Tag Archives: traumatic brain injury

Northwestern University School of Medicine study: Concussions and female middle school students

2 Aug

According to Michelle Healy of USA Today, 1.35 million youths a year have serious sports injuries http://www.usatoday.com/story/news/nation/2013/08/06/injuries-athletes-kids-sports/2612429/ Among those injuries are concussions. Kids Health has some great information about concussions at their site:

What Is a Concussion and What Causes It?
The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. When a person gets a head injury, the brain can move around inside the skull and even bang against it. This can lead to bruising of the brain, tearing of blood vessels, and injury to the nerves. When this happens, a person can get a concussion — a temporary loss of normal brain function.
Most people with concussions recover just fine with appropriate treatment. But it’s important to take proper steps if you suspect a concussion because it can be serious.
Concussions and other brain injuries are fairly common. About every 21 seconds, someone in the United States has a serious brain injury. One of the most common reasons people get concussions is through a sports injury. High-contact sports such as football, boxing, and hockey pose a higher risk of head injury, even with the use of protective headgear.
People can also get concussions from falls, car accidents, bike and blading mishaps, and physical violence, such as fighting. Guys are more likely to get concussions than girls. However, in certain sports, like soccer, girls have a higher potential for concussion.http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

https://drwilda.com/2012/03/06/dont-ignore-concussions/
See, Update: Don’t ignore concussions https://drwilda.com/2012/05/20/update-dont-ignore-concussions/
More studies are pointing to the risks of girls playing contact sports.

Science Daily reported in Middle-school girls continue to play soccer with concussion symptoms:

Concussions are common among middle-school girls who play soccer, and most continue to play with symptoms, according to a study by John W. O’ Kane, M.D., of the University of Washington Sports Medicine Clinic, Seattle, and colleagues.
Sports-related concussions account for 1.6 to 3.8 million injuries in the United States annually, including about 50,000 soccer-related concussions among high school players. Injury-tracking systems for younger players are lacking so they are largely unstudied, according to the study background.
Using an email survey and interviews, the authors evaluated the frequency and duration of concussions in young female soccer players, as well as whether the injuries resulted in stopping play and seeking medical attention. Their study included 351 soccer players (ages 11 to 14 years) from soccer clubs in the Puget Sound region of Washington.
Among 351 players, there were 59 concussions with 43,742 athletic exposure hours. Concussion symptoms can include memory loss, dizziness, drowsiness, headache and nausea. Cumulative concussion incidence was 13 percent per season with an incidence of 1.2 per 1,000 athletic exposure hours. Symptoms lasted a median four days (average 9.4 days). Heading the ball accounted for 30.5 percent of concussions. Most players (58.6 percent) continued to play with symptoms, with almost half (44.1 percent) seeking medical attention, according to the results.
The authors note that the rate of 1.3 concussions per 1,000 athletic exposure hours was higher than what has been reported in other studies of girls soccer at the high school and college levels…. http://www.sciencedaily.com/releases/2014/01/140120173456.htm

Another study from Northwestern School of Medicine, Concussion and Female Middle School Athletes focuses on girls. Coaches and parents must be alert to signs of concussion. WebMD has a good description of what a concussion is and the signs of concussion http://www.webmd.com/brain/tc/traumatic-brain-injury-concussion-overview

Citation:

From The JAMA Network | August 01, 2014
Concussion and Female Middle School Athletes FREE ONLINE FIRST
Cynthia LaBella, MD1
[+] Author Affiliations
JAMA. Published online August 01, 2014. doi:10.1001/jama.2014.6668
Text Size: A A A
Article
References
JAMA Pediatrics
Concussion Among Female Middle-School Soccer Players
John W. O’Kane, MD; Amy Spieker, MPH; Marni R. Levy, BS; Moni Neradilek, MS; Nayak L. Polissar, PhD; Melissa A. Schiff, MD, MPH
Importance Despite recent increased awareness about sports concussions, little research has evaluated concussions among middle-school athletes.
Objectives To evaluate the frequency and duration of concussions in female youth soccer players and to determine if concussions result in stopping play and seeking medical care.
Design, Setting, and Participants Prospective cohort study from March 2008 through May 2012 among 4 soccer clubs from the Puget Sound region of Washington State, involving 351 elite female soccer players, aged 11 to 14 years, from 33 randomly selected youth soccer teams. Of the players contacted, 83.1% participated and 92.4% completed the study.
Main Outcomes and Measures Concussion cumulative incidence, incidence rate, and description of the number, type, and duration of symptoms. We inquired weekly about concussion symptoms and, if present, the symptom type and duration, the event resulting in symptom onset, and whether the player sought medical attention or played while symptomatic.
Results Among the 351 soccer players, there were 59 concussions with 43 742 athletic exposure hours. Cumulative concussion incidence was 13.0% per season, and the incidence rate was 1.2 per 1000 athletic exposure hours (95% CI, 0.9-1.6). Symptoms lasted a median of 4.0 days (mean, 9.4 days). Heading the ball accounted for 30.5% of concussions. Players with the following symptoms had a longer recover time than players without these symptoms: light sensitivity (16.0 vs 3.0 days, P = .001), emotional lability (15.0 vs 3.5 days, P = .002), noise sensitivity (12.0 vs 3.0 days, P = .004), memory loss (9.0 vs 4.0 days, P = .04), nausea (9.0 vs 3.0 days, P = .02), and concentration problems (7.0 vs 2.0 days, P = .02). Most players (58.6%) continued to play with symptoms, with almost half (44.1%) seeking medical attention.
Conclusions and Relevance Concussion rates in young female soccer players are greater than those reported in older age groups, and most of those concussed report playing with symptoms. Heading the ball is a frequent precipitating event. Awareness of recommendations to not play and seek medical attention is lacking for this age group.
JAMA Pediatr. 2014;168(3):258-264. doi:10.1001/jamapediatrics.2013.4518.

Parents must be alert to what is happening with the children when they participate in athletic events and activities.

Resources:

Concussions http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

Concussion http://www.emedicinehealth.com/concussion/article_em.htm

Concussion – Overview http://www.webmd.com/brain/tc/traumatic-brain-injury-concussion-overview

Related :

Study: Effects of a concussion linger for months https://drwilda.com/2012/12/13/study-effects-of-a-concussion-linger-for-months/

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Johns Hopkins study: Education mitigates the effects of brain injury

24 Apr

Education Portal defines illiteracy in the article, Illiteracy: The Downfall of American Society.

Most people think of literacy as a simple question of being able to read. But while a young child who can work her way through a basic picture book is considered to have age-appropriate literacy levels, an adult who can only read at the most fundamental level is still functionally illiterate.
The world requires that adults not only be able to read and understand basic texts, but also be able to function in the workplace, pay bills, understand legal and financial documents and navigate technology – not to mention the advanced reading comprehension skills required to pursue postsecondary education and the opportunities that come with it.
As a result, when we talk about the effects of illiteracy on society, we’re talking primarily about what happens when you have a large number of adults whose literacy skills are too low to perform normal, day-to-day tasks. However, it is worth keeping in mind that childhood illiteracy is, of course, directly correlated to adult illiteracy. http://education-portal.com/articles/Illiteracy_The_Downfall_of_American_Society.html

The key concept is the individual cannot adequately function in the society in which they live. That means that tasks necessary to provide a satisfactory life are difficult because they cannot read and/or comprehend what they read.
Research is taking the concept of literacy a step farther with the concept of cognitive reserve.

Jon Hamilton of NPR reported in the article, Education May Help Insulate The Brain Against Traumatic Injury:

A little education goes a long way toward ensuring you’ll recover from a serious traumatic brain injury. In fact, people with lots of education are seven times more likely than high school dropouts to have no measurable disability a year later.
“It’s a very dramatic difference,” says Eric Schneider, an epidemiologist at Johns Hopkins and the lead author of a new study. The finding suggests that people with more education have brains that are better able to “find ways around the damage” caused by an injury, he says.
The study looked at the medical records of 769 adults who suffered traumatic brain injuries serious enough to require an inpatient hospital stay and rehabilitation. A year after the injury, just 10 percent of people who didn’t finish high school had no disability, compared with 39 percent of people with enough years of education to have received a college degree. People with advanced degrees did even better.
One reason for the difference may be something known as “cognitive reserve” in the brain, Schneider says. The concept is a bit like physical fitness, he says, which can help a person recover from a physical injury. Similarly, a person with a lot of cognitive reserve may be better equipped to recover from a brain injury…
For several decades, studies have shown that people with more education, and presumably more cognitive reserve, are less likely to develop the memory and thinking problems of Alzheimer’s disease. The new study suggests the benefits of education and cognitive reserve extend to brain damage caused by injury rather than disease.
There’s no guaranteed way to increase your cognitive reserve, Schneider says. But there are hints that staying physically and socially active helps, and that “pursuing lifelong learning may be beneficial,” he says.
One limitation of the study is that it relied on a standard disability rating scale, which relies on measures such as a person’s ability to return to work. That could have meant that a college graduate returning to an office job was less likely to be declared disabled than, “a roofer with balance issues,” Schneider says. He adds that even people with a disability rating of zero may still have mental or physical problems caused by their brain injury. http://www.npr.org/blogs/health/2014/04/23/306228476/education-may-help-insulate-the-brain-against-traumatic-injury

Citation:

Functional recovery after moderate/severe traumatic brain injury
A role for cognitive reserve?
1. Eric B. Schneider, PhD,
2. Sandeepa Sur, MSc, MHS,
3. Vanessa Raymont, MBChB, MSc, MRCPsych,
4. Josh Duckworth, MD,
5. Robert G. Kowalski, MBBCh, MS,
6. David T. Efron, MD,
7. Xuan Hui, MD, ScM,
8. Shalini Selvarajah, MD, MPH,
9. Hali L. Hambridge, ScM and
10. Robert D. Stevens, MD
+SHOW AFFILIATIONS
| + SHOW FULL DISCLOSURES
1. From the Center for Surgical Trials and Outcomes Research, Department of Surgery (E.B.S., D.T.E., X.H., S. Selvarajah, H.L.H.), Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine (R.G.K., R.D.S.), and Departments of Neurology (R.D.S.) and Neurosurgery (R.D.S.), Johns Hopkins School of Medicine, Baltimore, MD; Tulane Center for Aging (S. Sur), Tulane University School of Medicine, New Orleans, LA; Department of Radiology (V.R., J.D., R.D.S.), Johns Hopkins University, Baltimore, MD; and Centre for Mental Health (V.R.), Department of Medicine, Imperial College London, UK.
1. Correspondence to Dr. Schneider: eschnei1@jhmi.edu
+ AUTHOR DISCLOSURES: ERIC B. SCHNEIDER, PHD
+ AUTHOR DISCLOSURES: SANDEEPA SUR, MSC, MHS
+ AUTHOR DISCLOSURES: VANESSA RAYMONT, MBCHB, MSC, MRCPSYCH
+ AUTHOR DISCLOSURES: JOSH DUCKWORTH, MD
+ AUTHOR DISCLOSURES: ROBERT G. KOWALSKI, MBBCH, MS
+ AUTHOR DISCLOSURES: DAVID T. EFRON, MD
+ AUTHOR DISCLOSURES: XUAN HUI, MD, SCM
+ AUTHOR DISCLOSURES: SHALINI SELVARAJAH, MD, MPH
+ AUTHOR DISCLOSURES: HALI L. HAMBRIDGE, SCM
+ AUTHOR DISCLOSURES: ROBERT D. STEVENS, MD
1. Published online before print April 23, 2014, doi: 10.1212/WNL.0000000000000379 Neurology 10.1212/WNL.0000000000000379
» Abstract
Full Text (PDF)
1. Also available:
2. Accompanying Comment
Abstract
Objective: To evaluate the hypothesis that educational attainment, a marker of cognitive reserve, is a predictor of disability-free recovery (DFR) after moderate to severe traumatic brain injury (TBI).
Methods: Retrospective study of the TBI Model Systems Database, a prospective multicenter cohort funded by the National Institute on Disability and Rehabilitation Research. Patients were included if they were admitted for rehabilitation after moderate to severe TBI, were aged 23 years or older, and had at least 1 year of follow-up. The main outcome measure was DFR 1 year postinjury, defined as a Disability Rating Scale score of zero.
Results: Of 769 patients included, 214 (27.8%) achieved DFR at 1 year. In total, 185 patients (24.1%) had <12 years of education, while 390 (50.7%) and 194 patients (25.2%) had 12 to 15 years and ≥16 years of education, respectively. DFR was achieved by 18 patients (9.7%) with <12 years, 120 (30.8%) with 12 to 15 years, and 76 (39.2%) with ≥16 years of education (p < 0.001). In a logistic regression model controlling for age, sex, and injury- and rehabilitation-specific factors, duration of education of ≥12 years was independently associated with DFR (odds ratio 4.74, 95% confidence interval 2.70–8.32 for 12–15 years; odds ratio 7.24, 95% confidence interval 3.96–13.23 for ≥16 years).
Conclusion: Educational attainment was a robust independent predictor of 1-year DFR even when adjusting for other prognostic factors. A dose-response relationship was noted, with longer educational exposure associated with increased odds of DFR. This suggests that cognitive reserve could be a factor driving neural adaptation during recovery from TBI.
Received July 18, 2013.
Accepted in final form January 21, 2014.
© 2014 American Academy of Neurology

Cognitive reserve is the key concept in interpreting this study.

Molly Edmonds wrote in the How Stuff Works article, Can you delay dementia?

But don’t get downhearted; even if you didn’t go for that Ph.D., you can still start challenging the brain at any age to build up cognitive reserve. Software and video games meant to challenge the brain have begun popping up on the market, though scientists warn that these tools don’t have much science behind them [sources: Belluck, Larson]. You don’t even have to get that high-tech. In one study, participants who worked a crossword puzzle four days of the week had a 47 percent lower risk of dementia than those who did a crossword once a week . Mental activities like playing chess and other board games, learning a foreign language, volunteering, reading and playing a musical instrument all keep the brain humming. Finding a friend to do some of these activities with is also a bonus — in a study that examined over 1,000 people, those with a limited social network were 60 percent more likely to have dementia after a three-year period .
For a real-life example of how cognitive reserve can delay dementia, look no further than the 678 Catholic Sisters of Notre Dame, of Mankato, Minn. These nuns’ cognitive states were studied for years as doctors tried to learn more about dementia, and doctors conducted postmortem exams on the women’s brains. In one examination, doctors found that some of the nuns who had signs of Alzheimer’s disease in the brain hadn’t demonstrated a lack of cognitive function while still alive. The doctors did notice that the blood vessels in the brain were in exceptionally good shape, however, meaning that even as Alzheimer’s started to appear, the brain found a way to work around the challenges [sources: Whitehouse, Tan]. That’s not to say that cognitive reserve can delay dementia forever — if the women had lived longer, they may have developed dementia eventually.
Your brain depends on a regular flow of blood, so another way to keep those cerebral blood vessels working well is good old-fashioned exercise. Read on to find out what other physical activities can help your brain. http://health.howstuffworks.com/mental-health/dementia/delay-dementia1.htm

Just as one must exercise their body to stay healthy, they must also exercise their brain.

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Canadian study: Teens who have suffered a concussion at higher risk for bullying and suicide

16 Apr

Kids Health has some great information about concussions at their site:

What Is a Concussion and What Causes It?
The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. When a person gets a head injury, the brain can move around inside the skull and even bang against it. This can lead to bruising of the brain, tearing of blood vessels, and injury to the nerves. When this happens, a person can get a concussion — a temporary loss of normal brain function.
Most people with concussions recover just fine with appropriate treatment. But it’s important to take proper steps if you suspect a concussion because it can be serious.
Concussions and other brain injuries are fairly common. About every 21 seconds, someone in the United States has a serious brain injury. One of the most common reasons people get concussions is through a sports injury. High-contact sports such as football, boxing, and hockey pose a higher risk of head injury, even with the use of protective headgear.
People can also get concussions from falls, car accidents, bike and blading mishaps, and physical violence, such as fighting. Guys are more likely to get concussions than girls. However, in certain sports, like soccer, girls have a higher potential for concussion.
http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_
https://drwilda.com/2012/03/06/dont-ignore-concussions/
See, Update: Don’t ignore concussions https://drwilda.com/2012/05/20/update-dont-ignore-concussions/

Bryan Toporek reported in the Education Week article, Once-Concussed Teenagers Found to Be at Higher Risk for Bullying, Suicide:

Teenagers who have suffered a traumatic brain injury such as a concussion are twice as likely to be bullied and roughly three times as likely to attempt suicide compared to those who haven’t, according to a new study published online today in the open-access journal PLOS ONE.
The study drew upon data from the 2011 Ontario Student Drug Use and Health Survey, which contains responses from nearly 9,300 students between grades 7 and 12 in 181 publicly funded schools across Ontario. Questions about traumatic brain injuries were added to the OSDUHS for the first time in 2011 and were answered by a subsample of 4,816 students.
The teenagers were asked whether they had ever suffered a head injury that resulted in them being unconscious for at least five minutes or required at least one night’s stay in a hospital. Just under 20 percent of the students involved in the study had suffered at least one head injury that met either of those qualifications….
http://blogs.edweek.org/edweek/schooled_in_sports/2014/04/once-concussed_teenagers_found_to_be_at_higher_risk_for_bullying_suicide.html

Citation:

Research Article
Suicidality, Bullying and Other Conduct and Mental Health Correlates of Traumatic Brain Injury in Adolescents
Gabriela Ilie mail,
Robert E. Mann,
Angela Boak,
Edward M. Adlaf,
Hayley Hamilton,
Mark Asbridge,
Jürgen Rehm,
Michael D. Cusimano
Published: April 15, 2014
•DOI: 10.1371/journal.pone.0094936

Objective
Our knowledge on the adverse correlates of traumatic brain injuries (TBI), including non-hospitalized cases, among adolescents is limited to case studies. We report lifetime TBI and adverse mental health and conduct behaviours associated with TBI among adolescents from a population-based sample in Ontario.
Method and Findings
Data were derived from 4,685 surveys administered to adolescents in grades 7 through 12 as part of the 2011 population-based cross-sectional Ontario Student Drug Use and Health Survey (OSDUHS). Lifetime TBI was defined as head injury that resulted in being unconscious for at least 5 minutes or being retained in the hospital for at least one night, and was reported by 19.5% (95%CI:17.3,21.9) of students. When holding constant sex, grade, and complex sample design, students with TBI had significantly greater odds of reporting elevated psychological distress (AOR = 1.52), attempting suicide (AOR = 3.39), seeking counselling through a crisis help-line (AOR = 2.10), and being prescribed medication for anxiety, depression, or both (AOR = 2.45). Moreover, students with TBI had higher odds of being victimized through bullying at school (AOR = 1.70), being cyber-bullied (AOR = 2.05), and being threatened with a weapon at school (AOR = 2.90), compared with students who did not report TBI. Students with TBI also had higher odds of victimizing others and engaging in numerous violent as well as nonviolent conduct behaviours.
Conclusions
Significant associations between TBI and adverse internalizing and externalizing behaviours were found in this large population-based study of adolescents. Those who reported lifetime TBI were at a high risk for experiencing mental and physical health harms in the past year than peers who never had a head injury. Primary physicians should be vigilant and screen for potential mental heath and behavioural harms in adolescent patients with TBI. Efforts to prevent TBI during adolescence and intervene at an early stage may reduce injuries and comorbid problems in this age group…. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0094936
Here is the press release from St. Michael’s Hospital:
Teenagers who have had a concussion also have higher rates of suicide attempts, being bullied and high-risk behavior, study finds
Toronto, April 15, 2014
Teenagers who have suffered a traumatic brain injury such as a concussion are at “significantly greater odds” of attempting suicide, being bullied and engaging in a variety of high risk behaviours, a new study has found.
They are also more likely to become bullies themselves, to have sought counselling through a crisis help-line or to have been prescribed medication for anxiety, depression or both, said Dr. Gabriela Ilie, lead author of the study and a post-doctoral fellow at St. Michael’s Hospital.
They have higher odds of damaging property, breaking and entering, taking a car without permission, selling marijuana or hashish, running away from home, setting a fire, getting into a fight at school or carrying or being threatened by a weapon, she said in a paper published today in the journal PLOS ONE.
Dr. Ilie said the study provides the first population-based evidence demonstrating the extent of the association between TBI and poor mental health outcomes among adolescents.
“These results show that preventable brain injuries and mental health and behavioural problems among teens continue to remain a blind spot in our culture,” Dr. Ilie said. “These kids are falling through the cracks.”
The data used in the study was from the 2011 Ontario Student Drug Use and Health Survey developed by the Centre for Addiction and Mental Health. The survey, one of the longest ongoing school surveys in the world, contains responses from almost 9,000 students from Grades 7-12 in publicly funded schools across Ontario. The OSDUHS began as a drug use survey, but is now a broader study of adolescent health and well-being. Questions about traumatic brain injury were added to the survey for the first time in 2011.
“We know from a previous study based on OSDUHS data that as many as 20 per cent of adolescents in Ontario said they have experienced a traumatic brain injury in their lifetime,” said Dr. Robert Mann, senior scientist at CAMH and director of the OSDUHS. “The relationship between TBI and mental health issues is concerning and calls for greater focus on prevention and further research on this issue.”
Dr. Ilie said the teenage years are already a turbulent time for some, as they try to figure out who they are and what they want to be. Since a TBI can exacerbate mental health and behavioural issues, she said primary physicians, schools, parents and coaches need to be vigilant in monitoring adolescents with TBI.
In addition, she said many TBI experienced by youth occur during sports and recreational pursuits, and are largely preventable through use of helmets and the elimination of body checking in hockey.
The study found that adolescents who had suffered a TBI sometime in their life had twice the odds of being bullied at school or via the Internet and almost three times the odds of attempting suicide or being threatened at school with a weapon compared to those without a TBI.
This research was funded by a Canadian Institute of Health Research Team Grant in Traumatic Brain Injury and Violence and by the Ontario Neurotrauma Foundation. Additional funding was obtained from a grant from AUTO21, a member of the Networks of Centres of Excellence program that is administered and funded by the Natural Sciences and Engineering Research Council, the Social Sciences and Humanities Research Council, in partnership with Industry Canada, and ongoing funding support from the Ontario Ministry of Health and Long-Term Care.
About St. Michael’s Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.
Media contacts
For more information, or to arrange an interview with Dr. Sievenpiper, contact:
Leslie Shepherd
Manager, Media Strategy
416-864-6094
shepherdl@smh.ca
About CAMH
The Centre for Addiction and Mental Health (CAMH) is Canada’s largest mental health and addiction teaching hospital, as well as one of the world’s leading research centres in its field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit http://www.camh.ca.
For more information on OSDUHS or to interview Dr. Mann, please contact:
Kate Richards
Media Relations
Centre for Addiction and Mental Health (CAMH)
Office: 416 535 8501 x36015
Mobile: 416 427 7743
kate.richards@camh.ca
http://www.camh.ca

The Sports Concussion Institute has some great information about concussions http://www.concussiontreatment.com/concussionfacts.html

People must take concussions very seriously.

Resources:

Concussions
http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

Concussion http://www.emedicinehealth.com/concussion/article_em.htm

Concussion – Overview http://www.webmd.com/brain/tc/traumatic-brain-injury-concussion-overview

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

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Concussions: American Academy of Pediatrics issued recommendations for “return to learn” checklists

27 Oct

Moi wrote in Don’t ignore concussions:
Kids Health has some great information about concussions at their site:

What Is a Concussion and What Causes It?
The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. When a person gets a head injury, the brain can move around inside the skull and even bang against it. This can lead to bruising of the brain, tearing of blood vessels, and injury to the nerves. When this happens, a person can get a concussion — a temporary loss of normal brain function.
Most people with concussions recover just fine with appropriate treatment. But it’s important to take proper steps if you suspect a concussion because it can be serious.
Concussions and other brain injuries are fairly common. About every 21 seconds, someone in the United States has a serious brain injury. One of the most common reasons people get concussions is through a sports injury. High-contact sports such as football, boxing, and hockey pose a higher risk of head injury, even with the use of protective headgear.
People can also get concussions from falls, car accidents, bike and blading mishaps, and physical violence, such as fighting. Guys are more likely to get concussions than girls. However, in certain sports, like soccer, girls have a higher potential for concussion.http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

https://drwilda.com/2012/03/06/dont-ignore-concussions/
See, Update: Don’t ignore concussions https://drwilda.com/2012/05/20/update-dont-ignore-concussions/

Jan Hoffman reported in the New York Times article, Concussions and the Classroom:

Because of heightened awareness about the hazards of sports-related concussions, many states have implemented standards determining when an injured student may resume playing contact sports. But only a few states have begun to address how and when a student should resume classwork.
On Sunday the American Academy of Pediatrics issued recommendations for “return to learn” checklists to alert doctors, school administrators and parents to potential cognitive and academic challenges to students who have suffered concussions.
“They’re student athletes, and we have to worry about the student part first,” said Dr. Mark E. Halstead, the lead author of “Returning to Learning Following a Concussion,” a clinical report in this week’s Pediatrics.
For adolescents prone to risk-taking behaviors, concussions are not just the nasty by-products of sports. Dr. Halstead, an assistant professor in pediatric sports medicine at Washington University, recently treated a 15-year-old girl whose concussion came not from a soccer match, but because “she was running backwards in a school hallway and cracked heads with someone.”
The academy emphasized that research about recovery protocols and cognitive function is scant: There is no established rest-until-recovered timeline. The new recommendations are based on expert opinions and guidelines developed by the Rocky Mountain Youth Sports Medicine Institute in Denver.
Doctors generally recommend that a student with a concussion rest initially, to give the brain time to heal. That may mean no texting, video games, computer use, reading or television. But there’s a big question mark about the timing and duration of “cognitive rest.” Experts have not identified at what point mental exertion impedes healing, when it actually helps, and when too much rest prolongs recovery. Although many doctors are concerned that a hasty return to a full school day could be harmful, this theory has not yet been confirmed by research.
The student’s pediatrician, parents and teachers should communicate about the incident, the recommendations said, and be watchful for when academic tasks aggravate symptoms such as headaches, dizziness, sensitivity to light and difficulty concentrating. The academy acknowledged that case management must be highly individualized: “Each concussion is unique and may encompass a different constellation and severity of symptoms.”
Most students have a full recovery within three weeks, the article said. But if the recovery seems protracted, specialists should be consulted.
Many school officials do not realize they can make simple accommodations to ease the student’s transition back to the classroom, the academy said.
To alleviate a student’s headaches, for example, schedule rests in the school nurse’s office; for dizziness, allow extra time to get to class through crowded hallways; for light sensitivity, permit sunglasses to be worn indoors. Students accustomed to 45-minute classes might only be able to sit through 30 minutes at the outset, or attend school for a half-day.
“Parents need to follow up with schools and make sure plans are being followed,” Dr. Halstead said…. http://well.blogs.nytimes.com/2013/10/27/concussions-and-the-classroom/?ref=education&_r=0

Citation:

From the American Academy of Pediatrics
Clinical Report
Returning to Learning Following a Concussion
1. Mark E. Halstead, MD, FAAP,
2. Karen McAvoy, PsyD,
3. Cynthia D. Devore, MD, FAAP,
4. Rebecca Carl, MD, FAAP,
5. Michael Lee, MD, FAAP,
6. Kelsey Logan, MD, FAAP,
7. Council on Sports Medicine and Fitness, and Council on School Health
Abstract
Following a concussion, it is common for children and adolescents to experience difficulties in the school setting. Cognitive difficulties, such as learning new tasks or remembering previously learned material, may pose challenges in the classroom. The school environment may also increase symptoms with exposure to bright lights and screens or noisy cafeterias and hallways. Unfortunately, because most children and adolescents look physically normal after a concussion, school officials often fail to recognize the need for academic or environmental adjustments. Appropriate guidance and recommendations from the pediatrician may ease the transition back to the school environment and facilitate the recovery of the child or adolescent. This report serves to provide a better understanding of possible factors that may contribute to difficulties in a school environment after a concussion and serves as a framework for the medical home, the educational home, and the family home to guide the student to a successful and safe return to learning.

Here is the press release:

After a Concussion Students May Need Gradual Transition Back to Academics
10/27/2013
American Academy of Pediatrics offers new guidance on “returning to learning” after concussion
ORLANDO, Fla. — A concussion should not only take a student athlete off the playing field – it may also require a break from the classroom, according to a new clinical report from the American Academy of Pediatrics (AAP).
In the clinical report, “Returning to Learning Following a Concussion,” released Sunday, Oct. 27 at the AAP National Conference & Exhibition in Orlando, the AAP offers guidance to pediatricians caring for children and adolescents after suffering a concussion.
“Students appear physically normal after a concussion, so it may be difficult for teachers and administrators to understand the extent of the child’s injuries and recognize the potential need for academic adjustments,” said Mark Halstead, MD, FAAP, a lead author of the clinical report. “But we know that children who’ve had a concussion may have trouble learning new material and remembering what they’ve learned, and returning to academics may worsen concussion symptoms.”
Dr. Halstead will deliver a plenary address on concussion injuries at 10:30 a.m. ET Oct. 27 at the Orange County Convention Center. A news briefing on the new clinical report will immediately follow. Reporters interested in covering either event should check in at the press room, W203B.
Research has shown that a school-aged student usually recovers from a concussion within three weeks. If symptoms are severe, some students may need to stay home from school after a concussion. If symptoms or mild or tolerable, the parent may consider returning him or her to school, perhaps with some adjustments. Students with severe or prolonged symptoms lasting more than 3 weeks may require more formalized academic accommodations.
The AAP recommends a collaborative team approach to help a student recovering from a concussion. This team should consist of the child or adolescent’s pediatrician, family members and individuals at the child’s school responsible for both the student’s academic schedule and physical activity. Detailed guidance on returning to sports and physical activities is contained in the 2010 AAP clinical report, “Sport-Related Concussion in Children and Adolescents.”
A symptom checklist can help evaluate what symptoms the student is experiencing, and how severe they are.
“Every concussion is unique and symptoms will vary from student to student, so managing a student’s return to the classroom will require an individualized approach,” said Dr. Halstead. “The goal is to minimize disruptions to the student’s life and return the student to school as soon as possible, and as symptoms improve, to increase the student’s social, mental and physical activities.”
Because relatively little research has been conducted on how concussion affects students’ learning, the AAP based its report primarily on expert opinion and adapted it from a concussion management program developed at the Rocky Mountain Hospital for Children, Center for Concussion in Denver, Colo. The AAP calls for further research on the effects and role of cognitive rest after concussion to improve understanding of the best ways to help a student recovering from a concussion.
Information for parents about returning to learning after a concussion also will be available on HealthyChildren.org (starting Oct. 27).
###
The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.

Parents must be alert to what is happening with the children when they participate in athletic events and activities.

Resources:

Concussions
http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

Concussion
http://www.emedicinehealth.com/concussion/article_em.htm

Concussion – Overview
http://www.webmd.com/brain/tc/traumatic-brain-injury-concussion-overview

Related :

Study: Effects of a concussion linger for months
https://drwilda.com/2012/12/13/study-effects-of-a-concussion-linger-for-months/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

NCAA beginning to take concussions seriously

22 Jul

Moi posted in Don’t ignore concussions:
Kids Health has some great information about concussions at their site:

What Is a Concussion and What Causes It?
The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. When a person gets a head injury, the brain can move around inside the skull and even bang against it. This can lead to bruising of the brain, tearing of blood vessels, and injury to the nerves. When this happens, a person can get a concussion — a temporary loss of normal brain function.
Most people with concussions recover just fine with appropriate treatment. But it’s important to take proper steps if you suspect a concussion because it can be serious.
Concussions and other brain injuries are fairly common. About every 21 seconds, someone in the United States has a serious brain injury. One of the most common reasons people get concussions is through a sports injury. High-contact sports such as football, boxing, and hockey pose a higher risk of head injury, even with the use of protective headgear.
People can also get concussions from falls, car accidents, bike and blading mishaps, and physical violence, such as fighting. Guys are more likely to get concussions than girls. However, in certain sports, like soccer, girls have a higher potential for concussion.
http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

Dr. Rivara has published a study of how serious concussions can be.
Lindsey Tanner of AP reports on a new study about concussions in the article, Even mild concussions can cause lingering symptoms:

Children with even relatively mild concussions can have persistent attention and memory problems a year after their injuries, according to a study that helps identify which kids may be most at risk for lingering symptoms.
In most kids with these injuries, symptoms resolve within a few months but the study results suggest that problems may linger for up to about 20 percent, said study author Keith Owen Yeates, a neuropsychologist at Ohio State University’s Center for Biobehaviorial Health.
Problems like forgetfulness were more likely to linger than fatigue, dizziness and other physical complaints, the study found.
Forgetfulness, difficulty paying attention, headaches and fatigue were more common in study children who lost consciousness or who had other mild head trauma that caused brain abnormalities on imaging tests, compared with kids who didn’t get knocked out or who had normal imaging test results.
The study looked at symptoms up to a year after injury so it doesn’t answer whether any kids had longer-lasting or permanent problems.
“What parents want to know is if my kid is going to do OK. Most do OK, but we have to get better at predicting which kids are going to have problems,” Yeates said.
Those who do may need temporary accommodations, including extra time taking school tests, or wearing sunglasses if bright light gives them headaches, he said.
Most children studied had concussions from playing sports or from falls. About 20 percent had less common mild brain trauma from traffic accidents and other causes.
Concussions involve a blow to the head that jostles the brain against the skull, although imaging scans typically show no abnormalities. Other mild brain trauma can cause tissue damage visible on these scans.
The study included 186 children aged 8 to 15 with mild concussions and other mild brain injuries treated at two hospitals, in Cleveland and Columbus, Ohio. The reports are based on parents’ reports of symptoms up to 12 months after the injuries.
The brain injuries studied were considered mild because they involved no more than half an hour of unconsciousness; 60 percent of kids with concussions or other brain trauma — 74 children — had no loss of consciousness.
Overall, 20 percent — 15 children — who lost consciousness had lingering forgetfulness or other non-physical problems a year after their injury; while 20 percent who had abnormal brain scans — six kids — had lingering headaches or other physical problems three months after being injured.
http://www.seattlepi.com/news/article/Even-mild-concussions-can-cause-lingering-symptoms-3383079.php#ixzz1oMUeQVuu

Citation:
Concussion
Time to Start Paying Attention
Frederick P. Rivara, MD, MPH
Arch Pediatr Adolesc Med. Published online March 5, 2012. doi:10.1001/archpediatrics.2011.1602
Coaches and parents must be alert to signs of concussion. https://drwilda.com/2012/03/06/dont-ignore-concussions/

Brad Wolverton reported in the Chronicle of Higher Education article, NCAA Medical Chief on Concussions: ‘There’s a Sense of Urgency’:

Since starting at the NCAA, in January, Dr. Hainline, a neurologist and the former top medical officer of the United States Tennis Association, has been traveling the country to spread the word about three of the biggest challenges he sees: concussion, which he calls the “elephant at the table”; student-athlete mental health; and the delivery of health care in a “patient-centered” model.
If you read some of the e-mails filed on Friday in the U.S. District Court for the Northern District of Illinois, where the case is being heard, you might think NCAA colleges have a long way to go on that last challenge.
According to a 2010 NCAA survey on concussions, nearly half of the responding institutions said they had allowed players back into a game on the same day of a concussion diagnosis. One assistant trainer said he had personally seen a football player knocked unconscious and then returned in the same quarter of a contest.
Dr. Hainline would not comment on the NCAA’s concussion litigation, saying that it raised complex questions that could take hours to explain (he and David Klossner, the NCAA’s director of health and safety, spoke to me for more than 30 minutes).
But Dr. Hainline said that, until the end of 2012, there was not a widely accepted consensus among medical experts about the need to keep players out of action on the same day of a concussion. Before that, one closely watched set of guidelines suggested that players should not be returned on the same day—but left open a window for adult or elite athletes under special circumstances.
Dr. Hainline argued that the decision to return is complicated by the players themselves, who often report that they are ready to go even when they shouldn’t. He pointed to a forthcoming study showing that 50 percent of players in one Division I conference were underreporting injuries, including concussion….http://chronicle.com/blogs/players/ncaas-medical-chief-on-concussions-theres-a-sense-of-urgency/33301?cid=pm&utm_source=pm&utm_medium=en

People must take concussions very seriously.

Resources:

Concussions http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_
Concussion http://www.emedicinehealth.com/concussion/article_em.htm
Concussion – Overview
http://www.webmd.com/brain/tc/traumatic-brain-injury-concussion-overview

Related:

Study: Effects of a concussion linger for months
https://drwilda.com/2012/12/13/study-effects-of-a-concussion-linger-for-months/
Update: Don’t ignore concussions
https://drwilda.com/2012/05/20/update-dont-ignore-concussions/
Where information leads to Hope. ©  Dr. Wilda.com
Dr. Wilda says this about that ©
Blogs by Dr. Wilda:
COMMENTS FROM AN OLD FART©                            http://drwildaoldfart.wordpress.com/
Dr. Wilda Reviews ©                                                 http://drwildareviews.wordpress.com/
Dr. Wilda ©                                                                                          https://drwilda.com/

Study: Effects of a concussion linger for months

13 Dec

Moi wrote in Don’t ignore concussions:

Kids Health has some great information about concussions at their site:

What Is a Concussion and What Causes It?

The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. When a person gets a head injury, the brain can move around inside the skull and even bang against it. This can lead to bruising of the brain, tearing of blood vessels, and injury to the nerves. When this happens, a person can get a concussion — a temporary loss of normal brain function.

Most people with concussions recover just fine with appropriate treatment. But it’s important to take proper steps if you suspect a concussion because it can be serious.

Concussions and other brain injuries are fairly common. About every 21 seconds, someone in the United States has a serious brain injury. One of the most common reasons people get concussions is through a sports injury. High-contact sports such as football, boxing, and hockey pose a higher risk of head injury, even with the use of protective headgear.

People can also get concussions from falls, car accidents, bike and blading mishaps, and physical violence, such as fighting. Guys are more likely to get concussions than girls. However, in certain sports, like soccer, girls have a higher potential for concussion. http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

https://drwilda.com/2012/03/06/dont-ignore-concussions/

See, Update: Don’t ignore concussions https://drwilda.com/2012/05/20/update-dont-ignore-concussions/

A concussion is a serious injury.

Bryan Toporek reports about concussions in the Education Week article, Concussions Alter Children’s Brains for Months, Study Finds:

Months after sustaining a mild traumatic brain injury (mTBI) such as a concussion, the changes in a child’s brain still persist even if the child is symptom-free, according to a study published online today in The Journal of Neuroscience.

Researchers from the Albuquerque-based Mind Research Network and the University of New Mexico studied 15 children between the ages of 10 and 17 who had sustained a concussion to examine the lasting effects of the injury, comparing the results to 15 healthy controls between the ages of 11 and 17.

Previous research has suggested that concussions affect the brain’s white matter, which contains nerve fibers that transmit signals from one area of the brain to another, according to the National Institutes of Health.

Thus, both the healthy and concussed children underwent “diffusion tensor imaging” (DTI), which specifically images white matter in the brain, and neuropsychological testing two separate times. The concussed children were tested and imaged within 21 days of sustaining their injury, and then once more in a follow-up visit roughly three to five months after their initial screening….

On a brief related note: I just went through yesterday and updated our youth-concussion law map.

Of note: Both Michigan and Hawaii have passed youth-concussion laws since July, making 43 states (including the District of Columbia) that now have such laws. Not far behind is Ohio, whose youth-concussion bill just passed through the state Senate last week after being approved by the state House in June. It’s waiting to be sent to Gov. John Kasich for a signature.

 

http://blogs.edweek.org/edweek/schooled_in_sports/2012/12/concussions_alter_childrens_brains_for_months_after_injury_study_finds.html?intc=es

Citation:

Neurobiology of Disease

Diffusion Abnormalities in Pediatric Mild Traumatic Brain Injury

  1. Andrew R. Mayer1,2,3,
  2. Josef M. Ling1,
  3. Zhen Yang1,2,
  4. Amanda Pena1,
  5. Ronald A. Yeo1,2, and
  6. Stefan Klimaj1

Abstract

Pediatric mild traumatic brain injury (pmTBI) is the most prevalent neurological insult in children and is associated with both acute and chronic neurobehavioral sequelae. However, little is known about underlying pathophysiology and how injuries change as a function of recovery. Fractional anisotropy, axial diffusivity, and radial diffusivity were examined in 15 semi-acute pmTBI patients and 15 well-matched controls, with a subset of participants returning for a second visit. A novel analytic strategy was applied to capture spatially heterogeneous white matter injuries (lesions) in addition to standard analyses. Evidence of cognitive dysfunction after pmTBI was observed in the domains of attention (p = 0.02, d = −0.92) and processing speed (p = 0.05, d = −0.73) semi-acutely. Region of interest (ROI) and voxelwise analyses indicated increased anisotropic diffusion for pmTBI patients, with an elevated number of clusters with high anisotropy. Metrics of increased anisotropy were able to objectively classify pmTBI from healthy controls at 90% accuracy but were not associated with neuropsychological deficits. Little evidence of recovery in white matter abnormalities was observed over a 4-month interval in returning patients, indicating that physiological recovery may lag behind subjective reports of normality. Increased anisotropic diffusion has been previously linked with cytotoxic edema after TBI, and the magnitude and duration of these abnormalities appear to be greater in pediatric patients. Current findings suggest that developing white matter may be more susceptible to initial mechanical injury forces and that anisotropic diffusion provides an objective biomarker of pmTBI.

  • Received July 13, 2012.
  • Revision received October 12, 2012.
  • Accepted October 16, 2012.

This Article

  1. The Journal of Neuroscience, 12 December 2012, 32(50): 17961-17969; doi: 10.1523/​JNEUROSCI.3379-12.2012
  1. » Abstract

  2. Full Text

  3. Full Text (PDF)

The Sports Concussion Institute has some great information about concussions:

Resources

http://www.concussiontreatment.com/concussionfacts.html

People must take concussions very seriously.

Resources:

Concussions                                                                                    http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

Concussion                                                        http://www.emedicinehealth.com/concussion/article_em.htm

Concussion – Overview                                                   http://www.webmd.com/brain/tc/traumatic-brain-injury-concussion-overview

Where information leads to Hope. ©                     Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©                            http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©                                                 http://drwildareviews.wordpress.com/

Dr. Wilda ©                                                                                          https://drwilda.com/