Such symptoms can persist for a lifetime, leading to ongoing impairments and disability. Persisting symptoms may be categorized as Post Traumatic Encephalopathy, signaling enduring pathological changes in the brain.
Around 200,000 patients with concussions and various lasting brain function impairments join the healthcare system each year. Even patients who recover within the year often go through months of intensive rehabilitation post-trauma. Those with poorer outcomes typically include individuals with previous brain injuries or additional injuries to areas such as the face, jaw, eyes, ears, neck, skull, and other organ systems.
Editor’s Note: In addition to being a renowned physician and esteemed brain specialist, Dr. Ralph Lilly was also my Uncle Ralph, the older brother of my father, Earle Lilly.
Dr. Lilly passed away in 2021 before he could complete his book about the Healers—the family, friends, and companions who support brain-injured individuals and help guide them toward new, often different, often improved lives. However, his co-author, Diane F. Kramer, continued his legacy, recently announcing the publication of their book, “Second Lives: The Journey of Brain-Injury Survivors and their Healers.”
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Ralph B. Lilly, M.D.
October 28, 1935 – October 10, 2021
About Ralph Lilly, M.D.
Dr. Lilly was born in Revere and Chelsea, Massachusetts, and graduated from Revere High School in 1952. Standing at 6’4”, he was recruited for the football team at Brandeis University during his undergraduate studies, but disliking violence and physical confrontation, he left the team while remaining active in an administrative role.
After graduating from Brandeis, he took a position as a chemistry teacher and basketball coach in St. John, New Brunswick. Following one year, he enrolled in Dalhousie Medical School in Halifax, Nova Scotia, before completing his residency at The Barrow Neurologic Institute in Phoenix, AZ, and entering private practice.
His life dramatically changed in 1980 when he was struck by a drunk driver while stopped at a red light on his motorcycle. Both he and his companion sustained severe injuries from the traumatic brain injury, which led Ralph to a new path in life and career.
After two years away from work, he began a Fellowship at UCLA, tailored for him by the Chair of Neurology, Dr. Frank Benson, a pioneer in Neurobehavior. Working alongside Dr. Benson and Dr. Jeff Cummings at UCLA for a year, he gained insights into the brain and the consequences of damage on behavior. This experience guided him towards a focus on Neurobehavior.
From Los Angeles, he moved to Providence, Rhode Island, where he became the Director of Neurological Services at Butler Psychiatric Hospital, associated with Brown University’s Medicine Program.
Dr. Lilly played a crucial role in training the medical and nursing staff at Butler and other facilities in Rhode Island and Massachusetts, on Neurobehavior and the impacts of Acquired Brain Injury.
After nine years at Butler, Dr. Lilly relocated to Houston, TX, where he treated more acutely injured patients alongside Dr. John Cassidy at the Neurobehavioral Institute of Houston. Gaining valuable experience from Dr. Cassidy, Ralph worked with countless patients and families, providing not only medical care but also psychological support.
Dr. Lilly served as the first Medical Director of the Houston Polo Club, establishing a system for rapid intervention in case of injuries on the field, ensuring timely transport to emergency care when necessary.
Eventually, Ralph joined the University of Texas at the Houston Medical Center’s Department of Neurosurgery, where he closely collaborated with the Chief of Neurosurgery, Dr. Guy Clifton. Initially working with Dr. Clifton and his surgical team, Ralph eventually attended to patients across all ICUs at Memorial Hermann Hospital in Houston.
In his final decade, Dr. Lilly focused on his outpatient clinic in Houston. He treated patients and families regardless of their ability to pay, offering his expertise, empathy, and affection.
Throughout his extensive career, Dr. Lilly profoundly impacted countless lives, utilizing his skills, patience, and relentless determination in the face of significant challenges.
Dr. Lilly aimed to complete his book on the Healers—those family members, friends, and companions who stand alongside brain-injured individuals and assist them in navigating their new, often changed, often enhanced lives. Though he passed before realizing this dream, his co-author Diane F. Kramer continued the effort, and their book, Second Lives: The Journey of Brain-Injury Survivors and their Healers, is now published.
