By: Dr. Irina Fedulow Plante, PT DPT, Board Certified Neurologic Clinical Specialist, RYT 200

Seeing the beauty of fresh powder, breathing in the crisp air and waxing your board or skis excites many
of us gearing up for the winter season. One of the last things any of us think about is a concussion or brain
injury. While this sounds daunting, the information provided in this blog is meant to educate, not scare you.
The more knowledge you have, the better prepared you will be no matter what life or the mountains throw
at you.

Our brains are made of delicate tissue suspended and bathed in fluid (cerebrospinal fluid) that provides a
protective environment against gravity and unexpected movements. A traumatic brain injury (TBI) is
described as a sudden and violent blow to the head that can result in an array of different symptoms (see
the list below). The severity of a TBI is classified on degree of loss and alteration of consciousness, grading
on the Glasgow Coma Scale and post-traumatic amnesia (the ability to recall events before, during and
after the event). Lastly, imaging doesn’t always represent the extent of injury due to potential
inflammatory responses and injury at the microscopic level, especially within the first 24 hours. Symptoms
can last days to months or even years depending on many factors ranging from extent of injury, access to
support, gender, age, timeframe obtaining treatment and several other things.

Research has shown that females tend to have more severe and persistent symptoms. The theory behind
this is that women have less pronounced neck muscles to support the brain, smaller heads resulting in less
dispersion from external forces, hormonal fluctuations due to menstruation and lastly, we are more likely
to report symptoms when comparing to males. ⁵ Here are some of the most typical symptoms seen with a
TBI 3 :
1. Headache
2. Nausea or vomiting
3. Loss of balance
4. Disorientation
5. Visual changes (double vision, blurriness or
6. dilated pupils)
7. Confusion, agitation or other mood changes
8. Loss of consciousness
9. Lightheadedness or dizziness
10. Slurred speech
11. Fatigue
12. Sensory sensitivity (to light, sound, etc.)
13. Pain
14. Muscle weakness
15. Convulsions or seizures
16. Changes in the menstrual cycle

So what to do after sustaining a TBI. Old research stated to rest with lights off and no stimulation for at
least 1-2 weeks. We now know that this will most likely hinder progress. While it’s important to rest and
recover, gradually reintroducing activities is critical. Your neurologist and occupational/physical therapist
(find one that has a lot of experience with TBI) will be able to help you determine what your physical and
mental starting point is and progression during recovery.

Some of the key things focused on during rehabilitation will be monitoring symptoms, gradual
desensitization of symptoms, exercises ranging from aerobic, mobility and strength training, visual,
vestibular (inner ear) and proprioceptive exercises, balance exercises, energy conservation techniques, pain management and other pertinent exercises geared toward recovery. It would also be encouraged to speak
to a mental health specialist to help with stress management, address behavioral and emotional changes
and provide calming techniques to resume prior activities when appropriate. You should always ask your
medical provider for the activities and exercises that are most beneficial for you. Every individual presents
differently, so there isn’t one specific protocol for traumatic brain injuries.

Partaking in outdoor and backcountry activities ultimately means more risk, but there are ways to help
reduce the likelihood of a brain injury:
1. Check your helmet. There shouldn’t be any cracks, soft spots or loose parts. It’s advised by the
Consumer Product Safety Commission to purchase a new helmet every 5-10 years depending on its
usage. 2
2. Prepare, prepare, prepare. Look over all your gear and know how to use it properly. Taking an
avalanche preparedness class or something related to what you’re doing is strongly encouraged.
Always keep up to date with the weather conditions and prepare for the unexpected.
3. Try not to go alone. The wilderness is unpredictable so go out with a group or a buddy. Know your
level of expertise and technique and what terrain you’re comfortable navigating safely.
4. Train properly. Make sure you are performing exercises and activities pertinent to your sport. Not
training appropriately greatly contributes to your injury risk. There is a great webinar called
“Prerehab to Backcountry Skiing and Snowboarding” on outdoorwomenswellness.com to help get
you going. If you are unsure of your training, seek out the advice of a physical therapist who is well-
versed in your sport of choice.
5. Reflect on your mental space. Mental fatigue can lead to burnout (both physically and mentally)
leading to more injuries and decreasing your reaction time, which isn’t an ideal combination.
Engage in meditation, mindfulness or activities that bring you joy to help reduce stress before going
outdoors.

What if you’re not sure if you or your buddy had a brain injury??? Brain injuries greatly vary in severity and symptoms may not show up initially; they can develop gradually or rapidly in hours or days later. Some
symptoms to look out for are visual changes, disorientation, unable to recall information, nausea or
vomiting, clear discharge from nose or ears, headache and dizziness. This is not a comprehensive list of
symptoms. If something feels off, get help as quickly as possible. Also, do no attempt to go higher in
altitude if you suspect a brain injury.

Remember that a brain injury means that your brain is now working on half a tank of gas, meaning you will
need time to recalibrate and adjust to a new normal way of living as you recover. Things may take longer to
complete or you may need to take more rest breaks during daily or recreational activities. Every brain injury
is different and it’s important not to compare what you hear about a friend of a friend or see on social
media. It’s important to get the proper care and support as you recover. The research has shown over and
over again, getting treatment earlier significantly helps improve future outcomes, so don’t delay if you
experienced a brain injury or suspect one no matter how mild you think the symptoms are. ⁸

Lastly, in the past five to seven years, here has been a momentous shift focusing specifically on how
females are impacted by traumatic brain injuries. Small studies have shown that the menstrual cycle can
possibly impact the severity of the brain injury; for example, if a female is in the luteal phase (greater levels
of progesterone) during the injury, there is a higher chance of more prominent symptoms versus while in
the follicular phase (greater levels of estrogen)e. ⁹ Neuroimaging studies show females have brain cortexes
(the outer layer of the brain that plays a role with the majority of neurologic function) that are typically 6% thicker than males. ⁶ However, after sustaining a brain injury, there is more thinning in that region in
females leading to more emotional, physical, cognitive and sensory changes. Research is also looking at
axons (often called the “electrical grid” and thinner than a piece of hair), the long thin cablelike structures
that send messages from cell to cell throughout the brain. Researchers have observed that females have
thinner axons than males, which indicates more sensitivity to damage when comparing to male
counterparts.

It’s encouraging to see that the health and wellbeing of females is becoming more addressed within the
medical field, with more organizations emerging to better bridge the gap between male and female health.
for females. Always trust your instinct and strive to be the best advocate for yourself.