Talk:Post-concussion syndrome

message: Revert first and ask questions later?  Is that policy?  129.7.254.33 06:19, 23 October 2007 (UTC)
replies: text: Well, you're right that that's not the normal practice.  But in this case, a couple things: first, the info was put in front of a reference, so it made it look like the reference said that, which it didn't.  Second, there's no reference for that information.  According to the very fundamental verifiability policy, it's the responsibility of the person who wants to add the info to provide a reference for it.  So if you want to add the info, all you need to do is find a source for it and cite it.  delldot on a public computer talk 05:16, 13 January 2008 (UTC)
thread_title: Heading

message: Hi!
Usually in talk pages of articles in Wikipedia, no one is addressed in particular. In this case it's different. I know the one I am addressing has actually nurtured the article since more than last 20 months.
So, hi dilldot (on public computer)!
As I started reading your article, it just occurred to me that I should see the page history. I was amazed and overwhelmed to see the entire article being edited singlehandedly by you. Congratulations! I also happened to see your user page, Wikipedia (and neurology, in particular) seems to keep you really busy. I really feel overwhelmed by users who have put in as much effort as you. Well, I have just gone through "your" article
*I thought the lead is a bit longer than required. Especially information pertaining to treatment and prognosis should have been restricted. I know though some would disagree with this. But may be leaving that out would leave something to be looked forward to in the article. Moreover, with all the information given in it, it is looking more like a summary rather than a lead, which should be an "initiation" into the article and not the conclusion. Rather some information could be given about the salient features of concussion, viz., that the diagnosis is only on functional bases and that no structural changes are found.
:*Shortened slightly.  There's disagreement on the physiological basis of concussion, I think I'll leave discussion of that to concussion.  delldot talk 20:31, 7 May 2008 (UTC)
replies: text: *I just went ahead and removed that sentence, it wasn't adding much anyway, and the prevalence thing is dealt with later.  delldot on a public computer talk 04:45, 8 May 2008 (UTC)

text: *Uh oh, not sure about this one, I may have introduced distortions.  How's this simplification? "Apathy, or lack of motivation, another common symptom in PCS, may result directly from the syndrome or may be secondary to depression."  delldot talk 20:59, 7 May 2008 (UTC)

text: *Good point.  So changed.  delldot talk 20:16, 7 May 2008 (UTC)

text: *Explained, wikilink removed.  Implemented the wording suggestion, thanks! delldot talk 20:16, 7 May 2008 (UTC)

text: *Another good point.  delldot talk 20:16, 7 May 2008 (UTC)

text: *Done. delldot talk 20:16, 7 May 2008 (UTC)

text: *Done. delldot talk 20:31, 7 May 2008 (UTC)

text: *Reworded with explanation. delldot talk 20:31, 7 May 2008 (UTC)

text: *Done. delldot talk 20:31, 7 May 2008 (UTC)

text: *I think the deal is that we're talking about how many people have it by a given amount of time after the injury; the sentence in the source I'm citing is, "Prevalence rates at three
months post-injury have been found to range from 24–84%".  Reworded for clarification. delldot talk 21:12, 7 May 2008 (UTC)

text: Thanks so much for the kind words and thorough review!  Certainly not harsh in the least, very sensible. I've made a few changes and will make more tonight.  delldot talk 20:16, 7 May 2008 (UTC)
thread_title:  My views 

message: I'm not convinced that a photo of a woman massaging her temples while reading in the library is a helpful representation in this article. Axl (talk) 09:24, 17 May 2008 (UTC)
replies: text: Yeah, I admit it's definitely reaching.  I've been having trouble thinking of how to illustrate this article: It's the most frustratingly intangible thing I've ever written about! I can remove the crappy picture.  Any other ideas for images?  delldot on a public computer talk 09:35, 17 May 2008 (UTC)
replies: text:  Hmm, I just had a look on Wikimedia Commons, and your young lady is the closest match. I'll keep looking. Axl (talk) 09:42, 17 May 2008 (UTC)
replies: text: Aww, thank you Axl.  Yeah, good luck on that, I didn't have any. :P If you think of any ideas for any images (i.e. not just for the symptoms section), definitely let me know.  delldot on a public computer talk 09:45, 17 May 2008 (UTC)
replies: text:  What do you think?  Still reaching too much?  delldot on a public computer talk 09:57, 17 May 2008 (UTC)

text: Unfortunately I couldn't find any appropriate headache pictures. Sigh However the EEG picture looks reasonable for this article. Axl (talk) 10:34, 24 May 2008 (UTC)
thread_title:  Headache picture 

message: I'm not sure this redirect is quite right -- I've also seen chronic brain syndrome used as a term for dementia in general (here for example) -- maybe a disambiguation page?Matt Kurz (talk) 19:14, 1 June 2009 (UTC)
thread_title:  redirect from Chronic Brain Syndrome 

message: The opening sentence of the article currently says that post-concussion syndrome was "historically known as shellshock" - I've removed that because afaik it seems whoever wrote that was thinking of post-traumatic stress, but thought I'd mention it here in case I'm wrong. :-) 86.131.92.88 (talk) 17:20, 5 November 2009 (UTC)
replies: text: That was me who added it, and no I didn't get confused with PTSD :-) Have a look at  for more info on this. --sciencewatcher (talk) 18:28, 5 November 2009 (UTC)
replies: text: I also disagree with the statement that shell shock was an old term for PCS. The two terms are not synonymous. Shell shock was a term that first described a set of symptoms affecting soldiers in the First World War. PCS describes similar symptoms that can occur in anyone who has previously sustained a mild Traumatic Brain Injury (TBI). The mild TBI, prior to PCS, may have been sustained in any scenario (including, but definitely not limited to soldiers in combat). It's true that mild TBI was/is one of the perceived causes of shell shock (tbi in the form of shock waves from explosions affecting the brain). I also observe that post-traumatic stress can be a factor in both PCS and shell shock, however, that is not what you have said. Shell shock and PCS are related but not in the way you have insinuated. The first sentence of the article should define the term PCS and mention any synonyms. It is not appropriate to use the term shell shock to define PCS, though it would be appropriate to say that PCS is now considered a possible contributing factor in shell shock. 80.1.55.240 (talk) 21:04, 30 November 2013 (UTC)
thread_title:  Shellshock 

message: This article could use an image in the lead.  Not sure what but... Doc James (talk · contribs · email) 03:02, 19 December 2009 (UTC)
thread_title: Image

message: Should not this be mentioned?  As a layperson I see no clear differences. 
http://www.headachedrugs.com/archives/post_traumatic.html
~~  —Preceding unsigned comment added by Elemming (talk • contribs) 07:43, 26 October 2010 (UTC)
replies: text: It should be mentioned if there is a link. However I did a google scholar search and only found 5 hits for 'post-traumatic headache syndrome' and none seemed to mention post-concussion syndrome. --sciencewatcher (talk) 13:34, 26 October 2010 (UTC)
thread_title:  post-traumatic headache syndrome? 

message: "Post-concussion syndrome, also known as postconcussive syndrome or PCS, and historically called shell shock, is a set of symptoms that a person may experience for weeks, months, or occasionally up to a year or more after a concussion – a mild form of traumatic brain injury (abbreviated TBI).  .  .  "
" . . occasionally up to a year or more . . "  No, incorrect, there are guys who are retired NFL players who have had serious symptoms for a lot longer than a year.  Watch some ESPN in recent weeks and see this.  And maybe this is a case in which just people telling their stories is running ahead of formalized research.  Although I suspect this is the wiki disease of understating.  When in doubt, when there's controversy, just understate, sand it down even more.  Well, we end up doing our readers a disservice.  If we have the sources to back it up (good not perfect sources) I don't think we need to excessively understate.
And the part about shell shock, I have most commonly heard that in reference to World War I and I've heard it described as serious depression.  Well, maybe the concussive injuries were the cause of a lot of these cases of depression.  "Shell shock" is how they best understood it at the time.  I'm not sure we should lead with a historical term which is partially right, partially not.  FriendlyRiverOtter (talk) 00:01, 24 May 2012 (UTC)
replies: text: The lead is confusing in the proposed timing, wandering around between short term, long term and short term onset. 
The shell shock part confusion is due to WWI misinterpretation of combat stress reaction, it was thought at the time, that the injury was due to explosives injuring the brain. Later study found that the issue was psychological, which is the current belief. 
There also seems to be some confusion in concepts. One can have traumatic brain injury that doesn't cause long term issues and one can have traumatic brain injury that causes damage that the brain cannot compensate for. The tau protein detection is an early finding in research that indicates damage has occurred in the past, with some being probable multiple injury induced changes. 
Even so, it's rather outside of the scope of the article, as it is ongoing research that is still poorly understood and utterly useless in diagnosing PCS. 
Head trauma is still not well understood. Relatively mild head injuries can result in significant emergent conditions, while more severe injuries can result in no significant medical issues, with little to lead researchers anything to ascertain why there is such a wide difference in spectrum with disparate mechanisms of injury. As an example, a man is hit with a back hoe and thrown two meters, his head being part of what was struck by the bucket. He got up and returned to work, only reporting bruising. Another man fell off the lowered back gate of a truck he was climbing into, landing on an unimproved dirt road. He was hospitalized for a subdural hematoma after complaining of vision changes several hours later. So, we have to consider when writing our rather poor level of understanding injuries of the head overall and the current extremely poor understanding of concussions in general.Wzrd1 (talk) 00:21, 15 August 2012 (UTC)
thread_title:  Our first sentence is just plain wrong 

message: The Causes section is generally taking the either-or approach, whereas I think the newer understanding is that it's BOTH-AND.  That both interact to cause a downward spiral.
In general, our article here needs a lot of work.  And perhaps paradoxically, maybe we should seemingly lower our standards and go with a healthy number of good sources, rather than a scant number of 'perfect' or 'great' sources.  FriendlyRiverOtter (talk) 00:15, 24 May 2012 (UTC)
replies: text: i agree.  4 1/2 years later, the article still needs work.  i found the article quite slanted when i read it.  it's the little things--use of phrases like "most experts agree," "it has been argued," "it appears that," and "it has been argued," etc.  then, the sources related to these phrases are quite out of date.  especially for a medical article, and especially for a medical "issue" that has gotten a LOT of interest lately.Colbey84 (talk) 08:37, 27 November 2016 (UTC)
thread_title:  Physiological or Psychological?  More sophisticated understanding is that it's BOTH-AND.   

message: The whole news coverage on concussions and brain injury, that it’s typically not the first concussion.  But rather that it’s the fourth, or the seventh, or the second, that it is highly variable depending on each individual.  For example, let’s say a cyclist (not just to pick on football) has experienced a concussion and has largely recovered, and this cyclist asks his or her doctor:  “Doctor, will I be okay even if I get a second concussion?”
As I understand it, with current knowledge and information, the doctor cannot say one way or another.  (although with each concussion, the third, the fourth, the fifth, the risk increases that the next one will prove to be damaging).
This has been a central fact in the news coverage of concussions.  And yes, I think someone who has maybe worked ten years or longer as a medical journalist, like a reporter for CNN, LA Times, etc, etc, etc, often are pretty good sources.  They can act as ‘bridge’ persons between medical publications written for doctors and interested lay persons like ourselves.  And we don’t need to dive into how much experience a particular medical journalist has or what his or her credentials are.  Rather, this is where we trust the credibility of the source (with all kind of judgment calls on our part of course).  And so, I come back to the not very dramatic conclusion that we want a variety of good sources.  
And to be clear, I am not a medical journalist either.  I am just someone who is interested in the topic.FriendlyRiverOtter (talk) 19:34, 26 May 2012 (UTC)
replies: text: I'm going to go ahead and delete this paragraph and refer here.  It is a judgement call whether a lousy section is better than no section at all. FriendlyRiverOtter (talk) 20:22, 26 May 2012 (UTC)
replies: text: Toned down the language and added references. Doc James (talk · contribs · email) 21:41, 29 May 2012 (UTC)
thread_title:  Not included in lead that it's typically a subsequent concussion which causes problems.  This is a main fact which should be included. 

message: from Prognosis section (last paragraph):
"  .  .  .  If another blow to the head occurs after a concussion but before its symptoms have gone away, there is a very slight risk of developing the extremely rare but deadly second-impact syndrome (SIS).  In SIS, the brain rapidly swells, greatly increasing intracranial pressure.  People who have repeated mild head injuries over a prolonged period, such as boxers and Gridiron football players, are at risk for Chronic traumatic encephalopathy (or the related variant dementia pugilistica), a severe, chronic disorder involving a decline in mental and physical abilities."
"  .  .  a very slight risk  .  .  "
"  .  .  the extremely rare but deadly  .  .  "
Wow.  How definite we are without any references whatsoever.  
And I'm not saying we should emphasize the danger side.  I'm advocating middle-of-the-road.  Let's just try to lay the known information onto the table without either over-stated or under-stating.
(And the little bit I've read, this second-impact syndrome may be different from post-concussion syndrome with depression, irritability, memory loss.)  FriendlyRiverOtter (talk) 20:13, 26 May 2012 (UTC)
replies: text: I'm going to go ahead and delete this paragraph and refer here.  It is a judgement call whether a lousy section is better than no section at all. FriendlyRiverOtter (talk) 20:22, 26 May 2012 (UTC)
replies: text: Toned down the language and added references. Doc James (talk · contribs · email) 21:41, 29 May 2012 (UTC)
thread_title: Aggressively skeptical claims regarding second-impact syndrome.  No references cited.

message: 1)  We don't mention tau protein.
2)  We don't mention in the lead that it's primarily a danger of subsequent concussions.
3)  The first sentence of our entire article estimates lower time periods, and this is simply not always the case.
4)  We are taking an either-or approach to the question of physiological or psychological.
::I ask people who can spare the time to please jump in and help out with both the writing and the research.  FriendlyRiverOtter (talk) 21:01, 26 May 2012 (UTC)
thread_title:  Four current problems with our article (May 2012). 

message: ORIGINAL ARTICLE, “Permanent post-concussion symptoms after mild head injury,” Brain Injury, 25(5): 462–470, NIGEL S. KING & SIMON KIRWILLIAM, May 2011.
Introduction
“  .  .  ‘mild head injury’ (MHI)  .  .  ”
“  .  .  ‘postconcussion symptoms’ (PCS)  .  .  ”
“  .  .  Twenty-to-forty per cent may, however, continue to experience PCS at 6 months post-injury [5] and a small minority still have difficulties at 1 year and beyond [6].  .  ”
“  .  .  Studies have also identified predisposing factors to experiencing more severe or longer lasting PCS. These include; (i) being over the age of 40 [11, 12]; (ii) being female [12, 13]; (iii) sustaining previous MHIs [12, 14]; (iv) having pre- or post-morbid psychopathology or substance misuse [15]; and (v) pursuing a compensation claim [16].  .  ”
References
[5.] Englander J, Hall K, Simpson T, Chaffin S. Mild traumatic brain injury in an insured population; subjective complaints and return to employment. Brain Injury 1992;6:161–166.[6.] Binder LM, Rohling ML, Larrabee GJ. A review of mild head trauma. Part 2: clinical implications. Journal of Clinical and Experimental Neuropsychology 1997;19:432–457...[12.] Edna TH, Cappelen J. Late postconcussional symptoms in traumatic head injury. An analysis of frequency of risk factors. Acta Neurochirurgica 1987;86:1–12..[14.] Gronwall D, Wrightson P. Cumulative effects of concussion. Lancet 1975;2:995–999.
----------------------
My local library has databases which includes Brain Injury, including a PDF of the full article.  I'm not sure whether it's available generally over the Internet.  
Here's the abstract:  http://informahealthcare.com/doi/abs/10.3109/02699052.2011.558042   But apparently one needs to log in to see the entire article.  FriendlyRiverOtter (talk) 19:45, 29 May 2012 (UTC)
replies: text: Introductions to primary sources do not act as reviews. Pubmed has a button on the left side that will limit your search to review articles. Please use reviews from the last 5 or 10 years at most. Cheers Doc James (talk · contribs · email) 21:30, 29 May 2012 (UTC)
thread_title: Introduction from primary source, which acts as a literature review

message: In our Diagnosis section, it currently states:  "In order to meet these criteria, a patient must have had a head injury with loss of consciousness[23] and develop at least three of the eight symptoms marked with a check mark in the table at right under "ICD-10" within four weeks.[33][34]"
Now, what ICD-10 actually says, ICD-10, International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010, F07.2 Postconcussional syndrome, World Health Organization."A syndrome that occurs following head trauma (usually sufficiently severe to result in loss of consciousness) and includes a number of disparate symptoms such as headache, dizziness, fatigue, irritability, difficulty in concentration and performing mental tasks, impairment of memory, insomnia, and reduced tolerance to stress, emotional excitement, or alcohol."
::To me, this is so old school.  Concussion <--> loss of consciousness, that's like a 1950s understanding.  The seemingly 2010 revision "(usually sufficiently severe  .  .  ,"  I guess is some improvement.  But I think it would help a lot to include things like the 2008 Concensus Statement, "  .  .  may or may not involve loss of consciousness.  .  "  And in general, I favor us finding and including a variety of good sources.  FriendlyRiverOtter (talk) 20:58, 15 June 2012 (UTC)
thread_title: Diagnosis section

message: I think there's a lot of benefit to the 2008 Consensus statement where they talk about a graded series of steps as far as reintroducing oneself to activities.  And they emphasize both physical rest and cognitive rest, including such activities as school and video games.  The graded series and the cognitive rest are two things a lot of people are not going to know, or only know partially, and we have an authoritative source backing them up.
I've read some doctors prescribe antidepressants after a stroke in an attempt to help a patient grow new nerve connections (not new nerve cells themselves).  I mean, what it is, is what it is.  Don't know if this works, don't know if physicians also prescribe antidepressants post concussion.  I do think depression is starting to get the attention it deserves as a serious condition and a treatable condition.  I've also read that the first antidepressant is not necessarily the one which will work for a patient, and that it's sometimes important for a person to step down from an antidepressant in phases even if the medication doesn't seem to be working.  Now, this is getting a little far afield, but I've heard depression mentioned often enough in the context of post-concussion, that I think it's valuable to include some of this information, provided we can find good sources.
Merck recommends aspirin or similar NOT be used for headache that if there's damaged blood vessels, can lead to bleeding. 
2008 Consensus Statement end material, Concussion injury advice:“  .  .  Use paracetamol or codeine for headache.  Do not use aspirin or anti-inflammatory medication  .  .  ”
Concussion, last full review/revision January 2008 by Kenneth Maiese, MD:"  .  .  For concussion, acetaminophen is given for pain. Aspirin or another nonsteroidal anti-inflammatory drug (NSAID—see Pain: Nonsteroidal Anti-Inflammatory Drugs) should not be taken because they interfere with blood clotting and may contribute to bleeding from damaged blood vessels.  .  "
Whereas our article currently writes:  "  .  .  Side effects of medications may affect people suffering the consequences of MTBI more severely than they do others, and thus it is recommended that medications be avoided if possible; . . ref name="McAllister02"/> there may be a benefit to avoiding narcotic medications. . . ref name="ropper">  .  .  "  Well, the obvious contradiction is that codeine is an opiate and thus arguably a 'narcotic,' and I don't know about paracetamol.  Of course, doesn't mean it's a bad thing.  Like any medication, properly used, under a doctor's guidance, can be beneficial.  And I think we should put at least a fair amount of weight on the 2008 Consensus Statement.
And then there's the whole dynamic aspect.  From Merck:  "  .  .  Repeated concussions may increase a person's risk in later life for dementia, Parkinson's disease, and depression.  .  "  From the Consensus statement . . . Zurich, November 2008:  "4.5. The role of pre-participation concussion evaluation  .  .  .  .  Questions pertaining to disproportionate impact versus symptom severity matching may alert the clinician to a progressively increasing vulnerability to injury.  .  .  ”
I take it, this rather technical formal language, what they're saying is if a football player or a hockey player gets another concussion from a smaller blow, wow, that's kind of a warning sign, a sign to ease back, to start enjoying your non-contact sports, and to give the contact sports a good.  Once again, the dynamic aspect, which needs to be a part of the conversation.
And what about the old school advice that after a head injury, a person should be watched, and the first night sleeping they should be woken up every 90 minutes (?) or so.  And then there's the tragedy which happened to the actress Natasha Richardson several years ago while skiing.  This may have been a different type of head injury, highlighting the importance of a clinician evaluating for a range of potential injuries. FriendlyRiverOtter (talk) 20:51, 16 June 2012 (UTC)
thread_title: Treatment section

message: Physicians must be brought up to speed on concussion risks, CMAJ News, Canadian Medical Association Journal (CMAJ), Jordan Fallis, Vol. 184 (2), February 7, 2012, (first published electronically December 19, 2011). 
"  .  .  .  Revisions to international concussion guidelines are also needed, the panelists argued [special seminar on concussions in hockey held at Scotiabank Place in December 2011]. The current guidelines were developed in 2008, when the Third International Conference on Concussion in Sport developed the Consensus Statement on Concussion in Sport, which lays out evidence-based guidelines for physicians, trainers and other health care professionals on how to treat concussed patients (http://sportconcussions.com/html/Zurich%20Statement.pdf). An update is expected to be released after a conference to be held in Zurich, Switzerland in November 2012." 
::So, when this comes out, we can read it and possibly incorporate parts of it into our article.  And at the same time, we can also look for other good sources.  FriendlyRiverOtter (talk) 18:47, 25 June 2012 (UTC)
thread_title:  International conference on concussion and sport scheduled for Nov. 2012 

message: I was just reading the source for this claim, and it doesn't convincingly show that (depending on what exactly is meant by 'psychological'). The author may believe this is true, but that would only justify saying something like "Some researchers are convinced that it has been shown that psychological factors play an important role in the presence of post-concussion symptoms."
Given the difficulty of meaningfully diagnosing PCS and the potential for confounding factors, I think that this claim needs to be more cautiously phrased. Evidence that, post-concussion, those with on-going symptoms are also likely to develop emotional or cognitive cannot really be used to claim that they play an important role in the presence of post-concussion symptoms, particularly given how little we understand as to what causes people to suffer from mental health problems.  — Preceding unsigned comment added by 87.115.186.110 (talk) 01:40, 9 November 2013 (UTC)
thread_title:  re: "It has been convincingly shown that psychological factors play an important role in the presence of post-concussion symptoms." 

message: the DSM V is out and it doesn't have "postconcussional disorder" in it.  so all references to that should either be removed, or adjusted to show that it is only in the DSM-IV (and maybe earlier).
i'd think this is obvious/factual enough, but if a source is needed:
http://www.acnr.co.uk/2015/04/postconcussion-syndromedisorder-or-mild-traumatic-brain-injury-diagnostic-issues-and-treatment/
or, to show that others were wondering about it:
https://www.researchgate.net/post/Where_did_the_Post-Concussive_Disorder_of_DSM-
Colbey84 (talk) 13:13, 27 November 2016 (UTC)
thread_title:  DSM V 

message: some of the sources are pretty old, especially for a medical article, and especially for a medical topic that has had a LOT of interest.
combining these older sources with the use of phrases like "most experts agree," "it has been argued," "it appears that," "it has been argued" (and others) makes this article appear slanted.  i mean, one of these sources is from 1995, and as was noted on this Talk page in another section, we should "use reviews from the last 5 or 10 years at most."
i don't have time to really dig into this (or into editing this page), but i note that others have shown quite an interest in this article, so maybe someone will find the time to work on this.  i did find some possible sources.  this one was mentioned before on this Talk page, but it was updated, so this is a link to the newer version:
"Military blast exposure, ageing and white matter integrity"
http://brain.oxfordjournals.org/content/138/8/2278
but the biggest issue with this article is now summed up by this: "A longstanding controversy surrounding PCS concerns the nature of its etiology..."
and then the way the rest of the article is presented (as i noted, with the above phrases).  i don't know for sure whether this is still a controversy, but my quick perusal of some of the following sources seems to indicate that it's not.  or not as much of one.
* "Postconcussive Syndrome in the ED" – Sep. 2016
http://emedicine.medscape.com/article/828904-overview
"While recent research has shown that psychological factors may be present early, other studies using imaging techniques such as magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), and magnetoencephalography (MEG) have demonstrated the presence of organic brain injury in patients with persistent postconcussive syndrome at greater than 1 year after injury."
* "Classification and Complications of Traumatic Brain Injury" – June 2016:
http://emedicine.medscape.com/article/326643-overview
* "Role of Pre-Morbid Factors and Exposure to Blast Mild Traumatic Brain Injury on Post-Traumatic Stress in United States Military Personnel." – Mar. 2016:
https://www.ncbi.nlm.nih.gov/pubmed/27027526
* "Traumatic Brain Injury (TBI) - Definition and Pathophysiology" – 2015:
http://emedicine.medscape.com/article/326510-overview
* "Prevalence of mental health conditions after military blast exposure, their co-occurrence, and their relation to mild traumatic brain injury." – 2015:
https://www.ncbi.nlm.nih.gov/pubmed/26479126
* "Mild traumatic brain injury and postconcussive syndrome: a re-emergent questioning" – 2012:
https://www.ncbi.nlm.nih.gov/pubmed/22980474
* "CURRENT CONTROVERSIES IN TRAUMATIC BRAIN INJURY" – 2011:
http://www.aqua.ac.nz/upload/resource/Current%20controversies%20in%20traumatic%20brain%20injury.pdf
* "Mild traumatic brain injury (concussion) during combat: lack of association of blast mechanism with persistent postconcussive symptoms." – 2010:
https://www.ncbi.nlm.nih.gov/pubmed/20051900
* "Experience with mild traumatic brain injuries and postconcussion syndrome at Kandahar, Afghanistan." – 2010:
https://www.ncbi.nlm.nih.gov/pubmed/21181651
this page has MANY sources on it (and an interesting discussion).  but one of the participants noted that the following 5 sources were directly related to this controversy:
How soon can the demyelinating process start in mild traumatic brain injury?:
https://www.researchgate.net/post/How_soon_can_the_demyelinating_process_start_in_mild_traumatic_brain_injury
Stapert et al 2006 http://arnop.unimaas.nl/show.cgi?fid=4933
Silver et al, 2009 http://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2009.08111676
Bigler, 2013a http://journal.frontiersin.org/article/10.3389/fnhum.2013.00395/abstract
Le et al 2008 http://online.liebertpub.com/doi/abs/10.1089/neu.2008.0566
Spencer et al 2010 http://online.liebertpub.com/doi/abs/10.1089/neu.2008.0566
Colbey84 (talk) 13:39, 27 November 2016 (UTC)
thread_title:  2016 - this article needs some serious updating 

message: Decided i should probably put this is a separate section, as i noted in the "Dubious" tag there would be one.
It's not so much that i think a Merck online manual is "dubious," but that i thought the way it was being used was.  As in, for a sentence talking about malingering and, basically, people lying about their medical symptoms to get a benefit in some other way, the source was a Merck manual that discussed PEDIATRIC PCS.
AND...that Merck page is no longer available.  So it can't even be perused to see if Merck truly asserted that children were claiming they had concussive symptoms so they could get a check from someone.
I did find 2 available Merck pages, but didn't change that reference because i was unsure what the intent of the original author was.
* Merck Manuals, Professional version, Traumatic Brain Injury
http://www.merckmanuals.com/professional/injuries-poisoning/traumatic-brain-injury-tbi/traumatic-brain-injury
* Merck Manuals, Consumer version, Concussion
http://www.merckmanuals.com/home/injuries-and-poisoning/head-injuries/concussion
Colbey84 (talk) 13:46, 27 November 2016 (UTC)
thread_title:  Merck manual as source 

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thread_title:  External links modified 

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thread_title:  External links modified 

message: Yesterday I added a paragraph to say:
:Recently hyperbaric oxygen therapy has been found to help the brain recover. Patients were treated with pure oxygen at a pressure of 2 atm absolute in a series of 40 one-hour sessions.
This was promptly reverted by User:Sciencewatcher with the comment that the study had no control and that a controlled study of 2012 found no effect. So I reverted back to my versioin with the comment that he should read the reference in New Scientist. Now he has reverted that again saying that New Scientist is not a reliable source for medical information. I doubt that he read the article, because rather than making medical claims, it quotes Lindell Weaver, the author of a study in 2015 which concluded that hyperbaric oxygen therapy was no better than a sham treatment. He admits that the "sham" treatment did involve putting people into a hyperbaric chamber, so actually they were getting a higher-than-normal oxygen pressure, and that "the burden of evidence is starting to suggest there is a favourable effect". The New Scientist article also says that in the new research they could see that the hyperbaric oxygen therapy caused regrowth of blood vessels and nerve fibre in the affected region of the brain. This would not happen in a sham treatment. This is in the "reliable source" in the second reference I gave. But I object to excluding a source like the New Scientist article on the excuse that the magazine is not a reliable reference. Can Sciencewatcher deny that Weaver said the above, just because it's in New Scientist rather than the Lancet? Let's not be slaves to technicalities. Let's try to give readers the most up-to-date information on what's going on in this field of research! Eric Kvaalen (talk) 07:44, 12 November 2017 (UTC)
replies: text: If you read WP:MEDRS it explains why we don't use sources like newscientist for medical information. Also, your argument doesn't hold water. We know that psychological treatments do in fact cause changes in brain structure. If the hyperbaric oxygen had an effect, you would expect it to be dose dependent, so having mildly elevated pressure would be a valid placebo. That's why we don't use sources like newscientist, because they don't rigorously examine the science. --sciencewatcher (talk) 16:30, 12 November 2017 (UTC)
replies: text: I find it very frustrating that whenever I add some interesting or potentially useful information to an article like this, someone who has a "watchpoint" set on the article comes along within minutes and, because he has never heard the information before or thinks it's nonsense, reverts my changes. They always cite backup from this or that Wikipedia policy. These people always get the last word, because no one else pays attention, and you can't just revert or you'll be accused of waging an edit war. But Wikipedia policy can be cited both ways. There's a policy saying that we should use second- or third-hand sources rather than first-hand sources because the former show that something is significant and accepted by a wider group than just the researchers. So for example, my New Scientist article says that one of the researchers who hadn't found an effect is now admitting that there probably is an effect (not just placebo). But then Sciencwatcher says that New Scientist is off limits, so we can't even mention this interesting line of research! I'll bet that in a few years it will be clear that hyperbaric oxygen therapy does work and it will be used all over the world. By the way, even if it were a placebo effect, it would be worth doing! Eric Kvaalen (talk) 09:33, 15 November 2017 (UTC)
replies: text: Look, it's nothing to do with me. Feel free to re-add your change and I won't revert it (but someone else probably will, as it is a clear violation of MEDRS). I would suggest you read up on MEDRS and see why we rely on peer-reviewed secondary sources (which new-scientist isn't). --sciencewatcher (talk) 17:22, 15 November 2017 (UTC)
thread_title: Hyperbaric oxygen therapy

message: Hi  thanks for all your hard work to improve this article. I reversed your edit for now, but it is still archived. Do you mind adding your suggestions here so we can go through them slowly and ensure that all the content is appropriate for Wikipedia before adjusting the article live? I encourage you to also speak with your instructor and consult WP:MEDRS to help determine which sources are appropriate for Wikipedia. This is a tough topic to edit on. You may need to use your instructor as well to help you interpret the secondary study papers that you find. Concussion research is evolving rapidly (and is super interesting), basically anything pre-2017 is outdated. Thanks so much. It is great to see new editors here, we hope that you stick around and help improve the article! JenOttawa (talk) 23:03, 1 December 2021 (UTC)
replies: text: Pinging  here as well from Wikieducation. The folks at Wikied are excellent at helping students and have a ton of great resources.JenOttawa (talk) 23:07, 1 December 2021 (UTC)
thread_title:  Suggestions to improve the article 

message: I was bold and removed a small paragraph on chiropractic methods as it was based on one case series report. Here is the removed text (pasted below. If anyone has ideas for how to improve this section with higher quality sources that meet MEDRS please add in. 
 Upper cervical care 
 Post-concussion syndrome can sometimes be the result of a misalignment in the upper cervical spine (neck) specifically the C1 (Atlas) or C2 (Axis) which surround the brain stem. Some individuals have found relief through upper cervical care. An upper cervical chiropractor is a specialist who uses x-rays to identify misalignments in the upper cervical spine then gently repositions the top two bones of the neck. There are currently approximately seven different chiropractic methods of repositioning the C1 bone, however the three most popular techniques are NUCCA (adjustment done by hand), Blair Technique (adjustment done by hand), and Atlas Orthogonal (adjustment done by a machine).
  
JenOttawa (talk) 17:36, 19 July 2023 (UTC)
replies: text: if you disagree with this please reach out or discuss here. Happy to work together to improve this article and leave in if we can find higher quality sources.JenOttawa (talk) 17:40, 19 July 2023 (UTC)
replies: text: There is one recent systematic review here that I just found sharing evidence on non-pharmacological whiplash treatment and mTBI. . The 6th Consensus on Concussion in Sport would also be helpful for improving this article as they have a recommendation that is based on expert consensus and the results of their systematic review on interventions. JenOttawa (talk) 17:52, 19 July 2023 (UTC)
replies: text:  Hi JenOttawa. I apologize for the revert, I had no idea about the weak source, thanks for pinging me and letting me know about this. I was a bit confused on why the IP left no edit summary (which i mistaked for an unexplained deletion). Cheers, Dinoz1 (chat?) (he/him) 18:10, 19 July 2023 (UTC)
replies: text: Hi  no problem at all. I am not sure who the IP was either, the edit just caught my eye so I checked the source.  I felt badly removing it right after you put it back in, it was not my intention! Have a terrific day! JenOttawa (talk) 18:23, 19 July 2023 (UTC)
thread_title:  Section on upper cervical care