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Concussions Anatomy of the Brain, Trauma, Treatment and Recovery Jan Moss, RN Genex Services 1 © 2016 Genex Services, LLC Special Thanks 2 © 2016 Genex Services, LLC Concussions – You only have one brain…. Definition of Concussion Diagnosis Treatment and Recovery Case Studies 3 © 2016 Genex Services, LLC What is a concussion? Bonk on the head Usually not serious Resolves without treatment You see stars and have a headache for awhile Something you can work through If it’s bad you might throw up 4 © 2016 Genex Services, LLC What is the medical definition of a concussion? 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 your brain normally works. There may be no visible sign of a brain injury. Concussion, also known as minor head trauma, is the most common type of traumatic brain injury. It is typically defined as a head injury with a temporary loss of brain function. A concussion is a traumatic brain injury that alters the way your brain functions. OFTEN MISSED initially. Greatly misunderstood 5 © 2016 Genex Services, LLC Anatomy of the brain 6 © 2016 Genex Services, LLC Brain hemispheres 7 © 2016 Genex Services, LLC Diagnosis Any strike to the head should be evaluated immediately Loss of consciousness, amnesia Field test/medical test Witnesses “Symptoms are self-reported by the athlete, often using a symptom scale. Reliance on an athlete's self-report of symptoms as a fundamental part of diagnosing a concussion is complicated by the subjective nature of the assessment and by the possibility of an athlete underreporting the symptoms” • Policy break, Loss of work avoidance, pride • (Cracked helmet = trip to ED) Diagnostics • CT or MRI of the head 8 © 2016 Genex Services, LLC Objective Assessments Cognitive Test • Objective measurement tool • Can be done prior to injury, at time of injury, as follow up measurement • MACE (Military Acute Concussion Eval)* • ACE (Acute Concussion Evaluation)** Balance Error Scoring System • Balance on dominant leg, Test for 20 seconds, count errors (touching, open eyes, wave hand) *https://dvbic.dcoe.mil/.../DVBIC_Military-Acute-Concussion-Evaluation_Pocket-Card **https://www.cdc.gov/headsup/pdfs/providers/ace-a.pdf 9 © 2016 Genex Services, LLC Signs/Symptoms immediate assessment Observed •Appears dazed or stunned (such as glassy eyes) •Is confused about assignment or position •Forgets an instruction or play •Is unsure of score or opponent •Moves clumsily or has poor balance •Answers questions slowly •Loses consciousness (even briefly) •Shows mood, behavior, or personality changes •Cannot recall events prior to hit or fall •Cannot recall events after hit or fall 10 © 2016 Genex Services, LLC Symptoms Reported by Athlete •Headache or “pressure” in head •Nausea or vomiting •Balance problems or dizziness •Double or blurry vision •Sensitivity to light or noise •Feeling sluggish, hazy, foggy, or groggy •Concentration or memory problems •Confusion •Feeling more emotional, nervous, or anxious •Does not “feel right” or is “feeling down” Symptoms of Concussion One or many Physical •Headache •Fuzzy or blurry vision •Dizziness •Fatigue •Drowsiness •Sensitivity to light or noise •Balance problems •Nausea or vomiting (early on) •Increased Sx with Heart Rate 11 © 2016 Genex Services, LLC Vary in intensity Cognitive •Amnesia •Difficulty thinking clearly •Feeling slowed down •Difficulty concentrating •Difficulty remembering new information •Repetitive questions Vary in onset Emotional •Irritability •Sadness •Feeling more emotional •Nervousness or anxiety Sleep •Sleeping more than usual •Sleeping less than usual •Trouble falling asleep Treatment of concussions Early identification MRI/CT Scan Neurologist who specializes in brain injury Neuro-optomotrist or neuro-opthamologist Neuropsychologist Brain injury rehab program focused on concussions. 12 © 2016 Genex Services, LLC Treatment and Recovery Time Physical, cognitive, speech therapies Medications 15% of Concussed patients have symptoms at 1 year Symptoms can appear after acute injury “Post Concussive Syndrome” can be catch all Objective, consistent repetition of testing Wax/Wane symptoms 13 © 2016 Genex Services, LLC Acute Recovery Focus on symptom resolution (no two concussions are the same) Cognitive and Physical Rest and time Avoid physically and/or mentally demanding activities Avoid activities that could lead to additional injury. Return to normal activities gradually Avoid activities that require quick reflexes such as driving a car Avoid alcoholic beverages Use tools • Write down things to help you remember them • Alarms/Reminders • Repetition Do one activity at a time May want to avoid flying 14 © 2016 Genex Services, LLC Physical Recovery Address symptoms of balance, weakness Aerobic activity will increase symptoms and delay recovery Premature return to activity may increase risk of reinjury 15 © 2016 Genex Services, LLC Cognitive Recovery NO SCREENS Therapy Eliminate or decrease activities that require concentration Mental stimulation may increase symptoms 16 © 2016 Genex Services, LLC Treatment Medications Treat symptoms, not the concussion. No standard approach found. • Sleep • Melatonin, Trazadone, Nortriptylene • Physical • Headaches – analgesics, antidepressants, • Emotional • Depression (Increased in elderly) – Serotonin, antidepressants • Cognitive • No pharmaceuticals recommended 17 © 2016 Genex Services, LLC Education Unlike a fracture, injury is not evident to patient, employer, coworkers, family Signs and Symptoms are unfamiliar, startling, and vary patient to patient Concussive symptoms may linger far after other injuries (ie fractured ankle in fall) Often questioned validity of injury • Especially if employee is suspect 18 © 2016 Genex Services, LLC Claim Management Subjective injury • Attempt to seek as much objective findings as possible Prevention of secondary injuries RTW Challenges • Driving, Cognition, Lethargy, Physical Demands Seek Expertise Opinion (IME) 19 © 2016 Genex Services, LLC What are some signs that recovery is not normal? The majority of individuals will recover with rest and time. Persistent symptoms beyond 3-4 weeks would be considered outside of the norm. Severe symptoms such as severe headaches, vertigo, double vision, nausea/vomiting, inability to concentrate are indicators that the injury is more significant and should be treated as if it is a TBI and not a mere concussion. 20 © 2016 Genex Services, LLC Case Studies ME! Natasha Richardson 45 y/o male truck driver cleared to drive 25 y/o male; s/p severe TBI 75 y/o male with secondary injury 51 y/o female – delayed report due to situation 21 © 2016 Genex Services, LLC Conclusions Always seek evaluation and diagnosis of head injury • Do not let other injuries overshadow • Prevent additional injury Signs/Symptoms and Treatment will vary RTW is difficult to manage Diagnosis of No concussion is difficult 22 © 2016 Genex Services, LLC Questions? Anatomy of the Brain, Trauma, Treatment and Recovery [email protected] 23 © 2016 Genex Services, LLC