Transcript Traumatic Brain Injury Focus on Concussions

Traumatic Brain Injury
Focus on Concussions
Presenters:
William Thoreson
& Sarah Bonin
Image : http://en.wikipedia.org/wiki/Traumatic_brain_injury
Traumatic Brain Injury in Sports
http://www.youtube.com/watch?v=rapohLQ0UJw
Here is what I can expect
Symptoms of Post-concussion Syndrome
Symptom
Sleep difficulties
Poor concentration
Irritability
Fatigue
Depression
Memory problems
Headaches
Anxiety
Trouble thinking
Dizziness
Blurry or double vision
Sensitivity to bright light
Percentage
80%
71%
66%
64%
63%
59%
59%
58%
57%
52%
45%
40%
www.mentalhealth.va.gov/docs/tbi.pdf
What can my family expect?
• Remember to be patient with your injured
family member
• For each step forward it may seem that there
are 2 steps backward
• The family member will be unpredictable and
so the family should have a predictable
routine
• Repetition of procedures, skills, and
communication is needed
What does the future hold?
• For concussion the future is bright
– Almost full recovery within months is normal
• For severe TBI the future is uncertain
– Relearning
– Relapsing
– Dr. appointments and rehabilitation
– Frustration & hope
Images: http://minerva.union.edu/smithj2/howitworks1.htm
http://www.clipartillustration.com/clipart-illustration-orange-man-holding-question-mark/
Types of Traumatic Brain Injury (TBI)
• TBI is characterized by A bump, blow, or jolt to
the head that disrupts normal functioning of the
brain. It can be acute or sustained.
• 2 Categories
• Closed TBI- all damage in contained inside
skull
• Open (penetrating) TBI- object penetrates
through skin & skull leaving an open wound
How common is TBI?
• 1.7 million people are annually
diagnosed with a TBI
Rates in men
0-4 yr. old male children
• 75% of TBI are concussions (mild TBI)
Severity of Injury
• Concussion or mild TBI- brief change in
mental status or consciousness
• Severe TBI- extended period of
unconsciousness or amnesia
Mechanisms: 3 Current Ideas
• *Membrane Poration*- membranes stretch
causing a separation which increases calcium
movement into the cell.
– Calpain(a protease) is activated which sets into
motion the degradation of cytoskeletal proteins in
axons.
• Integrin Mediation-integrins hold cells in
intracelluar matrix and pull on neurons with
jarring motions causing neuron pull-back and
membrane sheering or tearing and calcium ions
move in.
– Calpain is activated
Mechanisms: 3 Current Ideas
• Changes in ion channel receptors by changes
in gene expression. Increase in #’s of receptors
for NMDA & AMPA which increase basil levels
of calcium in the cell.
– This may be linked to delayed onset of symptoms
• Current thought is that concussion is a
combination of the mechanisms above.
Interview with Dr. Patrick Alford
Image: http://www.cdc.gov/TraumaticBrainInjury/causes.html
Types of Injuries that cause TBI
If you notice an of these symptoms
consult a doctor immediately!
Thinking/
Remembering
Difficulty thinking
clearly
Feeling slowed down
Physical
Emotional/
Mood
Sleep
Irritability
Sleeping more than
usual
Sadness
Sleep less than usual
More emotional
Trouble falling asleep
Headache
Fuzzy or blurry vision
Nausea or vomiting
(early on)
Dizziness
Difficulty concentrating
Sensitivity to noise or
light
Balance problems
Difficulty remembering Feeling tired, having no
Nervousness or anxiety
new information
energy
Onset of symptoms in hrs., days, weeks, months, or longer
Short & Long-term functional changes
to the Frontal & Temporal Lobes
• Normal Temporal Lobe
Function
• recognizing and
processing sound
• understanding and
producing speech
• various aspects of
memory
• Temporal Lobe
Problems
• hearing loss
• language problems
• sensory problems like
the inability to
recognize a familiar
person’s face
Short & Long-term functional changes
to the Frontal & Temporal Lobes
• Normal Frontal Lobe
Function
–
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–
–
–
–
–
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planning
organizing
problem solving
memory
impulse control
decision making
selective attention
controlling our behavior
and emotion
• Frontal Lobe Problems
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emotions
impulse control
language
memory
social and sexual
behavior
Concussion Treatments
• Diagnosis sometimes difficult – young children,
culture (be tough)
• Recovery depends on many factors
– Severity of concussion
– Age
– Overall health
•
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•
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Rest
Stay away from activities that could reinjure
Minimize drugs and alcohol
Heal completely to prevent long term problems
Strategies for Treatments or Cures
• Concussion prevention is most emphasized
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CDC “Heads-Up” Program
Coach, Player, and Parent Education Programs
Improved technology – Helmets, mouth guards
Baseline Testing
• Test before season, then before returning to play
• Severe Traumatic Brain Injury
– Brain Trauma Foundation in-hospital guidelines (CDC)
• 50% decrease in deaths
• Save $288 million in medical and rehabilitation
• $3.8 billion in lifelong social costs
Ethical Questions
• Baseline testing
– Is it reliable?
– Cost?
– School/District, League Policy
• Rule Changes in Sports/Culture
– NFL, NHL, MSHSL, NCAA
Links to Other Problems
• Shaken Baby Syndrome
• Leading cause of child maltreatment deaths in US
• Chronic Traumatic Encephalopathy – CTE
– Degenerative and progressive disease that comes
from too many hits to the head
– CTE has been found in the brains of retired players
who have killed themselves
– Symptoms include confusion, impaired judgment,
impulse control problems, aggression, depression,
and progressive dementia – Boston University
Why did Junior Seau kill himself?
Exploring athletes and depression
Read more:
http://sportsillustrated.cnn.com/2012/wdepressionriters/the_bonus/07/02/retired-athletes/index.html#ixzz22xnDhqYv
Derek Boogaard: A Brain ‘Going Bad’
http://www.nytimes.com/2011/12/06/sports/hockey/derek-boogaard-a-brain-goingbad.html?pagewanted=all
Center for the Study of Traumatic Encephalopathy, Boston University
Impact for Learning
• Can be huge due to high percentage of young
people affected
• Lack of diagnosis for various reasons can lead to
learning problems
• Lack of understanding on the importance of
recovery can result in returning to school or sport
to soon
• All Information from CDC unless otherwise noted
http://www.cdc.gov/TraumaticBrainInjury/index.html