EXS 396: concussion (final)

what is a concussion

a mild traumatic brain injury (TBI)

-caused by bump, blow, or jolt to the head/body that causes the brain to move rapidly back and forth

-can stretch brain cells and create chemical changes that temporarily interfere with normal brain function

-can have immediate symptoms or be delayed

types of concussions

-direct impact injury (blunt force)

-acceleration-deceleration injury (car accidents)

-blast injury (explosions)

causes of concussions

-falls are most common

-sudden acceleration or deceleration of head

-concussions common among athletes of contact sports (football or soccer)

risk factors for concussions

-activities that can lead to falls; especially for kids/older adults

-high-risk sports (football, hockey, soccer, etc)

-not using proper safety equipment and supervision

-auto accidents

-pedestrian or bike accidents

-military combat

-physical abuse

-having a previous concussion increases risk of another

physical symptoms of concussion

persistent headache (common)

nausea/vomiting

dizziness

balance problems

blurry/double vision

sensitivity to light/noise

ringing in ears

cognitive symptoms of concussion

feel foggy or slowed down, difficulty concentrating, memory problems (amnesia), delayed response to questions, slurred speech

emotional symptoms of concussion

Irritability, sadness, nervousness/anxiety, mood swings

Sleep-Related Symptoms of Concussion

sleeping more or less than usual

trouble falling asleep

delayed symptoms of concussion

-may not occur for days

-trouble with concentration and memory

-irritability and personality changes

-changes in taste and smell

complications

post-traumatic headaches: headaches for several days/weeks after a brain injury

post-traumatic vertigo: spinning or dizziness for days/weeks after

second impact syndrome (SIS)

second impact syndrome (SIS)

a 2nd concussion before the symptoms of the 1st go away

-may result in rapid brain swelling

-can lead to death

-must never return to sport when still experiencing symptoms

effects of multiple brain injuries/concussions

chronic traumatic encephalopathy (CTE)

cognitive decline: difficulty with concentrating, thinking, and organization

mental health issue: increased risk of depression, anxiety, personality changes, and suicide

CTE

a progressive brain disease linked to repeated head impacts, often found in athletes

-causes dementia, memory loss, confusion, aggression, depression

-only can diagnose post-mortem

SIS vs CTE

SIS= acute/immediate, 2 concussions in close proximity, rapid and fatal cerebral edema, diagnosed during/immediately after, symptoms are: coma, death, rapid neurological collapse

CTE=chronic/long term, caused by 100s-1000s of impacts (sub-concussive), progressive tau protein accumulation in brain, symptoms: memory loss, depression, dementia, aggression, diagnosed post-mortem

persistent post-concussive symptoms/syndrome

-may have symptoms lasting longer than expected (beyond 3 months)

-longer lasting symptoms include headaches, dizziness, and trouble with thinking

-key history Qs: previous concussion history, time since concussion, strategies used to reduce symptoms and stressors in recovery process

-assess vital signs, demeanor, and coordination

-patients may present similarly but have more neurobehavioral symptoms (irritability, depression, sadness)

what does creighton use for concussion testing?

SWAY app

-have baseline, can test on phone during game

-assess balance/cognition/etc

returning to sports/activity

-must be done w/ approval of healthcare provider

-each step takes minimum 24 hrs

-can only move to next step if they don't have any new symptoms at the current step

-if new symptoms arise/come back, the athletes pushing too hard; stop and rest

6 step return to play progression

1. back to regular activity (school)

2. light aerobic activity (5-10 mins to increase HR; bike, walk, light jog, NO lifting)

3. moderate activity (jog, brief run, mod-intensity lifting)

4. heavy, non-contact activity (sprint/run, high-intensity bike, lifting, sport-specific drills in all planes of movement)

5. practice and full contact (return to practice/full contact in controlled practice)

6. competition