Katherine Lynn, RN, BSN

Mild Traumatic Brain Injuries

(Concussions)

10,400 11,000 43,681 176,300

1,700,000

Multiple Sclerosis Spinal Cord InjuriesHIV/AIIDS Breast CancerTraumatic Brain Injury

Why are we here?

Source: The Brain Injury Association of America based on data from the Centers for Disease Control and Prevention, American Cancer Society, and National Multiple Sclerosis Society

3000 deaths a year are a result of an unintentional traumatic brain injury (TBI).

Concussions occur in 10% of high school and college athletes.

Children’s brains are more vulnerable to injury and take longer to recover because they are still developing.

The brain is more vulnerable to injury after suffering from a concussion.

Females are more vulnerable than males and take longer to recover.

Why are we here?

Traumatic Brain Injuries

Traumatic Brain Injury

Definition:A Complex pathophysiologic process affecting

the brain induced by traumatic biomechanical forces altering brain metabolism.

Normal brain imaging- no damage to brain anatomy.

A concussion is a type of brain injury that changes the way the

brain normally works.

Concussion (Mild Traumatic Brain Injury)

Thinking/Rememberin

gEmotion

al

Physical Sleep

Symptoms Reported by a Student

Source: Centers for Disease Control and Prevention (CDC)

A student may report: Difficulty thinking clearly Difficulty concentrating or remembering Feeling more slowed down Feeling sluggish, hazy, foggy, or groggy

Thinking/Remembering

Source: Centers for Disease Control and Prevention (CDC)

A student may report: Headache or “pressure” in head Nausea of vomiting Balance problems or dizziness Fatigue or feeling tired Blurry or double vision Sensitivity to light or noise Numbness or tingling Does not “feel right”

Physical

Source: Centers for Disease Control and Prevention (CDC)

A student may report: Irritable Sad More emotional than usual Nervous

Emotional

Source: Centers for Disease Control and Prevention (CDC)

A student may report: Drowsy Sleeps less than usual Sleeps more than usual Has trouble falling asleep

(Only ask about sleep symptoms if the injury occurred on a prior day)

Sleep

Source: Centers for Disease Control and Prevention (CDC)

School staff may notice the student:Appears dazed or stunnedIs confused about eventsAnswers questions slowlyRepeats questionsCan’t recall events prior to or after the hit,

bump, or fallLoses consciousness (even briefly)Shows behavior or personality changesForgets class schedule or assignments

Observations

Source: Centers for Disease Control and Prevention (CDC)

A student should be taken to the nurse and seen in an ER right away if she/he has:One pupil larger than the otherDrowsiness or cannot be awakenedA headache that gets worse or doesn’t go awayWeakness, numbness, or decreased

coordinationRepeated vomiting or nausea

Danger Signs

Source: Centers for Disease Control and Prevention (CDC)

A student should be taken to the nurse and seen in an ER right away if she/he has:Slurred speechConvulsions or nauseaDifficulty recognizing people or placesIncreasing confusion, restlessness, or agitationUnusual behaviorLoss or consciousness (even briefly!!)

Danger Signs

Source: Centers for Disease Control and Prevention (CDC)

If you notice or suspect that a student has:

Any kind of forceful blow to the head or to the body that results in rapid movement of the

headand/or

Any sign or symptom of a concussion

When to send a student to the health room:

So what is the big deal?

Repeated mild TBIs occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits.

Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal.

.Source: Centers for Disease Control and Prevention (CDC)

Tracy’s Story

Rapid cerebral swelling caused by another injury to the brain while it is still healing from the initial brain injury/concussion

Over 80% fatal (the brain swells, bleeds, and the player dies on the field)

Usually occurs to children 18 and under.

Second Impact Syndrome

Source: Amy Valasek, MD FAAP

Personal Protective Equipment (PPE)Properly fitting equipmentPlaying by the rulesCoach, parent, and family educationBaseline testingHeads Up Campaign-

http://www.cdc.gov/concussion/headsup/

Prevention

A Child has a ConcussionNow What?

Step 1: Complete rest, no activityStep 2: Light exercise such as free play, walking, or

stationary cycling for 10-15 minutesStep 3: Sport-specific activity for 20-30 minutes (ex.

Skating for hockey, running for soccer)Step 4: “On field” practice with no contactStep 5: “On field” practice with body contact, after

medical clearanceStep 6: Game DayEach step should take a minimum of 24 hours. If any post-concussive

symptoms do occur along the stepwise progression, the athlete is required to drop back to the previous asymptomatic stage

Stepwise Guidelines

Source: McCrory et al., 20091

Difficulty organizing tasksProblems completing activities involving a lot of

concentrationProblems reading or looking at a computer

screenProblems remembering or learning new

informationImpulsive behaviorIrritability

Students Returning to School May Experience:

Source: Centers for Disease Control and Prevention (CDC )

Students returning to school following a concussion may need to:Take rest breaks as neededSpend fewer hours at schoolBe given more time to take tests or complete

assignmentsReceive help with schoolworkReduce time spent on the computer, reading,

and/or writing

Returning to School

Source: Centers for Disease Control and Prevention (CDC)

Parents, teachers, and support staff meet to develop a plan to support the child as they heal and return to school.

The school and family will work together to follow the child’s physician’s orders.

As symptoms decrease, extra support can be decreased.

Most concussions resolve in 7-10 days. Serious concussions can take up to 2 years to fully recover from.

Returning to School

Know Your Concussion ABCs

A •Access the situation

B •Be alert for signs and symptoms

C •Contact a health care provider

Source: Centers for Disease Control and Prevention (CDC)

No two concussions are the same!!and

When in doubt, sit it out!!

Remember:

Questions?

1. McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M, Cantu R. Concensus Statement on Concussion in Sport: the 3rd Internation Conference on Concussion in Sport held in Zurich. Br J Sports Med. 2009;43:i76-i84.

2. Grant, Jo (Speaker). (2012, March 26). Childhood Neurology. PESI HealthCare.

3. Valasek, Amy (Speaker). (2010, March 17). Sport Related Concussion in Pediatric Athletes. Towson Orthopedic Associates.

4. Center for Disease Control and Prevention. Injury prevention and Control: Traumatic Brain Injury. March 29, 2012. http://www.cdc.gov/concussion/index.html.

References