6. Physiology of Concussion
• Micro to severe bleeding where brain impacts
with skull
• Cerebral hypoxia as breathing interrupted
• Brain swelling into an enclosed space, raising
Intra-Cerebral Pressure (ICP)
• Cascade effect:brain swelling hypoxia
• Protein deposits: TDP-43 has toxic effect on
brain tissue; linked to ALS, Parkinson's &
Dementia Pugilistica, now called Chronic
Traumatic Encephalopathy (CTE)
8. Cognitive Signs of MTBI
• CONFUSION
• Slurred speech
• Slowed reaction time
• Short term memory loss
• Reasoning, concentration issues
• Sleep disturbance
• Affective disorders: irritability, socially
inappropriate, depressed
9.
10. ImPACT Tool
(Immediate Post-Concussion
Assessment and Cognitive Testing)
• Scanning & processing speed & accuracy
• Reaction time
• Impulse control
• Post-concussion symptom scale
• Requires training, pre-testing by computer
11. Risk Factors
• One head injury 3 x more likely to have a
second head injury
• Second head injury 8 x more likely to have
a third
• ~ one-half are intoxicated
12. Men, Men, Men, Men…
• Are 3.5 x more likely…
• 18-34 years old…
• Substance abuse…
• Psych co-morbidities…
• Summer, weekends, evenings
13. Glasgow Coma Scale
Eye opening Spontaneously 4
To speech 3
To pain 2
none 1
Speech Oriented 5
Confused 4
Inappropriate 3
Incomprehensible 2
None 1
Motor Response Obeys 6
Localizes pain 5
Withdraws to pain 4
Flexion to pain 3
Extension to pain 2
None 1
Maximum Score 15
14. Concussion Grading Scale
Grade I Grade II Grade III
Confusion,
symptoms last
<15 minutes,
no LOC
Symptoms last
>15 minutes,
no LOC
+LOC
(IIIa, coma lasts
seconds,
IIIb for minutes)
15. GOAT Score
Galveston Orientation & Amnesia Test
• Measures Post-Traumatic Amnesia (PTA)
• Length of PTA predicts cog/behavioral
recovery
• Duration of PTA & age at injury predicts
disability
• PTA > 2 weeks = poor prognosis
16. Fx Deficits
• Memory
• Attention/information processing speed
• Efficiency
• Intellectual, language, and perceptual
skills tend to be relatively preserved
24. Behavioral Mgt Plan
• Assess/Support Family
• NO ETOH or Rec Drugs!
• Manage rest/sleep cycle
• Manage irritation/aggression
• Facilitate compensatory aides
• Manage sexual acting out
