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TRAUMATIC BRAIN INJURY A BRIEF OVERVIEW

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Title: TRAUMATIC BRAIN INJURY A BRIEF OVERVIEW Author: EFENTON Last modified by: Patricia E. Endsley Created Date: 2/16/2005 6:26:56 PM Document presentation format – PowerPoint PPT presentation

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Title: TRAUMATIC BRAIN INJURY A BRIEF OVERVIEW


1
Cathy OConnor AT, MD, FACS Goodall
Hospital Maine Concussion Management Initiative
2
  • Educate about Mild Traumatic Brain Injury
  • How to identify a student with potential injury
  • How brain injury affects academic performance
  • Understand the need for academic accommodations
    during MTBI recovery.
  • Review more commonly used academic
    accommodations.

3
  • No spare brains available
  • Long lasting consequences if not managed properly
    in kids
  • Education and patience is the key
  • No spare brains available
  • Long lasting consequences if not managed properly
    in kids
  • Education and patience is the key

4
  • Mild Traumatic Brain Injury (MTBI)
  • Same injury and mechanism as what we see in
    military veterans who are victims of IEDs
  • Throw out all previous assumptions about
    concussion- new game

5
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6
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

7
Collins, et al. Neurosurgery 58275-286, 2006
8
  • Higher number of concussions/MTBI
  • MTBIs occurring too close in time
  • Re-injury prior to full recovery
  • Pre-existing learning disability or migraine
    issues
  • Physical exertion OR cognitive stress can cause
    symptom flare-ups prolong recovery.

9
  • May not be the athlete- could have happened
    outside of school, in gym class, slip and fall,
    etc
  • Symptoms may be delayed or not manifest until
    brain is cognitively stressed
  • Student not able to focus, pay attention, fails
    quiz or test, odd answer to verbal question,
    appears to have problem with lights

10
  • Physical
  • Headaches
  • Fatigue/tiredness
  • Dizziness with movement or mental exertion
  • Nausea
  • Light/noise sensitivity
  • Ringing in the ears

11
  • Cognitive
  • Inability to focus
  • Limited concentration
  • Inefficient short-term memory
  • Slowed thinking
  • Feeling mentally foggy
  • Poor reading comprehension

12
  • Sleep difficulties
  • Trouble falling asleep
  • Overnight awakening
  • Oversleeping/undersleeping
  • Feeling tired in the morning despite long hours
    in bed

13
  • Mood disruption
  • Irritability
  • Sadness
  • Nervousness
  • Anxiety
  • Depression

14
  • COGNITIVE
  • Fogginess
  • Concentration
  • Memory deficits
  • Cognitive fatigue

SLEEP DYSREGULATION Falling asleep Fragmented
sleep Too much/too little sleep
SOMATIC Headaches Dizziness Light/noise
sensitivity Tinnitus
MOOD DISRUPTION Irritability Sadness Anxiety
Adapted from Camiolo Reddy, Collins Gioia, 2008
15
  • Wake up fatigued
  • Develop headaches sitting in class
  • Cant 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

16
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17
  • Controls for individual factors such as LD, ADHD,
    medications, etc.
  • Can be done in large groups with educational
    seminars
  • Orients athletes to concussion issues at start of
    season
  • Annually for injured athletes every 2 years for
    those with no concussion history
  • Baseline and post injury testing

18
CASE 1 KICK-OFF RETURNER
DAY 3 6 10
13 14
Exertion
19
  • Improve with rest
  • Physical/sports exertion
  • Mental exertion
  • Sustained attention in class and during school
    day
  • Reading
  • Homework
  • Tests/quizzes

20
  • Temporary?
  • Short-lasting?
  • Improves more quickly with proper management
  • Complete recovery typically expected

21
  • Athletic Trainer
  • Monitoring of symptoms
  • Periodic neurocognitive testing
  • School Nurse
  • Daily clinical evaluations
  • Rest recovery area
  • Medication
  • Guidance counselor
  • Coordinates academic accommodations

22
  • Teachers
  • Adjust work according to changing status
  • Reassurance
  • Psychologists
  • Specific input for LD-ADHD students
  • Social Workers
  • Adjustment support - especially in longer
    recoveries

23
  • Consistent Message to the Student
  • The injury is real
  • Waiting for a full recovery is critical.
  • Prolonged recovery or even catastrophic injury by
    returning to activity too soon
  • Academic accommodations can be provided during
    recovery

24
  • Individualization
  • Accommodations
  • Key staff
  • Innovation
  • Integration/Team work
  • RN ATC
  • Guidance Teachers
  • Psychologists Social Workers
  • Parents
  • Fluid situation that will change over time

25
  • Excused absence from classes
  • Time out of school/complete rest to start?
  • Partial attendance as able
  • Morning fatigue/poor sleep gt arrive late
  • Afternoon fatigue in school gt leave early
  • Selective attendance?
  • Core classes vs. electives?
  • Avoid classes that are too challenging?

26
  • Rest periods during the school day
  • School nurses office
  • Go to rest before symptoms become too intense
  • Take Tylenol/Advil, etc. as recommended by
    doctor
  • Return to classes if feeling better
  • Early dismissal if rest does not help

27
  • Extension of assignment deadlines!
  • Homework, papers, projects
  • According to students capacity
  • Removes major source of pressure
  • Allows student to prioritize sleep
  • rest!

28
  • Excuse from some assignments ?
  • More common in lower grades
  • Less catch-up to do during/after recovery
  • Consolidate work into more manageable units

29
  • Postponement of quizzes tests
  • Until student is able to prepare and symptoms are
    under better control
  • Avoid high stakes testing (e.g. AP exams, SAT)
    while symptomatic
  • Extended time (x1.5 or x2) until recovered
  • Spring injuries - wait until summer to complete
    course work and exams?
  • Evaluate true necessity of exam/quiz for student
    assessment- ? Alternative format

30
  • Accommodation for light/noise sensitivity
  • Excuse from assemblies
  • Able to eat lunch away from cafeteria
  • Cap and/or sunglasses for light sensitivity
  • Avoid fluorescent lights, windows
  • Limit iPod, TV, computer exposure based on
    symptoms
  • Limit texting
  • Adapt music to what is comfortable

31
  • NO sports, gym, music/theater/dance
  • Use time for rest homework
  • Short practice visits to stay connected to team
  • DO NOT ride bus to away games with team
  • DO NOT sit on bench during games
  • In stands with family if symptoms allow
  • Prom

32
  • Limit other forms of physical exertion
  • Heavy backpacks
  • Climbing stairs
  • Walking home from school/bus stop
  • Caring for large animals, or walking the dog
  • Operating heavy equipment
  • DRIVING
  • Be aware of impaired judgement/ability to react
    to dangerous situations

33
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34
  • Outermost layer
  • Learn new info
  • Form thought
  • Make decisions
  • Memory function

35
  • Recent memory
  • Emotions
  • Concentration
  • Ability to learn new info and retain it
  • Storage of motor patterns and voluntary activity

36
  • Processing of sensory input
  • Sensory discrimination
  • Body orientation

37
  • Processing of all visual input

38
  • Expressed behavior childish, irritable, agitated
  • Information retrieval
  • Receptive speech/auditory input processing

39
  • www.cdc.gov/concussion
  • www.impacttestonline.com
  • www.sportsconcussion.net
  • www.sportslegacy.org

40
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