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Injury: Concussion

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Aida Maldonado

on 30 March 2018

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Transcript of Injury: Concussion

The Brain: what is it?
The brain is composed of mostly water and fatty tissue, making it the most fragile organ in the human body. The consistency of the brain is often described like gelatin. Cerebrospinal fluid protects the brain by insulating it against the solid interior of the skull (CSF acts as a shock absorber).

Diffuse axonal injury/ axonal shearing
Rapid movement or a hard hit to the head can cause the brain to shake and hit the interior of the skull. Shockwaves from the blow penetrate through the brain, stretching and tearing neural axons. Damaged neurons begin to release toxins that cause the axons of other close-by neurons to disintegrate, terminating neural communication in different parts of the brain.

Chronic Traumatic Encephalopathy
"CTE is a degenerative brain disease found in athletes, military veterans, and others with a history of repetitive brain trauma. In CTE, a protein called Tau forms clumps that slowly spread throughout the brain, killing brain cells."

-Concussion legacy Foundation

o Headache that gets worse and does not go away.
o Weakness, numbness or decreased coordination.
o Repeated vomiting or nausea.
o Slurred speech


Recovery
o After the initial monitoring period,
REST
is currently the best practice for concussion recovery.
Acute Care & Diagnosis
• A concussion is a type of mild traumatic brain injury—or mTBI—caused by a bump, blow, collision, or jolt. This causes the brain to bounce around and hit the hard interior of the skull. Neurons in the brain may suffer structural or chemical damage, thus discontinuing cell-to-cell communication
Rapid Neurological screening
Scat should be administered in a resting state (resting heart)
Thorough and efficient examination should take a minimum of 10 min.
Temporary loss of Brain function
Injury: Concussion
What is a concussion?
TBI causes functional short -or long term- changes that affect:
o
Thinking:
memory and reasoning
o
Sensation:
sight and balance
o
Language:
communication & expression
o
Emotion:
depression, anxiety, personality changes, aggression

Signs and Symptoms usually fall into the following four categories:
Cognitive
" An estimated 3.8 million concussions occur each year in the United States as a result of sport and physical activity"
-NATA
The CDC estimated 1.6-3.8 million concussions annually, However, the numbers are actually much higher due to the many concussions that go undetected or unreported

Some TBIs have been linked to epilepsy and increase the risk for degenerative brain disorders: Alzheimer’s disease, Parkinson’s, Dementia
About 75% of TBIs that occur each year are concussions or other forms of mild TBI.
-CDC


Physical

Emotional

Sleep
"The brain is composted of about 75% water and is the fattiest organ in the body, consisting of a minimum of 60% fat."
-RehabChicago
weights about 3 lbs
40% gray matter
60% white matter
The Brain is also composed of billions of neurons that send electrical signals to each other and to the body.
Every concussion presents itself differently due to the fact that there is an unlimited amount of areas (or combination of areas) where axons may become injured. Symptoms that become present are associated with the part(s) of the brain most injured during the initial blow and with the surrounding neurons that have become damaged due to the release of toxins
Entire Brain:
headaches, disorientation, confusion
Brain Stem:
nausea, dizziness, vomiting
Cerebellum:
poor muscle coordination, slurred speech

Symptoms and their associated brain anatomy
Occipital Lobe:
light sensitivity, blurred vision


Thalamus:
ringing in the ears
Frontal Lobe
: Loss of Consciousness, inability to focus, irritability, depression


Temporal lobe
: memory loss
Tau proteins assist the microtubules that support the structure of axons, repeated hits to the head cause the microtubules to unwind, this allows the Tau proteins to accumulate by clamping together. Tau proteins disrupt neuron communication and continues to spread even after the brain stops suffering from injuries.
CTE symptoms become more visible through out time because the Tau proteins are slowly piling up, symptoms show around the age of 40
CTE is caused by repetitive hits to the head sustained over a period of years.
The Etiology of CTE
CTE may lead to:
Impulse control problems
Aggression
Depression
Anxiety
Suicide
Parkinsons
Dementia
The
temporal lobes
are involved in
language
and
auditory processing
, but clinical studies have also linked regional atrophy to impairments in
memory
and
cognition.
-(churchill et al.)
(CDC.gov)
(CDC.gov)
SEEK IMIDIATE MEDICAL ATTENTION
Concussions happen often, but in rare cases an acute hemorrhage (bleed) occurs which results in a hematoma that may consolidate (blood clot) and increase pressure inside the skull.
o Unresponsive to stimulant
o Anisocoria (one pupil larger than the other)
o Convulsions/Seizures.
o Cannot recognize people or places.
o Increasing agitation.
o Unusual behavior.
Brain-bleed warning signs:
Cervical exam
Athlete’s speech
Ability to read
Visual tracking
Short-term memory
Balance & Gait
Sport Concussion Assessment Tool (SCAT)
SCAT5
Maddocks Questions
GCS

 At what venue are we today?
 Which half is it now?
 Who scored last in this match?
 What did you play last week?
 Did your team win the last game?

Maddocks Questions:
The most common scoring system used to describe the level of consciousness in a person following a traumatic brain injury.
Glasgow Coma Scale (GCS)

 Eye Opening (E)
• 4 = spontaneous
• 3 = to sound
• 2 = to pressure
• 1 = none
• NT = not testable

 Verbal Response (V)
• 5 = orientated
• 4 = confused
• 3 = words, but not coherent
• 2 = sounds, but no words
• 1 = none
• NT = not testable

 Motor Response (M)
• 6 = obeys command
• 5 = localizing
• 4 = normal flexion
• 3 = abnormal flexion
• 2 = extension
• 1 = none
• NT = not testable


 Severe: GCS 8 or less
 Moderate: GCS 9-12
 Mild: GCS 13-15

Avoid:
General physical exertion
Sports
Vigorous movements
Playing video games
Watching TV
Schoolwork
Reading
Phones
Computers
Alcohol
Drugs (Doctor approval)
Post-concussion syndrome (PCS)
PCS refers to the continuation of concussive symptoms that may persist for weeks, months, or even many years after a concussion has occured. Most symptoms caused by mild concussions are only present for 2-4 weeks, but when symptoms linger immediate rehabilitation is strongly recommended.

Cognitive symptom=
memory therapy, visual and verbal (ex. Memorization exercises)
Therapy should target each individual symptom and be tailored to fit each individual person:
Blurred Vision/Depth Perception=
ocular therapy (ex. VORx1, saccades)
Balance issuses=
vestibular therapy is ued to improve balance while reducing dizziness and vertigo (ex. Bola Ball, Moving Platform)
Behavioral/mood=
anxiety therapy (ex. Yoga)
VOR x1=
Vestibular Ocular Reflex (VOR) Exercise/ Gaze Stabilisation Exercise
Examples of Ocular Therapy
Saccades:
refer to the eye’s ability to quickly and accurately shift from one target to another. This is a critical skill in reading.
Types:

Vertical saccades
 Column saccades
 Number saccades
 Four square saccades

"Last resort, after therapy has failed, would be medications such as neurostimulants, anti-anxiety, sleep aids"

-DR. Robert Cantu
Prevention
Athletes at high risk of concussion should undergo baseline examinations before the competitive season.
Baseline exams
Protective equipment
Education
The AT should enforce the standard use of certified helmets while educating athletes, coaches, and parents that although such helmets help to prevent catastrophic head injuries, they do not significantly reduce the risk of concussions
-NATA
"(
Benson et al.
) evaluated 51 studies of protective equipment to determine if any form of protective equipment was useful in preventing sport-related concussion. Their results suggest that helmet use can reduce the risk of more serious head (eg, skull fracture) and brain (eg, subdural hematoma) injuries in recreational sports...Yet the ability of these devices to prevent concussion was inconclusive"
-NATA
Studies by the NATA
The Lack of Education: Studies by the NATA
more than 50% of high school athletes57 and 70% of collegiate athletes58 did not report concussions sustained during football. One reason for nonreporting was that athletes were not aware of the signs and symptoms of concussion.
(Broglio, Steven P, et al)
.
In a survey of youth sports coaches, 45% of respondents believed a concussion did not require immediate removal from a game or practice, and only 62% could correctly identify proper post-concussion management.
(Broglio, Steven P, et al).
Studies By the CDC
Research from separate studies shows that too many athletes:
Do not
Report
their concussion symptoms
Are not
Removed
immediately from play
Return
to play too soon.
Talk about concussions
Learn how to spot a concussion
Learn what to do if a concussion is suspected.
Model, expect, and reinforce safe play.
Support the return to learn and play process
Understand RTP is different for every individual
Education-Awareness- Attitudes

Athletes should feel comfortable reporting symptoms
Teammates should be supportive of those that must sit out due to concussion

NFL- Play Smart, Play Safe
“Concussion.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 July 2017, www.mayoclinic.org/diseases-conditions/concussion/diagnosis-treatment/drc-20355600.

“Traumatic Brain Injury & Concussion.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 22 Jan. 2016, www.cdc.gov/traumaticbraininjury/basics.html.

“What Is CTE?” Concussion Legacy Foundation, Barlett, 30 Aug. 2017, concussionfoundation.org/CTE-resources/what-is-CTE.

Broglio, Steven P, et al. “National Athletic Trainers’ Association Position Statement: Management of Sport Concussion.” Www.natajournals.org, 2014, natajournals.org/doi/pdf/10.4085/1062-6050-49.1.07?code=nata-site

Churchill, N. W., Hutchison, M. G., Graham, S. J., & Schweizer, T. A. (2018). Connectomic markers of symptom severity in sport-related concussion: Whole-brain analysis of resting-state fMRI. NeuroImage : Clinical, 18, 518–526

Echemendia RJ, Meeuwisse W, McCrory P, et alThe Sport Concussion Assessment Tool 5th Edition (SCAT5): Background and rationaleBr J Sports Med 2017;51:848-850.

Teasdale G, Allen D, Brennan P, McElhinney E, Mackinnon L. “The Glasgow Coma Scale: an update after 40 years”. Nursing Times 2014; 110: 12-16

Work Cited
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