Post Traumatic Head Injury
Most Common Complaint Following Whiplash
  • 70-90% of traumatic brain injuries will develop a headache. 
  • Can have cognitive, emotional, sleep, and physical disturbance.
  • There are many different types of concussions, so proper evaluation is important. 
  • 85% will recover in 3 years.
  • 80% will recover in 2 years.
  • 70% will recover in 1 year. 
Concussion = Brain Bruise
Mild Traumatic Brain Injury

WE MUST NOT FORGET ABOUT THE BRAIN. During all of this, we have a brain inside our skull being thrown around as well. Research has demonstrated tremendous force with minimal acceleration to the brain and structures around. Concussions are commonly sustained during motor vehicle accidents without even hitting your head. The brain is propelled from its resting position to the back of the skull and then from the back to the front most commonly known as coup and contrecoup injuries. A concussion is a cerebral contusion or bruising of the brain which is a type of traumatic brain injury. It is always important to be seen right away after a car accident. There are times when urgent referrals are warranted, or advanced imaging needed to ensure the good of the patient. 

What is a concussion?

 

  • Concussion = mTBI or mild traumatic brain injury.
  • You are considered to have a concussion when you sustain loss of consciousness for less than 30 min, have a change in neuro status (dilated pupils, confusion, headache, dizziness, sensitivity to light, etc), and when there are no findings on structural imaging (CT or MRI).
  • If concussions go untreated it can lead to what is known as post concussive syndrome or PCS. This leads to slower recovery and persistent symptoms.
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Incidence of concussion/mTBI:

 

  •  1.7-3.4+ million per year (may be as high as 6-8 million, but concussions often gounreported)
  • Children/pediatric sports related concussions doubled (ages 8-13) and youths (ages14-19) tripled from 1991- 2007 per ER visit information.
  • 15% of students (approximately 2.5 million) reported having at least one concussion during 12 months.
  • Urban versus Rural populations
  • ○ Urban (Denver area)- people are more likely to go to the ER and concussions are typically in the younger population and are related to sports/recreation.
  • ○ Rural (Johnstown)- people are less likely to go to the ER and concussions are more common amongst the older population, who are likely to have more trauma (i.e., falls).

● Overall, children and teens are more likely to be concussed and typically require more
recovery time as the brain is still developing.
● If you’ve had 1 concussion, you are more likely to have more.

Symptoms:

 

  • We consider the model of neurobiopsychosocial, which means that no behavior exists in isolation and that all factors matter in recovery. We believe in interdisciplinary treatment and referrals.
  • Physical- dizziness, headache, balance issues, vision changes, nausea, sensitivity to light or noise, numbness/tingling
  • Emotional- irritability, sadness, more emotional, nervousness
  • Cognitive- mental fogginess, feeling slowed down, difficulty concentrating, memory loss decreased auditory comprehension
  • Sleep- fatigue, sleeping more or less than usual, trouble falling asleep
Red Flags
Signs are important in concussions.
  • Increasing impairment of their conscious state. 
  • Nausea
  • Decrease in motor function, clumsy, stumbling, drunk. 
  • Changes in vital signs increase or decreased heart rate or blodd pressure. 
  • Seizures
  • Headaches most common symptom. 
  • Pupillary inequality or papilledema.
Treatment
  1. We believe in ACTIVE rehab versus “rest” after a concussion. Symptoms are fewer forthose who are more active versus those who are sleeping/resting more.
  2. Active rehab means continuing to do the things you would do typically, but in moderation. This aids in strengthening and exercising the brain. For example:
  • Instead of taking 3 days to a week off of school- think about going back to school for half days or taking frequent rest breaks during the day.
  • Instead of missing practice or work- think about doing “light duty” that is safe, but still functional.

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