cathy o’connor md, facs concussion 2013. goals for today update knowledge of injury and...
TRANSCRIPT
Cathy O’Connor MD, FACS
Concussion 2013
Goals for today
Update knowledge of injury and neurologic sequelae
How to screen children in school setting for mTBI/concusssion
Brain injured child in the academic setting- what can we do
What testing is available and how it should be utilized
Why is this important to you?
No spare brains available
Long lasting consequences if not managed properly in kids
Education and patience is the key
What is a concussion?
Forget what you were taughtWide range of presenting
symptoms–Immediate–Delayed
Kids vs adolescents vs adultsBe afraid….be very afraid….
Concussion since 1980
Used to be up to 17 different grading scales- no agreement
International Conference on Concussion in Sport– First one in Vienna 2001– 2012 Zurich update due now
Military research with the wars NFL- the elephant in the room
What do we know?
Disturbance in brain neurological function following a physical insult– Short circuit, dog food can hits wall– Reality: disturbance in glucose
metabolism, blood flow, ion balance No gross structural damage
– May have axonal damage not unlike a neuropraxia type injury
How much force?
Pick a number, any number Influence of genetics
– APO E2 Repetitive injuries Vectors of force
– Straight vs rotational vs combination– Translation from the body to the brain
Equipment – Helmets, mouthguards, head strap
Brain Metabolism is Related to Recovery◊ Over 200 High School Athletes Studied using fMRI◊ Hyperactivation predicts CLINICAL recovery time◊ Resolution of hyperactivation correlates with recovery
Time course of recovery
Collins, et al. Neurosurgery 58:275-286, 2006
Predicting the symptoms
If direct blow:– Location– Vector of force– Combination of forces
Transmission of force from body Whiplash of brain within skull Force waves
Right hemisphere
Processing multi-sensory input
simultaneously Visual spatial skills Memory stored in auditory, visual
and spatial modalities
Left hemisphere
Sequential Analysis: – Systematic, logical interpretation of
information. – Interpretation and production of
symbolic information:language, mathematics, abstraction and reasoning.
– Memory stored in a language format
Cerebral cortex
– Outermost layer– Learn new info– Form thought– Make decisions– Memory function
Frontal lobe
– Recent memory– Emotions– Concentration– Ability to learn new
info and retain it– Storage of motor
patterns and voluntary activity
Parietal lobe
– Processing of sensory input
– Sensory discrimination
– Body orientation
Occipital lobe
– Processing of all visual input
Temporal lobe
– Expressed behavior: childish, irritable, agitated
– Information retrieval
– Receptive speech/auditory input processing
Symptoms
PhysicalHeadachesFatigue/tirednessDizziness with movement or mental exertion
NauseaLight/noise sensitivityRinging in the ears
Sleep difficultiesTrouble falling asleepOvernight awakeningOversleeping/undersleepingFeeling tired in the morning despite long hours in bed
CognitiveInability to focusLimited concentrationInefficient short-term memory
Slowed thinkingFeeling mentally “foggy”Poor reading comprehension
Mood disruption IrritabilitySadnessNervousnessAnxietyDepression
COGNITIVE• Fogginess
• Concentration
• Memory deficits
• Cognitive fatigue
MOOD DISRUPTIONIrritability
Sadness
Anxiety
SLEEP DYSREGULATIONFalling asleep
Fragmented sleep
Too much/too little sleep
SOMATICHeadaches
Dizziness
Light/noise sensitivity
Tinnitus
Adapted from Camiolo Reddy, Collins & Gioia, 2008
– Wake up fatigued– Develop headaches sitting in class– Can’t fully grasp class material– Feel worse as the day wears on– Bothered by light/sound at school– Feel more exhausted after school– More symptomatic trying to do
homework– Upset and worried they are falling behind– Go to bed feeling worse
Second Impact Syndrome
Second force to brain while still recovering and SYMPTOMATIC from a first concussion
– Disrupts the autoregulation of blood flow to the brain- massive swelling
– 50% dead on the field– 50% permanent brain damage– Only seen in the adolescent under-22
Return to action Adolescents
– Not little adults– Longer recovery– Significant risk of long term academic
and behavioral issues if not managed well
Kids (6-10)– White paper from CDC by Dec 2013?– No research– No evidence based validated tools
What can you do
Identify-new injury vs delayed What are their current issues Additional evaluation if needed Modification of home, work, school to
maximize recovery and minimize long term problems
Safe place in school, source of information for all parties
Advocate for the child
Questions?