1. Concussions: Facts for School Staff
Perkins School for the Blind
Sarah Kochis RN CPNP

2. Definition of Mild Traumatic Brain Injury (MBTI)/Concussion
MBTI and concussion are used interchangeably
Definition from CDC:
“Complex pathophysiological process affecting the brain induced by traumatic biomechanical forces secondary to direct or indirect forces to the head”.
A mild jolt or blow to the head or body may cause the brain to shift or rotate suddenly within the skull. This sudden movement of the brain causes stretching and tearing of brain cells, damaging the cells and creating chemical changes in the brain.
Associated with normal structural finding on an MRI or CT scan
These chemical changes result in physical, emotional, and cognitive symptoms
Usually does NOT result in loss of consciousness
A concussion IS a brain injury

3. Why is MTBI/Concussion important?
75-90% of the TBI related deaths, hospitalizations and ED visits that occur each year are the result of a concussion or other MTBI
million sports and recreation related TBIs occur every year in the US. Most of these are MTBIs and are NOT treated in the hospital or ED
Direct and indirect medical costs from MTBI totaled approximately $12 billion in the US in 2000.
Those with a history of a concussion are at increased risk of sustaining another concussion
Concussions can have a more serious impact on a developing brain and need to be recognized and treated promptly.

4. Leading causes of MTBI Falls Motor vehicle trauma
Unintentionally struck by/against events
Assaults
Sports
At Perkins the cause is usually due to SIB or a fall related to seizure activity

5. Groups most at risk for MTBI
Infants and Children (ages 0-4)
Children and young adults (ages 5-24)
Older adults (75 and older)

6. Neuropathophysiology of MTBI/Concussion
Dysfunction in brain function from a MTBI is a result of abnormal brain metabolism NOT structural injury or damage. Therefore you will NOT see anything on a CT scan or MRI
This “neuronal dysfunction model” involves a cascade of ionic, metabolic and physiologic events.

7. How is a Concussion Recognized?
Ask the injured student (or staff) about :
1) ANY kind of forceful blow to the head or the body that resulted in rapid movement of the head
2) ANY change in the student’s behavior thinking or physical function
THERE IS NO SINGLE INDICATOR FOR A CONCUSSION. IT REQUIRES A SYMPTOM ASSESSMENT
Signs and symptoms of a concussion can take time to appear and can become more apparent when the child is performing tasks that require mental concentration and or physical exertion. This is where teachers, TAs and residential staff are VERY helpful.

8. OBSERVABLE Signs and Symptoms of Concussion:
Appears dazed or confused
Is confused about events
Answers questions slowly
Repeats Questions
Can’t recall events prior to the hit bump or fall
Can’t recall events after the hit bump or fall
Loses consciousness even briefly
Shows behavior or personality changes

9. Signs and Symptoms of a concussion: Symptoms REPORTED by the STUDENT
Thinking/Remembering
Difficulty thinking clearly
Difficulty concentrating or remembering
Feeling more slowed down
Feeling sluggish, hazy foggy or groggy
Physical
Headache or pressure in head
Nausea or 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”
Sleep
Sleeps LESS than usual
Sleeps MORE than usual
Has trouble falling asleep
Emotional
Irritable
Sad
More emotional than usual
Nervous
IF A STUDENT HAS ONE OR MORE SIGNS OR SYMPTOMS OF A CONCUSSION THEY MUST BE REFERRED TO A HEALTH PROFESSIONAL EXPERIENCED IN EVALUATING CONCUSSION

10. Danger Signs of Concussion
In some cases there may be reason to suspect that there is an intracranial bleed (bleed in the brain or surrounding structures)
If the student displays any of the following s/s they must be evaluated in the ED immediately:
One pupil larger than the other
Is drowsy and cannot be awakened
A headache that gets worse and does not go away
Weakness, numbness or decreased coordination
Repeated vomiting or nausea
Slurred speech
Convulsions or seizure
Cannot recognize people or places
Becomes increasingly confused restless or agitated
Has unusual behavior
Loses consciousness (even a brief loss of consciousness should be taken seriously)

11. Recognizing Concussion in Children with Developmental Delay
As with diagnoses of many other medical issues recognizing a concussion in a child with developmental delay can be challenging.
These children may not have the ability to tell you if they have pain or difficulty with memory concentration etc.
Good observations that identify signs/symptoms that are different than baseline are critical in identifying concussion in this population
Concussion may occur in situations that are not typical for a developmentally normal child.
If the head has come in contact with a hard surface always have the suspicion of a concussion
Concussions may occur from:
Falls
Self injurious behavior ie:head banging
Seizures

12. Recognizing Concussion in Children with Developmental Delay
Acute Signs and Symptoms of a concussion
Vomiting
Headache
Crying and inability to be consoled
Restlessness or irritability
Seizures
Dizziness or confusion
Persistent Signs and Symptoms of a concussion
Excessive crying
Persistent headache
Poor attention
Change in Sleep patterns
Change in eating habits
Increased behavioral outbursts
Sad or lethargic mood
Lack of interest in favorite toys/activities

13. What are your responsibilities
Report to the CRL or Program Nurse if a student has hit their head
Monitor student at risk for signs and symptoms of a concussion according to instructions from the program nurse
If a student is found to have a concussion you may be responsible for completing an observation checklist
Modify activities/school work according to recommendations from the program nurse

14. Resources http://hitstothehead.org/