Do not knock yourself out! Brain injury and brain health

00:00:03: Welcome to the Brain Health Mission Podcast, exploring how science policy and everyday choices shape the health of your brain.

00:00:10: And what you can do.

00:00:33: In today's episode we are talking about one of the biggest risk factors for reduced brain health, namely traumatic brain injury.

00:00:42: And joining me is Professor Hakan Ashina.

00:00:46: before we start talking why should try to avoid exposing our brains a serious injury organ?

00:00:53: Is there something you could tell the audience who YOU ARE and WHY this topic matters so much to

00:01:01: you?

00:01:01: Thank you, Yana.

00:01:02: It's a pleasure to be here and thank you for the invitation.

00:01:05: I'm a physician scientist working in neurology with much of my research focused on traumatic brain injury In particular post-traumatic headache or often referred to as headache after concussion.

00:01:18: What fascinates me about this field is the gap between how we traditionally describe these injuries And how patients actually experience them.

00:01:28: We use a term such as mild traumatic brain injury.

00:01:31: The word Mild describes the initial clinical presentation, it doesn't guarantee mild biological injuries and certainly does not guarantee a mild outcome.

00:01:42: that distinction matters because you can have normal imaging scan walk out of the emergency department look completely well and still have headache, dizziness, fatigue cognitive difficulties an impaired function weeks or months later.

00:01:59: So for me this is not simply a trauma medicine.

00:02:03: it isn't in fact you could say brain health across the life.

00:02:08: You already took us great into the theme of today but before we go little further into the topic I just wanted to ask Do you have any personal experience with brain injuries?

00:02:20: Because me, for instance one of my children went through a mild concussion once.

00:02:26: He had actually a jumping competition where this older brother... very bad idea!

00:02:31: The mother was turning her back on them because I needed to get dressed before getting out with him and then he fell from the staircase into a slipper of veranda And then he, of course hit his head.

00:02:45: He had no loss of conscience and I was extremely happy for that have to say but... ...he had a headache and he was vomiting.. ..and i was very scared.

00:02:56: as an neurologist mother you know all these things coming together.

00:03:00: we went to the hospital.

00:03:02: at first he was quite meek , he was very tired.

00:03:05: Then he started suggesting jumping competitions with other children at The Ward and realized this is going to go Very well.

00:03:14: He's not very hard injured, but do you have any personal experience yourself for your children?

00:03:20: Well actually I've very much experienced the same.

00:03:23: so a concussion in relation to a fall and The symptoms were sort of again just classical ones headache A little bit dizzy a little bit fatigue And then fortunately it also passed.

00:03:38: all of the symptoms remitted within a few days.

00:03:41: But my thinking is not only shaped, you could say by- My own experiences but also what I see clinically and scientifically.

00:03:48: Many do remit spontaneously... ...but in others it does persist And i think your son's story Is a very good one.

00:03:58: The same with mine As we did not lose consciousness Yet We had symptoms suggestive of a concussion.

00:04:05: That s exactly why loss of consciousness is such a poor gatekeeper For whether we take a head injury seriously, I mean you don't have to be knocked unconscious for the brain to have been injured.

00:04:19: The bigger question is... So it goes through your point right?

00:04:22: Is the person becoming more like themselves or less so?

00:04:26: and that's often more informative than one isolated symptom.

00:04:31: That interesting because what actually traumatic brain injury and you already made it harder for us, me as a listener.

00:04:41: Usually the loss of consciousness is what we are thinking about on the soccer field or whatever.

00:04:45: but then again... We knock our heads if not all times during our lives.

00:04:53: You want to get something in your kitchen so that you don't see an open car board when you race up and then you knock yourself and it hurts with this only something that is passing by, or should I take it seriously?

00:05:08: and so on?

00:05:10: And if that were the consciousness can't be sort of counted upon.

00:05:13: So what actually qualifies then as a traumatic brain injury?

00:05:19: What specific signs symptoms or circumstances determine whether its just... Something happens like you squeeze your finger You knock your head Or If It's Traumatic conscience that we shouldn't take data as the one and only sign, so what would you say?

00:05:39: What does it take to be

00:05:40: traumatic?".

00:05:41: There have been many definitions over these years.

00:05:45: The simplest definition I would say is a traumatic brain injury or TBI for short sort of an alteration in brain function or evidence of brain pathology caused by external force.

00:05:58: And there are two parts.

00:06:03: First, there has to be a plausible mechanical event.

00:06:07: The head is struck and the head strikes something or forces transmitted through the brain from rapid acceleration, deceleration of rotation for example during motor vehicle accidents.

00:06:20: And second... There have been evidence that not simply the scalp or skull has been affected.

00:06:28: That evidence might lose consciousness but it might instead be amnesia, confusion disorientation, snow responses neurological abnormality or characteristic acute symptoms headache dizziness etc.

00:06:45: Or could also be structural injury and an imaging.

00:06:48: so to take sort of your example if I for example hit my head on a cupboard say ouch!

00:06:56: But i remain completely normal afterwards It's not automatically a traumatic brain injury, right?

00:07:02: So the trauma is not the diagnosis.

00:07:05: The effect I would say on the brain Is the diagnosis and modern diagnostic criteria sort of reflect that principle.

00:07:13: Well, that's interesting that it's also trauma itself its affected house upon your brain.

00:07:19: Did i understand?

00:07:20: yes Interesting.

00:07:21: so If you have children like mine, they are grown-ups now but there used to be extremely active boys and I would run after them all the time.

00:07:30: if your child is falling off a swing or if yourself... You're riding bicycle then of course we had helmet on!

00:07:39: We still can fall in Scandinavia it's slippery for instance.

00:07:46: what are red flags?

00:07:51: Be aware of after such an injury in yourself or somebody close.

00:07:59: Several things, right?

00:08:00: Loss of consciousness is the most obvious one.

00:08:03: if it's there you should be aware.

00:08:05: but a person can as we just discussed remain awake throughout entire event and still have a concussion.

00:08:12: so You have to pay attention whether for example child feels dazed confused behaving somewhat differently.

00:08:21: They might have a gap in their memory or they may complain of headache, dizziness, nausea.

00:08:27: Also sensitivity to light and noise.

00:08:30: These are very traditional and prevalent symptoms.

00:08:34: In fact the modern definition of maltraumatic brain injury explicitly includes presentations without loss of consciousness.

00:08:44: And that's again where language really matters.

00:08:47: I mean mild means certain acute severity thresholds were not crossed.

00:08:53: It does not mean that it's imaginary, doesn't mean that is trivial.

00:08:57: So so that sort of important to assess.

00:09:00: and the way you could ask Going beyond did your blackout this?

00:09:06: what changed after they impact?

00:09:08: You know where are you confused?

00:09:09: Did you lose part of your memory that headache or nausea begin when you're sort of unsteady?

00:09:17: Did somebody notice that you were behaving differently?

00:09:21: That's a much better neurological history going just beyond whether or not they blacked out.

00:09:27: Yeah, but then again what is the time span we are talking about?

00:09:31: I mean i fall off of The bike and Then I get to myself.

00:09:34: it hurts in my head.

00:09:36: when would I?

00:09:38: When Would I expect the symptoms To come?

00:09:41: how one should I ask mother be aware Of the symptoms In my child with A arise immediately?

00:09:47: or do I have to look at the situation certain hours?

00:09:53: In most instances, symptoms would occur within twenty four hours.

00:09:57: Right but some symptoms might my first you know come to light a couple of days later Or you may not realize them at first especially in children.

00:10:08: that can be very variable.

00:10:10: So so i would say in general symptoms do occur almost immediately after impact or within twenty four to forty eight hours, but in some instances you do see later onset of symptoms.

00:10:23: So as a parent the first twenty-four to forty-eight hours are most important ones and then afterwards he would sort of assess continuously let's say for a week or so.

00:10:38: But it is often very clear those who develop more persistent symptoms and their acute symptoms are more pronounced as well.

00:10:47: There's pretty solid evidence to support that, but it is sort of a rule-of-thumb.

00:10:52: It isn't an absolute rule!

00:10:55: But it's nice to have rules of thumbs though.

00:10:57: so I mean... To say the listeners that blackouts shouldn't be the only thing they should look after?

00:11:03: Is there change in behaviour or in remembrance where these are very nice Science that you should look for in case.

00:11:13: You are worried of course

00:11:15: and if your word I mean the key sort of point is deterioration, right?

00:11:20: So it's there For example increasing confusion or drowsiness repeated vomiting or progressively severe headache seizure worse cases a new weakness or focal neurological science Or a child becoming let's say increasingly unlike themselves I mean, those situations they warrant urgent medical assessment.

00:11:44: So in children you could say that clinicians deliberately use certain let's say decision rules rather than scanning everybody because the CT scan itself involves radiation.

00:11:57: so... The goal from a clinical standpoint is to identify small group at meaningful risk without exposing every child with a bump on the head, so unnecessary imaging.

00:12:12: No true!

00:12:13: You shouldn't X-ray all of children.

00:12:15: that falls off their swing because then they x-ray departments had to be full.

00:12:21: but you have to be aware of deterioration.

00:12:24: I think if somebody is like you say behaving strangely becoming more perhaps apathic I mean slow.

00:12:33: these are signs to look for And I think it's a very good advice to be aware of the acute situation, but also especially in children too observe.

00:12:44: The next day for instance... In daily life, when we talk about traumatic brain injury and blackouts.

00:12:55: Sometimes at least not always but sometimes you think of knockouts in the boxing area... ...and all these things having been knocked out too many times that might get to a traumatic brain-injury like you suffer from for rest of your lives etc.

00:13:11: But there are obviously other risks except for boxing or MMA where you're hitting deliberately at the head, that imposes a risk to us in everyday life.

00:13:24: Are there situations where you think people should have protected their brains little better?

00:13:30: I mean let's say less dramatic answer and probably more important one is false particularly as populations age.

00:13:40: As you mentioned we naturally think about boxing rugby or high-speed car chases because they're usually dramatic but in many countries ordinary falls on stairs and bathrooms, on ice from ladders or bicycles represent a major part of the traumatic brain injury burden especially for older adults.

00:14:04: Alcohol also matters because it creates exposure to falls and road trauma.

00:14:10: cycling very popular e-scooters.

00:14:14: Yeah, we're getting to that.

00:14:16: They also matter because and speed converts let's say an ordinary loss of balance into a high energy event which is very important when you ask trauma physicians right?

00:14:28: And sport matters not only because of diagnosed concussion but because as you said some athletes they accumulate large numbers of repetitive headaches impacts over the years.

00:14:41: So I would say that the everyday principle is simple, right?

00:14:45: Risk is sort of force maybe multiplied by exposure.

00:14:50: If you reduce either one You also reduced opportunity for injury and in fact The Lancet Neurology Commission Specifically identifies road safety fall prevention an older adults and reduction of head impact exposure and sport a sort of major prevention targets for traumatic brain injuries.

00:15:14: We're getting into the e-scooters and the prevention, little later.

00:15:17: here is one... I have to say i'm very annoyed by their e-scooters especially when we see head injuries in young ones.

00:15:26: but if you come back today i can read it before i get into that educated!

00:15:31: If we talk about effects on traumatic brain injury or brain health How does it matter to have a traumatic brain injury?

00:15:40: What consequences does it have here and now, for instance on cognition.

00:15:46: And the risk of dementia in later life if you become... If you had a traumatic injury as a teenager for instance.

00:15:57: It's great question right.

00:15:59: answer important questions from the field.

00:16:03: what are the long-term consequences, especially the cognitive or neurodegenerative ones.

00:16:08: I would say we know enough to take it seriously but not enough to be deterministic.

00:16:15: and that's an important distinction because after traumatic brain injuries some people will develop persistent headache fatigue sleep disturbances mood symptoms limitations in work daily life.

00:16:32: That's very widespread.

00:16:34: But I would say that when a brain injury occurs, for example in the child The question is not simply what function was lost today right?

00:16:43: It sort of goes to your point like the brain still developing.

00:16:46: so we're also interested and whether they the Injury changes are developmental trajectory And we actually do know that more significant childhood brain injuries can affect cognition and function.

00:17:00: What we know much less precisely I would say, is how a single childhood concussion or let's say cumulative exposure to repeated head impacts will translate into risk thirty-forties of sixty years later.

00:17:16: Those studies are as you can appreciate extraordinary difficult to conduct.

00:17:22: You need decades of observation and excellent information on the original exposure while accounting for genetics, education environmental factors alcohol sleep.

00:17:37: There are many other determinants of brain health.

00:17:40: so I'd say that the answer is there's a signal worth investigating but also major uncertainty and good science actually requires us to save both.

00:17:54: Yeah!

00:17:56: And i think it's good.

00:17:56: you need be open.

00:17:57: we'll see huge resources in the juvenile brain so that it can compensate and you can have other networks taking over for those who are injured, etc.

00:18:13: The Lancet Commission has identified traumatic brain injury as one of risk factors for dementia probably as you say its intertwined with environmental factors.

00:18:28: If you are under the influence of drugs or alcohol and get your brain injured, and still use drugs and alcohol then of course have an added risk together.

00:18:39: You can have a brain that's much more vulnerable And so on...

00:18:44: One of other issues is also across traumatic brain injury studies we had many different populations being investigated right?

00:18:55: We cannot necessarily compare them.

00:18:57: There's one line of research focusing on civilians, right?

00:19:01: Another one focussing on military populations.

00:19:05: And then there are a lot of studies on athletes and the type of injury, their exposures

00:19:12: etc.,

00:19:13: they're all very different.

00:19:15: so it is very tricky even among let us say civilian population.

00:19:23: you have some.

00:19:23: which primary care?

00:19:25: where the setting is the primary care, right?

00:19:27: Others were it's the emergency room and again.

00:19:30: It's very different Right.

00:19:32: who goes to the emergency Room And Who Just Goes To Primary Care After A Couple Of Days With Some Lingering Symptoms.

00:19:39: So It Makes It Very Tricky.

00:19:42: But I Would Say That There Is Great Progress In The Field Especially with These Huge Multicenter Studies.

00:19:49: We Have This Center TBI Study in Europe And we have the track TBI study in the US, which has greatly advanced.

00:20:01: That is cool and that also helps of course like you say to sort out what's caused by traumatic brain injury?

00:20:10: What are other factors responsible for?

00:20:18: We come now to the myth busting section on this podcast.

00:20:24: We ask our guests if they have any favorite myths, or we

00:20:30: ask

00:20:30: questions in order to sort out things that people tend to believe.

00:20:36: Or events that are happening and we wonder on our podcast for the rational... behind this.

00:20:45: And I'm am as a soccer mom, i had two boys playing very much soccer and you know as a neurologist when they were doing the heading...I was standing there saying no!

00:20:54: No!

00:20:54: No!!

00:20:55: Oh ha!

00:20:56: I still remember by other mums that for sort of.. I always see my goosebumps when I saw all these hard balls coming out from anywhere.

00:21:09: so In some countries, they actually have prohibited younger children to hit the ball in soccer because of their risk for injury.

00:21:18: And other countries' coaches and soccer organisations say that this is exaggerated.

00:21:24: but also it's a matter of learning to meet the ball – my son has told me as well!

00:21:31: That being prepared means having muscular strength in the shoulders and not to let the ball fall on your head, but to sort of jump onto the ball when you are doing either a heading thing or so forth.

00:21:46: What do you as an expert think is heading something that should be avoided especially for smaller children?

00:21:53: Or does it just matter meeting

00:22:05: from what has actually been demonstrated scientifically, right?

00:22:09: So technique obviously matters in sport.

00:22:13: Preparation matters and muscular control probably matters but we don't really have strongly evidence that teaching a young child to meet the ball correctly makes let's say repetitive head impacts biologically irrelevant.

00:22:30: And although neck strength has often been sort of suggested as protective I wouldn't say that the evidence is sufficiently strong for us to say, that stronger neck muscles eliminate their risk.

00:22:44: Right?

00:22:44: So...I don't think at this stage one could reassure a parent by saying The child simply needs better technique.

00:22:53: That goes beyond the evidence we have.

00:22:56: But i would also avoid opposite exaggeration.

00:22:59: A football header Is not automatically a concussion.

00:23:04: One might be worried, but in most instances a concussion won't follow.

00:23:09: The concern is more so that the cumulative exposure and let's say unnecessary exposure particularly in developing brain of children.

00:23:19: And that leads us to think you know what is a sensible precautionary principle right?

00:23:25: I would say that children they can receive all the extraordinary physical psychological and social benefits of football or soccer, if you prefer without needing a large amount let's say repetitive heading practice at very young age.

00:23:44: So my take would be that reducing the exposure while your brain is developing it entirely reasonable and sensible.

00:23:55: I follow completely what you are saying.

00:23:59: age limit or that it could be advocated to other age limits like they have in some countries.

00:24:05: ten years, twelve years and I mean we have the same for a lot of things in our society to drive a car for instance.

00:24:13: To drink alcohol which is definitely not helping you but it might be nice having social settings now and then.

00:24:21: so yes because you are telling us about the cumulative effect.

00:24:25: that means that it adds up.

00:24:27: all the small injuries during your life might add-up one bigger for instance.

00:24:34: And to be honest, it's not as if... It is an entirely new thing.

00:24:39: If you think about sports martial arts in particular often any kind of contact sport there are certain restrictions In the junior ranks so that they don't have full contact Which makes a lot sense because You want minimize potential damage in developing brain.

00:25:03: Super.

00:25:03: That was very interesting and we got the answer to a question that is quite hot, I have to say at least among the soccer parents!

00:25:13: So it's good for you all soccer players out there or parents too future or present soccer players?

00:25:21: Maybe you should also look at whether your country supporting an age limit.

00:25:26: In this last part of our podcast talk, we talked about practice and practical tips.

00:25:41: How to prevent in a personal life getting an injury but also what you can do if you get the head injury?

00:25:52: Maybe I should take that first... If i would be so unlucky to fall off my bike and injure and would have them, they'd say to me in hospital

00:26:04: or

00:26:04: at the practice of the general practitioner that I had a concussion.

00:26:09: What should i then do with an acute phase?

00:26:12: And we don't think...I dont' have bleeding or something serious like this but I do have a concusion!

00:26:20: The general recommendation is you have some rest from the initial phase typically around a forty-eight hours, and then if your symptoms remit you might be good to go.

00:26:34: Then what we often say is should you have some lingering symptoms?

00:26:38: You can sort of gradually increase activity as long these symptoms do not worsen in their intensity or the disability that they cause.

00:26:50: And again most instances fortunately the prognosis In most instances, post-concussive symptoms they do remit spontaneously.

00:27:01: We don't have a complete understanding of why these symptoms... They remit in some and go away And others persist.

00:27:10: But the old days' recommendation was you just need to rest You must lie on your bed Stay there for long.

00:27:18: Now science has fortunately shown us that's not right way.

00:27:24: So it is again some rest in the short term, let's say for a first couple of days and then you gradually return to your sort-of normal activity as long as your symptoms permit right?

00:27:37: And if in doubt always I mean contact your physician for advice.

00:27:44: I often especially recommend trying avoid being on PC or mobile or look too much television because these are very potent stimuli, you know?

00:27:58: They can also be aggressive with the light and sounds.

00:28:04: I would say it's difficult to get patients to adhere there!

00:28:08: Yeah that is true!

00:28:11: The easiest thing then when... children because then the parents are taking care of that.

00:28:16: But it's true, so much true.

00:28:19: I mean we live so much our lives on the internet and social media too.

00:28:24: but still i see from a neurologist perspective its better to read a book you can look at your books than put them aside whereas social medias have a tendency do stay there for long Yeah.

00:28:42: Also to your point, I mean people who experience a concussion.

00:28:48: they are more sensitive to sensory stimuli such as light sound right especially the sharp and intense stimuli.

00:28:59: so it makes a lot of sense to recommend.

00:29:03: but i would also say that patients tend to realize once They quickly figure out that they're concussed and have these symptoms, post-concussive symptoms.

00:29:15: That it actually kind of exacerbates, worsens their symptoms right?

00:29:19: Yeah!

00:29:19: It's not worth it!

00:29:23: True... What do you then, Hakan to take care off your brain?

00:29:27: are there any tips that can give the listeners?

00:29:30: Well I wish i had something fancy.

00:29:34: but often this is very simple.

00:29:37: on glamorous things regular physical activity, good sleep taking your let's say cardiovascular health seriously not smoking.

00:29:48: and I mean when it comes specifically to trauma you could do some very basic things.

00:29:54: Wear a seat belt wear an appropriate helmet.

00:29:58: when cycling avoid one possible combinations of sorts speed and impair judgment.

00:30:07: but i think there is also Sort of an important philosophical point here, right?

00:30:12: Because protecting your brain health shouldn't mean that you become afraid of living.

00:30:17: Right because exercise is good for the brain sport Is good for their brains cycling as well.

00:30:23: when children should play older adults Should remain physically active.

00:30:28: so The goal cannot be zero risk.

00:30:32: but I would say that the goal should be intelligent risk reduction.

00:30:36: You keep the benefits and you remove the avoidable injuries.

00:30:42: I think that's... ...the fine line we have to

00:30:45: find.".

00:31:08: but that's part of it and its better than being passive, definitely.

00:31:13: But still we have to in the last minutes of this podcast address the e-scooter thing because I live in Norway And i'm quite annoyed when my colleagues at the new research department are telling me they get injuries from young children almost all night especially on weekends Also in Germany, a country where I newly read the statistics.

00:31:38: They have huge number of people who are actually dying from accidents on e-scooters and most of them under twenty five.

00:31:48: So this is the future that is sort of injuring themselves when you think about the E-Scooter thing... One thing is that they ride together, but you also see the neurosurgeons explain to me... ...that fall is so much graver than from a bicycle.

00:32:05: You're standing quite tall and your head is quite heavy when it stops or you crash into something then you really fall on your head not wearing a helmet!

00:32:16: Do you agree with me?

00:32:17: That the e-scooter things should be more regulated...?

00:32:20: And this probably isn't the risk society should be so lax about taking?

00:32:26: I do agree.

00:32:27: whether politicians will listen and legislate is of course another question but in principle, we've had the same issue this summer.

00:32:38: And it goes to your point.

00:32:40: that way they're seated... ...but also their speed by which the bike or e-scooter is going creates a lot of issues if they ride while impaired due to alcohol otherwise.

00:32:56: So I would always recommend a let's say properly fitted helmet for those kinds of activities, but again whether it should be Legislated that should be mandated.

00:33:09: That you have to wear one and obviously given my background I will say so.

00:33:15: Whether others agree?

00:33:17: I don't know.

00:33:18: But I do think it's important to say that We have to remember what protective equipment can and cannot do, right?

00:33:27: A helmet meaningfully reduces the risk of serious head injury.

00:33:32: It doesn't make a high-speed collision let's say harmless.

00:33:36: but I think it is one of the preventive measures which are worth considering because again could makes big difference especially in young people using these scooters and also getting into the accidents.

00:33:56: And still, I think it's done somewhere in Norway for instance that you can't ride e-scooters between twelve o'clock to five o' clock in the morning because at this time of night there is a risk for people being under influence from drugs or alcohol which are much higher than in the middle can't be observed either quite at police so easily.

00:34:22: So these are things that really should, I agree with you because i...I really feel it's such a waste.

00:34:30: we're exposing young ones who are controlled by the emotional brain and its cool to have four persons on an e-scooter today!

00:34:43: It gives them feeling of being wild.

00:34:46: but if they have a brain injury, which is not likely but has high risk to happen.

00:34:54: It's so high.

00:34:58: Yes it would lie!

00:34:59: Are

00:35:01: there other things in the last minutes you'd like to tell the decision makers or politicians?

00:35:10: because we are talking about the individual responsibility.

00:35:14: We've already talked a little bit about the e-scooters, but other things which you would like to see in society that should be more brain friendly and also helpful for preventing brain injury?

00:35:29: I think it's really important that we start treating neurological disorders as whole especially traumatic brain injuries preventable public health problem and not simply as a series of accidents, right?

00:35:47: And that means building national prevention strategy where let's say the burden actually comes from safer roads serious full-prevention programs for all adults evidence based rules in sport.

00:36:03: It could be mandating you have to wear helmet when operating certain, let's say e-scooters or other types of machinery.

00:36:12: Occupational safety could also be bolstered.

00:36:16: and because again the most effective treatment for traumatic brain injury is that the injury never happens right?

00:36:24: And prevention has to be systematic.

00:36:27: it cannot depend entirely I would say on whether an individual remembers policymakers can make a lot of good decisions by designing safer roads, safer sporting environments.

00:36:43: Identifying people at high risk for falling and reducing as we've discussed unnecessary exposure to head impacts right?

00:36:53: And most importantly I would say that prevention requires also... Prevention is one aspect.

00:37:00: the second one is coordinated systems of care once the injury happens.

00:37:06: it's really important that there is sort of a continuum of care.

00:37:10: That patients are not lost, they're not lost in the system.

00:37:14: and what often happens is once you leave the emergency room... There is no real plan right?

00:37:22: And It would be very important we give patience to write instructions In terms of What To Do If The Symptoms Linger They persist or they worsen So they can react appropriately.

00:37:36: And that's really the key, right?

00:37:37: Prevention on one end.

00:37:39: then once traumatic brain injury happens there has to be a continuum of care and structure in place.

00:37:49: That is fantastic!

00:37:50: I like it to sum up three points which you said prevention of brain injuries not happening.

00:38:01: it needs to be not only an individual responsibility but we also need a prevention strategy.

00:38:07: But then when you first have your injury, You'll also need the strategy for hope to cope with that injury.

00:38:14: and what should your advice be?

00:38:16: So that's nice!

00:38:17: We've talked about the e-scooters That I hope perhaps in couple of years will make new episode And both laugh at this episode In human history to think about us being so liberal and so ruthless in the e-scooter subject.

00:38:37: So really hope that!

00:38:39: It was a pleasure to have you with me on the podcast Håkon, And I hope that the listeners enjoy this episode as much as i did As a soccer mom my gutter and it's really forced on my advocation for having an age limit and heading in soccer.

00:38:56: but uh...as she said..to prevent is also important besides to treat and identify.

00:39:04: So, thank you so much for being on this podcast!

00:39:08: And as we are approaching the end I also thank our listeners joining us in the Brain Health Mission Podcast.

00:39:15: Both of those who follow us regularly take care of your brain the necessary.

00:39:24: wear a helmet all the time.

00:39:27: It's important to find the right balance, but then again prevention is always a good thing in brain injury as in other parts of brain health.

00:39:38: and if you enjoyed this episode follow us on your preferred podcast platform share it with your network and stay tuned for more exciting conversation

00:39:57: where science meets action for a healthier brain.

00:40:00: If you enjoyed today's episode, don't forget to follow us on Spotify or your favourite podcast app so that never miss an update!

00:40:07: For more tools tips and expert insights head to www.BrainHealthMission.org until next time.

00:40:16: take care of your brain.

00:40:17: it is the only one you've got.