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Concussions
Anatomy of the Brain, Trauma,
Treatment and Recovery
Jan Moss, RN
Genex Services
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Special Thanks
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Concussions – You only have one brain….
Definition of Concussion
Diagnosis
Treatment and Recovery
Case Studies
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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
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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
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Anatomy of the brain
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Brain hemispheres
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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
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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
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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
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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
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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.
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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
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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
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Physical Recovery
Address symptoms of balance, weakness
Aerobic activity will increase symptoms and delay recovery
Premature return to activity may increase risk of reinjury
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Cognitive Recovery
NO SCREENS
Therapy
Eliminate or decrease activities that require concentration
Mental stimulation may increase symptoms
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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
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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
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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)
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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.
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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
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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
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Questions?
Anatomy of the Brain, Trauma, Treatment and
Recovery
[email protected]
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