AD 2017 Q1

RESEARCH, EDUCATION & MEDICINE
EXPERT OPINIONS
c. Mild TBI and recovery months, but less than one
year, later: No diving for one full year after complete
symptom resolution.
d. Mild TBI and continuing symptoms: The symptoms
may be a problem for diving. For example, vertigo and
dizziness may be made worse on a boat. Vertigo may
cause nausea, which may be incompatible with safe
diving. Exposure to cold may make migraines worse.
Diving can be a significant stressor, so anxiety and
posttraumatic stress disorder (PTSD) are disqualifiers.
Cognitive problems may interfere with divers’ ability
to interpret their dive computer or follow directions
properly. Any drugs a diver takes must be reviewed with
specific advice about diving. Any symptoms warrant
evaluation by brain-injury and dive-medicine specialists.
All diving is not the same. Diving in relatively shallow,
clear, warm water without current is very different from
cold, rough water with poor visibility. Recommendations
for diving should specify the type of diving.
Massey: When symptoms resolve early I suggest
waiting a week, but the longer the symptoms persist,
the longer I would delay diving. Symptom duration is
important in determining how long one should avoid
sports, including diving.
With a mild concussion, when symptoms resolve
within one day, diving within a week of resolution is
appropriate. If symptoms go on for a month, then diving
does not seem wise until after resolution and a period
of observation and medical reassessment, especially
with any symptoms beyond a headache. Any persistent
cognitive symptoms such as poor concentration would
require further observation and a conservative return
to activity. Rest and good sleep are reported to be
helpful. Subsequent neurological evaluation must assess
attention, orientation, judgment, insight and memory.
A CT scan is almost never helpful; an MRI should be
conducted when a clinical examination suggests bleeding
in the brain. An electroencephalogram (EEG) should be
considered in the event of persistent symptoms.
Alleman: From a commercial diving standpoint,
staying out of the water for at least six weeks would be
recommended, provided that the diver has a normal
neurological examination after this delay. From a
recreational standpoint, a longer period of time may be
considered since the individual is not compelled to dive
from a financial standpoint.
Are there any possible benefits of diving for
patients with a mild TBI?
Weaver: There is no scientific proof that patients with
mild TBI gain improvement by diving.
Massey: I doubt the existence of benefits based on
present information.
Alleman: There is no medical literature that supports
diving as beneficial for patients with mild TBI.
What are the main fitness-to-dive concerns with TBI?
Weaver: Headaches following mild TBI are common.
They can interfere with attention and concentration and
sometimes affect vision, which might make reading a
dive computer screen challenging.
Massey: One of the main concerns is cognitive
impairment, which relates to judgment, awareness
and reasoning. Will the diver make mistakes that he
or she otherwise would not, and will that affect the
diver’s safety?
Seizure risk varies with the degree of injury, but a
significant seizure risk would rule out further diving.
Whether the risk of a seizure is permanently elevated
in the postconcussive state is unknown. It is likewise
unknown whether there is a difference in the risk of
complex partial, simple partial, generalized, absence
and other types of seizures.
STEPHEN FRINK
66 | WINTER 2017