third thursday concussion presentation
TRANSCRIPT
“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
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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.)