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Mild TBI: Out of Sight, but not Out of Mind

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Title: Mild TBI: Out of Sight, but not Out of Mind


1
Mild TBIOut of Sight, but not Out of Mind
  • Ronald C. Savage, Ed.D.

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The CDCs definition of MTBI An MTBI
or concussion is defined as a complex
pathophysiologic process affecting the brain,
induced by traumatic biomechanical forces
secondary to direct or indirect forces to the
head. MTBI is caused by a jolt to the head or
body that disrupts the function of the brain.
This disturbance of brain function is typically
associated with normal structural neuroimaging
findings (i.e. CT Scan, MRI). MTBI results in a
constellation of physical, cognitive, emotional
and/or sleep-related symptoms and may or may not
involve a loss of consciousness (LOC). Duration
of symptoms is highly variable and may last from
several minutes to days, weeks, months, or longer
in some cases. (Aubry et al., 2002 McCrory
et al., 2005).
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Defining mTBI
  • mTBI is more neuro-chemical than it is
    physio-mechanical

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mTBI/Concussion Facts
  • Most mTBI/concussions do NOT involve loss of
    consciousness
  • A direct blow to the head, face, and neck can
    cause a mTBI/concussion
  • An indirect blow elsewhere on the body can
    transmit an impulsive force to the head,
    causing a mTBI/concussion

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How many Sports and Recreation concussions occur
each year?An estimated 1.6 to 3.8 million
sports- and recreation-related concussions occur
in the U.S. each year, including those for which
no medical care is sought. This range includes
both concussions with and without loss of
consciousness (LOC) and is based on studies that
suggest that injuries involving LOC may account
only for between 8 and 19.2 of sports
concussions. This estimate supersedes that
from an earlier CDC study that reported 300,000
sports- and recreation-related concussions per
year which was based only on those injuries with
LOC.
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Examining Relevance of Bell Ringers in High
School Athletes
Lovell, Collins, Iverson, Field, Podell, Cantu,
Fu J Neurosurgery 98296-301,2003 Lovell,
Collins, Iverson, Johnston, Bradley Amer J
Sports Med 3247-54,2004
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National Pediatric Trauma Registry Mechanism of
Injury for mTBI (B-19 years) N 8016
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MeasureMonitorManage
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Follow-up for a Sprained Ankle
  • Ice to reduce swelling
  • No or limited weight bearing
  • Elevate and rest
  • Use of crutches, bracing, wrapping
  • Lessen activities / modify environment
  • Slow return to activity
  • Rebuild strength

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Follow-up for Sprained Brain
  • Allow time for chemistry /swelling to subside
  • No or limited cognitive activities
  • Rest and more rest
  • Use of modifications, compensatory strategies
  • Lessen activities / modify environment
  • Slow return to activity
  • Rebuild strength

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Adoption of Computerized Neurocognitive Testing
for mTBI/Concussion
  • ImPACT
  • CogState
  • Headminders
  • ANAM

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Other Factors to consider
  • Age of the childyounger is not always better
  • Symptoms that persist for longer than 6-8 weeks
  • Cumulative effects of multiple mTBI/concussions

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When Can an Athlete Return to Play?
  • When medically cleared
  • No cognitive or physical activity of any kind
    while still symptomatic, including headaches
  • If symptom free with light activity, progress
    to increased activity
  • ALWAYS respect the brain and the time it needs to
    heal

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When Can Student Return to School?Accommodations?
Supports?
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Learning/Thinking Changes
  • Confused, foggy
  • Mixed up about time and place
  • Cant attend or concentrate
  • Forgetful, trouble remembering things
  • Difficulty organizing words or thoughts
  • Misunderstands things
  • Slow processing
  • Takes longer to do homework

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Behavioral/Emotional Changes
  • Sad, depressed or withdrawn
  • Anxious or nervous
  • Gets into arguments with friends / peers
  • Cries easily or for no reason
  • Restless, irritable or fussy
  • Acts without thinking
  • Becomes easily upset, angry or loses temper

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Physical Changes
  • Tires easily
  • Drowsy or sleepy
  • Needs extra sleep
  • Hard to fall and stay asleep
  • Sensitive to light and noise
  • Blurry vision
  • Ringing in ears
  • Has headache, is dizzy or lightheaded
  • Vomits or feels sick
  • Parts of body tingle or feel numb
  • Loses balance, trips or stumbles a lot
  • Feels worn out or exhausted

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Tips for helping the Student
  • Monitor w/ checklist
  • Reduce assignments
  • Build in rest periods
  • Give more time to complete work
  • Outline and order steps for big tasks
  • Give written directions or template
  • Use notebook check off to do list
  • Write down schedules w/places, times, etc
  • Meet with Teacher to review home work at end of
    day
  • Inform school nurse, counselor, sp edu

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mTBI/Concussion Communication PP
  • Coach / AT alerts school official
  • Nurse / Counselor alerts teachers
  • Nurse / Counselor meets with student
  • Nurse / Counselor tracks student with Teacher
    Progress Reports
  • Significant changes or ongoing symptoms reported
    to Coach/AT, Family, Physician
  • Possible referral to other specialists
  • Learning supports and modifications

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No head injury is too severe to despair of, nor
too trivial to ignore
  • Hippocrates, 4th Century, B.C.
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