1. Traumatic Brain Injury Focus on Concussions
Presenters:
William Thoreson
& Sarah Bonin
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2. Traumatic Brain Injury in Sports

3. Here is what I can expect
Symptoms of Post-concussion Syndrome
Symptom Percentage
Sleep difficulties 80%
Poor concentration 71%
Irritability 66%
Fatigue 64%
Depression 63%
Memory problems 59%
Headaches 59%
Anxiety 58%
Trouble thinking 57%
Dizziness 52%
Blurry or double vision 45%
Sensitivity to bright light 40%

4. 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

5. 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
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6. 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

7. How common is TBI?
1.7 million people are annually diagnosed with a TBI
75% of TBI are concussions (mild TBI)
Rates in men
0-4 yr. old male children

8. Severity of Injury
Concussion or mild TBI- brief change in mental status or consciousness
Severe TBI- extended period of unconsciousness or amnesia

9. 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

10. 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

11. Types of Injuries that cause TBI
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12. If you notice an of these symptoms consult a doctor immediately!
            
If you notice an of these symptoms consult a doctor immediately!
Thinking/ Remembering
Physical
Emotional/ Mood
Sleep
Difficulty thinking clearly
Headache Fuzzy or blurry vision
Irritability
Sleeping more than usual
Feeling slowed down
Nausea or vomiting (early on) Dizziness
Sadness
Sleep less than usual
Difficulty concentrating
Sensitivity to noise or light Balance problems
More emotional
Trouble falling asleep
Difficulty remembering new information
Feeling tired, having no energy
Nervousness or anxiety
Onset of symptoms in hrs., days, weeks, months, or longer

13. Short & Long-term functional changes to the Frontal & Temporal Lobes
Temporal Lobe Problems
hearing loss
language problems
sensory problems like the inability to recognize a familiar person’s face
Normal Temporal Lobe Function
recognizing and processing sound
understanding and producing speech
various aspects of memory

14. Short & Long-term functional changes to the Frontal & Temporal Lobes
Normal Frontal Lobe Function
planning
organizing
problem solving
memory
impulse control
decision making
selective attention
controlling our behavior and emotion
Frontal Lobe Problems
emotions
impulse control
language
memory
social and sexual behavior

15. Concussion Treatments
Diagnosis sometimes difficult – young children, culture (be tough)
Recovery depends on many factors
Severity of concussion
Age
Overall health
Rest
Stay away from activities that could reinjure
Minimize drugs and alcohol
Heal completely to prevent long term problems

16. Strategies for Treatments or Cures
Concussion prevention is most emphasized
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

17. Ethical Questions Baseline testing Rule Changes in Sports/Culture
Is it reliable?
Cost?
School/District, League Policy
Rule Changes in Sports/Culture
NFL, NHL, MSHSL, NCAA

18. 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

19. Why did Junior Seau kill himself? Exploring athletes and depression
Read more:
Derek Boogaard: A Brain ‘Going Bad’
Center for the Study of Traumatic Encephalopathy, Boston University

20. 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