Third Thursday Concussion Presentation

“You forgot

your helmet!”

What Parents (and Kids) Need to Know About

Concussion

Third Thursday at ThreeScott La Point, MA, LPC

Psychology Resident

Lakeview NeuroRehabilitation Center

“You forgot

your helmet!”

What Parents (and Kids) Need to Know About

Concussion

Third Thursday at ThreeScott La Point, MA, LPC

Psychology Resident

Lakeview NeuroRehabilitation Center

Take away points A concussion is a brain injury. Symptoms of concussion can be

subtle. Symptoms may not surface until 48

to 72 hours after injury. Recovery is different for every

person. Every concussion should be taken

seriously.

Myths & Facts

Diagnosis & Tx

Signs & Symptoms

Concussion CareScott La Point, MA, LPC

Today’s Agenda Myths & Facts of Concussion Concussion: What is it? Signs & Symptoms Diagnosis & Treatment Proper Helmet Fit

■ Resources■ References

Myths & Facts

Signs & Symptoms

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Myths & Facts You have to have loss of

consciousness to have sustained a concussion.

MYTH

Studies show that less than 10% of concussions result in loss of consciousness.

Myths & Facts

Signs & Symptoms

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Myths & Facts Concussions are only a result of a

direct blow to the head.

MYTH A concussion can be sustained by

a sudden, violent movement of the head caused by an unexpected external force to the body.

Myths & Facts

Signs & Symptoms

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Myths & Facts Injury to the brain occurs at the

initial impact of the concussion.

MYTH TBI is an evolving process at the

microscopic level of the brain. Chemical and metabolic changes occur for days, weeks to months after impact.

Myths & Facts

Signs & Symptoms

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Myths & Facts You need to wake someone with

a concussion every 20 minutes.

MYTH Though it is important to check on

someone periodically, it does not have to be every 20 minutes. Every 2-3 hours is sufficient.

Myths & Facts

Signs & Symptoms

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Myths & Facts Children recover at the same rate

as adults.

MYTH Children and teenagers actually

recover more slowly due to their developing brain. They are also prone to complications.

Myths & Facts

Signs & Symptoms

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Myths & Facts Everyone with a concussion

needs a CT scan or MRI right away.

MYTH

While there is damage to the brain cells in a concussion, the damage is at the microscopic level and neuroimaging does not reveal every injury.

Myths & Facts

Signs & Symptoms

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Myths & Facts You should not treat the headache

from concussion with any medications because they might mask the symptoms.

MYTH

OTC pain relievers, as ordered by the physician, are fine to use. At times, prescription medications may be needed.

Myths & Facts

Signs & Symptoms

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Myths & Facts Male and female athletes have the

same chance of sustaining a concussion.

MYTH

Female athletes are more prone to concussions, possibly because they more open to report an injury. Also, there are gender differences.

Myths & Facts

Signs & Symptoms

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Myths & Facts There are no long-term effects of

concussion.

MYTH A concussion that is not properly

treated can lead to post-concussion syndrome, with prolonged symptoms.

Myths & Facts

Signs & Symptoms

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Concussion defined A concussion is a type of traumatic

brain injury (TBI) caused by a bump, blow, or jolt to the head that can change the way the brain functions.

A concussion can also occur from a blow to the body that causes the head to move rapidly back and forth.

Even a “ding,” “getting your bell rung,” or what seems to be mild bump or blow to the head, can be serious. Concussion Care

Scott La Point, MA, LPC

Myths & Facts

Diagnosis & Tx

Signs & Symptoms

Basic anatomy A gelatin-like organ, weighing about 2

lbs. at birth and 3 lbs. as an adult. Neurons are the cells that make up the

nervous system; they communicate with each other and transmit information about what we take in and how we respond.

This is done by neurotransmitters at the synapse, the point where one cell ends and the next begins.

Concussion CareScott La Point, MA, LPC

Myths & Facts

Diagnosis & Tx

Signs & Symptoms

Concussion CareScott La Point, MA, LPC

Myths & Facts

Diagnosis & Tx

Signs & Symptoms

Concussion CareScott La Point, MA, LPC

Myths & Facts

Diagnosis & Tx

Signs & Symptoms

TBI Severity

Concussion CareScott La Point, MA, LPC

MILD: Concussion, “dazed and confused,” possible brief loss of consciousness (LOC); GCS 13-15

MODERATE: LOC > 30 minutes, posttraumatic amnesia (PTA); GCS 9-12

SEVERE: > 24 hrs. LOC, coma, PTA, fractures, bleeds; GCS 3-8

GCS rating given at acute stage; does not necessarily correlate with deficits

Myths & Facts

Diagnosis & Tx

Signs & Symptoms

ttt

Glasgow Coma Scale: 5Posttraumatic Amnesia: 37 days

Physical Headache (most

common) Double or blurred

vision Dizziness or

balance problems Poor balance Ringing in ears Seeing “stars”

Myths & Facts

Concussion CareScott La Point, MA, LPC

Signs & Symptoms

Nausea Numbness/

tingling Sensitivity to

light and/or noise

Neck pain Fatigue

Diagnosis & Tx

Cognitive Feeling in a “fog” Feel “slowed down” Difficulty remembering Difficulty concentrating Easily distracted Slowed speech Easily confused

Myths & Facts

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Signs & Symptoms

Emotional Inappropriate emotions Personality change Nervousness/anxiety Feeling more “emotional” Irritability Sadness Emotional lability

Myths & Facts

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Signs & Symptoms

Myths & Facts

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Signs & Symptoms

Psychosocial Irritability Difficulty accepting someone else’s point of view Low self-esteem Agitation Hostility Disinhibition Depression and/or Anxiety

Myths & Facts

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Signs & Symptoms

Behavioral Poor self-control; Impulsivity Limited insight into deficits Decreased understanding of social pragmatics Aggression Low stimulation threshold Low frustration tolerance Emotional dyscontrol

Myths & Facts

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Signs & Symptoms

Delayed symptoms Worsening headache Repeated vomiting Loss of consciousness Agitation Seizure Difficulty walking or balance Weakness Numbness Change in vision

Concussion CareScott La Point, MA, LPC

Myths & Facts

Diagnosis & Tx

Signs & Symptoms

Assessing a patient Questions to ask

Injury description Amnesia Observed signs, seizures

Assessment tools ACE, ImPACT, ANAM, SCAT-3,

MACE, OSU TBI-ID Neuroimaging Neuropsychological evaluationConcussion Care

Scott La Point, MA, LPC

Myths & Facts

Diagnosis & Tx

Signs & Symptoms

Treating a patient Rest, rest and more rest Education Symptom Management Pharmacology Prevention

Buckle up; Never drinking while drinking; No texting while driving

Safe living areas Obstacles; Child-proofingConcussion Care

Scott La Point, MA, LPC

Myths & Facts

Diagnosis & Tx

Signs & Symptoms

Factors in recovery Severity of injury, associated medical

complications Expectations for recovery Participation in rehabilitation Support network; use of

community and medical resources Hope, beliefs, patience and

communication skills Age and genderConcussion Care

Scott La Point, MA, LPC

Myths & Facts

Diagnosis & Tx

Signs & Symptoms

Myths & Facts

Diagnosis & Tx

Signs & Symptoms

Concussion CareScott La Point, MA, LPC

Take Away Points If a student complains of feeling “dazed,”

or has persisting headaches or nausea, contact his/her physician.

Symptoms may not surface for days. Take every concussion seriously. “If you’ve seen one brain injury…” Prevention (e.g., wearing a helmet) is the

only real treatment.

Myths & Facts

Concussion CareScott La Point, MA, LPC

Diagnosis & Tx

Signs & Symptoms

Fri., October 5, 2007 11 am to 12:30 pm

Brain Injury Association of Colorado -- 25th Anniversary

34

Resources

Myths & Facts

Diagnosis & Tx

Signs & Symptoms

Brain Injury Association of America: www.biausa.org

Brain Injury Association of NH: www.bianh.org

Brain Injury Navigator: www.binav.org

Brain Injury News and Information Blog: www.BrainInjury.blogs.com

Brain Injury Resource Center: www.headinjury.com

Brain Train: www.brain-train.com Centre for Neuro Skills:

www.neuroskills.com International Brain Injury Assoc.:

www.internationalbrain.org

International Brain Injury Assoc.: www.internationalbrain.org

Lash & Associates Publishing/ Training, Inc.: www.lapublishing.com

Medline Plus (TBI): http://www.nlm.nih.gov/medlineplus/traumaticbraininjury.html

National Resource Center for TBI: http://www.tbinrc.com

Neurotrauma Registry: www.neure.com

Ohio Valley Center for Brain Injury Prevention and Rehab: www.ohiovalley.org

Arciniegas, D.B., Harris, SN, Brousseau, K.M. (2003). Psychosis following traumatic brain injury. International

Review of Psychiatry, 15(4), 328-340.

Centers for Disease Control and Prevention (CDC). Sports-related recurrent brain injuries—United States.

Morbidity and Mortality Weekly Reports 1997;46(10):224–227.

Coetzer, R. (2007). Psychotherapy following traumatic brain injury: Integrating theory and practice. Journal of

Head Trauma Rehabilitation, 22(1), 39-47.

Folzer, S. (2001). Psychotherapy with “mild” brain-injured patients. America Journal of Orthopsychiatry, 71(2),

245-251.

Gedye, A., Beattie, B.L., Tuokko, H., Horton, A, & Korsarek, E. (1989). Severe head injury hastens age of onset of

Alzheimer’s disease. Journal of American Geriatrics Society, 37(10), 970-973.

Hesdorffer, D.C., Rauch, S.L, &Tamminga, C.A. (2009). Long-term psychiatric outcomes following traumatic

brain injury: A review of the literature. Journal of Head Trauma Rehabilitation, 24(6), 452–459.

Kim, E., Lauterbach, E., Reeve, A., Arciniegas, D., Coburn, K., Mendez, M., Rummans, T., & Coffey, E. (2006).

Neuropsychiatric complications of traumatic brain injury: A critical review of the literature, Journal

of Neuropsychiatry and Clinical Neurosciences, 19, 106–127.

Langlois J.A., Rutland-Brown, W., & Thomas ,K.E. (2006). Traumatic brain injury in the United States: emergency

department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention,

Nation Center for Injury Prevention and Control.

References

Myths & Facts

Diagnosis & Tx

Signs & Symptoms

McColl, M.A., Bickenbach, J., Johnston, J., Nishihama, S., Schumacher, M., Smith, K., Smith, M., & Yealland, B.

(2000). Changes in spiritual beliefs after traumatic disability. Archives of Physical Medicine and

Rehabilitation, 81(6), 17-823.

McGee, J. (2004). Insight: Neuroanatomy of behavior after brain injury or you don’t like my behavior? You’ll

have to discuss that with my brain directly. Premier Outlook. 4(2).

Prowe, G. (2010). Successfully surviving a brain injury: A family guidebook. Brain Injury Success Books:

Gainesville, FL.

Rohling, M.L., Faust, M.E., Beverly, B., & Demakis, G. (2009). Effectiveness of cognitive rehabilitation

following traumatic brain injury: A meta-analytic reexamination of Cicerone et al. (2000, 2005) systematic

reviews. Neuropsychology, 23(1), 20-39.

Thurman, D., Alverson, C., Dunn, K., Guerrero, J, Sniezek J. (1999). Traumatic brain injury in the United States: A

public health perspective. Journal of Head Trauma Rehabilitation, 14(6), 602–15.

Vaishnavi, S., Rao, V., & Fann, J.R. (2009). Neuropsychiatric problems after traumatic brain injury: Unraveling the

silent epidemic. Psychosomatics, 50(3), 198-205.

Whelan-Goodinson, R., Ponsford, J., Johnston, L, & Grant, F. (2009). Psychiatric disorders following traumatic

Brain injury: Their nature and frequency. Journal of Head Trauma Rehabilitation, 24(5), 324–332.

Myths & Facts

Diagnosis & Tx

Signs & Symptoms

References (cont.)