Mild Traumatic Brain Injuries (Concussions)

1. Mild Traumatic Brain Injuries(Concussions) Katherine Lynn, RN, BSN

2. Why are we here? Source: The Brain Injury Association of America based on data from the Centers for Disease Control and Prevention, American Cancer Society, and National Multiple Sclerosis Society

3. Why are we here? • 3000 deaths a year are a result of an unintentional traumatic brain injury (TBI). • Concussions occur in 10% of high school and college athletes. • Children’s brains are more vulnerable to injury and take longer to recover because they are still developing. • The brain is more vulnerable to injury after suffering from a concussion. • Females are more vulnerable than males and take longer to recover.

4. Traumatic Brain Injuries

5. Traumatic Brain Injury

6. Concussion (Mild Traumatic Brain Injury) • Definition: • A Complex pathophysiologic process affecting the brain induced by traumatic biomechanical forces altering brain metabolism. • Normal brain imaging- no damage to brain anatomy. A concussion is a type of brain injury that changes the way the brain normally works.

7. Symptoms Reported by a Student Source: Centers for Disease Control and Prevention (CDC)

8. Thinking/Remembering A student may report: • Difficulty thinking clearly • Difficulty concentrating or remembering • Feeling more slowed down • Feeling sluggish, hazy, foggy, or groggy Source: Centers for Disease Control and Prevention (CDC)

9. Physical A student may report: • Headache or “pressure” in head • Nausea of vomiting • Balance problems or dizziness • Fatigue or feeling tired • Blurry or double vision • Sensitivity to light or noise • Numbness or tingling • Does not “feel right” Source: Centers for Disease Control and Prevention (CDC)

10. Emotional A student may report: • Irritable • Sad • More emotional than usual • Nervous Source: Centers for Disease Control and Prevention (CDC)

11. Sleep A student may report: • Drowsy • Sleeps less than usual • Sleeps more than usual • Has trouble falling asleep (Only ask about sleep symptoms if the injury occurred on a prior day) Source: Centers for Disease Control and Prevention (CDC)

12. Observations School staff may notice the student: • Appears dazed or stunned • Is confused about events • Answers questions slowly • Repeats questions • Can’t recall events prior to or after the hit, bump, or fall • Loses consciousness (even briefly) • Shows behavior or personality changes • Forgets class schedule or assignments Source: Centers for Disease Control and Prevention (CDC)

13. Danger Signs • A student should be taken to the nurse and seen in an ER right away if she/he has: • One pupil larger than the other • Drowsiness or cannot be awakened • A headache that gets worse or doesn’t go away • Weakness, numbness, or decreased coordination • Repeated vomiting or nausea Source: Centers for Disease Control and Prevention (CDC)

14. Danger Signs • A student should be taken to the nurse and seen in an ER right away if she/he has: • Slurred speech • Convulsions or nausea • Difficulty recognizing people or places • Increasing confusion, restlessness, or agitation • Unusual behavior • Loss or consciousness (even briefly!!) Source: Centers for Disease Control and Prevention (CDC)

15. When to send a student to the health room: If you notice or suspect that a student has: Any kind of forceful blow to the head or to the body that results in rapid movement of the head and/or Any sign or symptom of a concussion

16. So what is the big deal?

17. Repeated mild TBIs occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits. • Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal. . Source: Centers for Disease Control and Prevention (CDC)

18. Tracy’s Story

19. Second Impact Syndrome • Rapid cerebral swelling caused by another injury to the brain while it is still healing from the initial brain injury/concussion • Over 80% fatal (the brain swells, bleeds, and the player dies on the field) • Usually occurs to children 18 and under.

20. Prevention • Personal Protective Equipment (PPE) • Properly fitting equipment • Playing by the rules • Coach, parent, and family education • Baseline testing • Heads Up Campaign- http://www.cdc.gov/concussion/headsup/ Source: Amy Valasek, MD FAAP

21. A Child has a Concussion Now What?

22. Stepwise Guidelines • Step 1: Complete rest, no activity • Step 2: Light exercise such as free play, walking, or stationary cycling for 10-15 minutes • Step 3: Sport-specific activity for 20-30 minutes (ex. Skating for hockey, running for soccer) • Step 4: “On field” practice with no contact • Step 5: “On field” practice with body contact, after medical clearance • Step 6: Game Day Each step should take a minimum of 24 hours. If any post-concussive symptoms do occur along the stepwise progression, the athlete is required to drop back to the previous asymptomatic stage Source: McCrory et al., 20091

23. Students Returning to School May Experience: • Difficulty organizing tasks • Problems completing activities involving a lot of concentration • Problems reading or looking at a computer screen • Problems remembering or learning new information • Impulsive behavior • Irritability Source: Centers for Disease Control and Prevention (CDC )

24. Returning to School • Students returning to school following a concussion may need to: • Take rest breaks as needed • Spend fewer hours at school • Be given more time to take tests or complete assignments • Receive help with schoolwork • Reduce time spent on the computer, reading, and/or writing Source: Centers for Disease Control and Prevention (CDC)

25. Returning to School • Parents, teachers, and support staff meet to develop a plan to support the child as they heal and return to school. • The school and family will work together to follow the child’s physician’s orders. • As symptoms decrease, extra support can be decreased. • Most concussions resolve in 7-10 days. Serious concussions can take up to 2 years to fully recover from.

26. Know Your Concussion ABCs Source: Centers for Disease Control and Prevention (CDC)

27. Remember: No two concussions are the same!! and When in doubt, sit it out!!

28. Questions?

29. References • McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M, Cantu R. Concensus Statement on Concussion in Sport: the 3rd Internation Conference on Concussion in Sport held in Zurich. Br J Sports Med. 2009;43:i76-i84. • Grant, Jo (Speaker). (2012, March 26). Childhood Neurology. PESI HealthCare. • Valasek, Amy (Speaker). (2010, March 17). Sport Related Concussion in Pediatric Athletes. Towson Orthopedic Associates. • Center for Disease Control and Prevention. Injury prevention and Control: Traumatic Brain Injury. March 29, 2012. http://www.cdc.gov/concussion/index.html.