1. “You
forgot
your
helmet!”
What Parents (and Kids)
Need to Know About
Concussion
Third Thursday at Three
Scott La Point, MA, LPC
Psychology Resident
Lakeview NeuroRehabilitation Center

2. “You
forgot
your
helmet!”
What Parents (and Kids)
Need to Know About
Concussion
Third Thursday at Three
Scott La Point, MA, LPC
Psychology Resident
Lakeview NeuroRehabilitation Center

4. Take away points
 A concussion is a brain injury.
 Symptoms of concussion can be
subtle.
 Symptoms may not surface until 48
to 72 hours after injury.
 Recovery is different for every
person.
 Every concussion should be taken
seriously.
Myths & Facts Diagnosis & TxSigns &
Symptoms
Concussion Care
Scott La Point, MA, LPC

5. Today’s Agenda
 Myths & Facts of Concussion
 Concussion: What is it?
 Signs & Symptoms
 Diagnosis & Treatment
 Proper Helmet Fit
■ Resources
■ References
Myths & Facts Signs &
Symptoms
Concussion Care
Scott La Point, MA, LPC
Diagnosis & Tx

6. Myths & Facts
 You have to have loss of
consciousness to have sustained a
concussion.
MYTH
 Studies show that less than 10% of
concussions result in loss of
consciousness.
Myths & Facts Signs &
Symptoms
Concussion Care
Scott La Point, MA, LPC
Diagnosis & Tx

7. Myths & Facts
 Concussions are only a result of a
direct blow to the head.
MYTH
 A concussion can be sustained by
a sudden, violent movement of the
head caused by an unexpected
external force to the body.
Myths & Facts Signs &
Symptoms
Concussion Care
Scott La Point, MA, LPC
Diagnosis & Tx

8. Myths & Facts
 Injury to the brain occurs at the
initial impact of the concussion.
MYTH
 TBI is an evolving process at the
microscopic level of the brain.
Chemical and metabolic changes
occur for days, weeks to months
after impact.
Myths & Facts Signs &
Symptoms
Concussion Care
Scott La Point, MA, LPC
Diagnosis & Tx

9. Myths & Facts
 You need to wake someone with
a concussion every 20 minutes.
MYTH
 Though it is important to check on
someone periodically, it does not
have to be every 20 minutes. Every
2-3 hours is sufficient.
Myths & Facts Signs &
Symptoms
Concussion Care
Scott La Point, MA, LPC
Diagnosis & Tx

10. Myths & Facts
 Children recover at the same rate
as adults.
MYTH
 Children and teenagers actually
recover more slowly due to their
developing brain. They are also
prone to complications.
Myths & Facts Signs &
Symptoms
Concussion Care
Scott La Point, MA, LPC
Diagnosis & Tx

11. Myths & Facts
 Everyone with a concussion needs
a CT scan or MRI right away.
MYTH
 While there is damage to the brain
cells in a concussion, the damage
is at the microscopic level and
neuroimaging does not reveal
every injury.
Myths & Facts Signs &
Symptoms
Concussion Care
Scott La Point, MA, LPC
Diagnosis & Tx

12. Myths & Facts
 You should not treat the headache
from concussion with any
medications because they might
mask the symptoms.
MYTH
 OTC pain relievers, as ordered by
the physician, are fine to use. At
times, prescription medications
may be needed.
Myths & Facts Signs &
Symptoms
Concussion Care
Scott La Point, MA, LPC
Diagnosis & Tx

13. Myths & Facts
 Male and female athletes have the
same chance of sustaining a
concussion.
MYTH
 Female athletes are more prone to
concussions, possibly because they
more open to report an injury. Also,
there are gender differences.
Myths & Facts Signs &
Symptoms
Concussion Care
Scott La Point, MA, LPC
Diagnosis & Tx

14. Myths & Facts
 There are no long-term effects of
concussion.
MYTH
 A concussion that is not properly
treated can lead to post-concussion
syndrome, with prolonged
symptoms.
Myths & Facts Signs &
Symptoms
Concussion Care
Scott La Point, MA, LPC
Diagnosis & Tx

15. Concussion defined
 A concussion is a type of traumatic
brain injury (TBI) caused by a bump,
blow, or jolt to the head that can
change the way the brain functions.
 A concussion can also occur from a
blow to the body that causes the head
to move rapidly back and forth.
 Even a “ding,” “getting your bell rung,”
or what seems to be mild bump or
blow to the head, can be serious.Concussion Care
Scott La Point, MA, LPC
Myths & Facts Diagnosis & TxSigns &
Symptoms

16. Basic anatomy
 A gelatin-like organ, weighing about 2
lbs. at birth and 3 lbs. as an adult.
 Neurons are the cells that make up the
nervous system; they communicate
with each other and transmit
information about what we take in and
how we respond.
 This is done by neurotransmitters at
the synapse, the point where one cell
ends and the next begins.
Concussion Care
Scott La Point, MA, LPC
Myths & Facts Diagnosis & TxSigns &
Symptoms

17. Concussion Care
Scott La Point, MA, LPC
Myths & Facts Diagnosis & TxSigns &
Symptoms

19. Concussion Care
Scott La Point, MA, LPC
Myths & Facts Diagnosis & TxSigns &
Symptoms

20. TBI Severity
Concussion Care
Scott La Point, MA, LPC
 MILD: Concussion, “dazed and
confused,” possible brief loss of
consciousness (LOC); GCS 13-15
 MODERATE: LOC > 30 minutes,
posttraumatic amnesia (PTA);
GCS 9-12
 SEVERE: > 24 hrs. LOC, coma, PTA,
fractures, bleeds; GCS 3-8
GCS rating given at acute stage; does not
necessarily correlate with deficits
Myths & Facts Diagnosis & TxSigns &
Symptoms

21. ttt
Glasgow Coma Scale: 5
Posttraumatic Amnesia: 37 days

22. Physical
 Headache (most
common)
 Double or blurred
vision
 Dizziness or
balance problems
 Poor balance
 Ringing in ears
 Seeing “stars”
Myths & Facts
Concussion Care
Scott La Point, MA, LPC
Signs &
Symptoms
 Nausea
 Numbness/
tingling
 Sensitivity to
light and/or
noise
 Neck pain
 Fatigue
Diagnosis & Tx

23. Cognitive
 Feeling in a “fog”
 Feel “slowed down”
 Difficulty remembering
 Difficulty concentrating
 Easily distracted
 Slowed speech
 Easily confused
Myths & Facts
Concussion Care
Scott La Point, MA, LPC
Diagnosis & TxSigns &
Symptoms

24. Emotional
 Inappropriate emotions
 Personality change
 Nervousness/anxiety
 Feeling more “emotional”
 Irritability
 Sadness
 Emotional lability
Myths & Facts
Concussion Care
Scott La Point, MA, LPC
Diagnosis & TxSigns &
Symptoms

25. Myths & Facts
Concussion Care
Scott La Point, MA, LPC
Diagnosis & TxSigns &
Symptoms

26. Psychosocial
 Irritability
 Difficulty accepting someone else’s point of view
 Low self-esteem
 Agitation
 Hostility
 Disinhibition
 Depression and/or Anxiety
Myths & Facts
Concussion Care
Scott La Point, MA, LPC
Diagnosis & TxSigns &
Symptoms

27. Behavioral
 Poor self-control; Impulsivity
 Limited insight into deficits
 Decreased understanding of social pragmatics
 Aggression
 Low stimulation threshold
 Low frustration tolerance
 Emotional dyscontrol
Myths & Facts
Concussion Care
Scott La Point, MA, LPC
Diagnosis & TxSigns &
Symptoms

28. Delayed symptoms
 Worsening headache
 Repeated vomiting
 Loss of consciousness
 Agitation
 Seizure
 Difficulty walking or balance
 Weakness
 Numbness
 Change in vision
Concussion Care
Scott La Point, MA, LPC
Myths & Facts Diagnosis & TxSigns &
Symptoms

29. Assessing a patient
 Questions to ask
 Injury description
 Amnesia
 Observed signs, seizures
 Assessment tools
 ACE, ImPACT, ANAM, SCAT-3,
MACE, OSU TBI-ID
 Neuroimaging
 Neuropsychological evaluationConcussion Care
Scott La Point, MA, LPC
Myths & Facts Diagnosis & TxSigns &
Symptoms

30. Treating a patient
 Rest, rest and more rest
 Education
 Symptom Management
 Pharmacology
 Prevention
 Buckle up; Never drinking while
drinking; No texting while driving
 Safe living areas
 Obstacles; Child-proofingConcussion Care
Scott La Point, MA, LPC
Myths & Facts Diagnosis & TxSigns &
Symptoms

31. Factors in recovery
 Severity of injury, associated medical
complications
 Expectations for recovery
 Participation in rehabilitation
 Support network; use of
community and medical resources
 Hope, beliefs, patience and
communication skills
 Age and genderConcussion Care
Scott La Point, MA, LPC
Myths & Facts Diagnosis & TxSigns &
Symptoms

32. Myths & Facts Diagnosis & TxSigns &
Symptoms
Concussion Care
Scott La Point, MA, LPC

33. Take Away Points
 If a student complains of feeling “dazed,”
or has persisting headaches or nausea,
contact his/her physician.
 Symptoms may not surface for days.
 Take every concussion seriously.
 “If you’ve seen one brain injury…”
 Prevention (e.g., wearing a helmet) is the
only real treatment.
Myths & Facts
Concussion Care
Scott La Point, MA, LPC
Diagnosis & TxSigns &
Symptoms

34. Fri., October 5, 2007
11 am to 12:30 pm
Brain Injury Association of
Colorado -- 25th Anniversary
34

35. Resources
Myths & Facts Diagnosis & TxSigns &
Symptoms
 Brain Injury Association of
America: www.biausa.org
 Brain Injury Association of NH:
www.bianh.org
 Brain Injury Navigator:
www.binav.org
 Brain Injury News and Information
Blog: www.BrainInjury.blogs.com
 Brain Injury Resource Center:
www.headinjury.com
 Brain Train: www.brain-train.com
 Centre for Neuro Skills:
www.neuroskills.com
 International Brain Injury Assoc.:
www.internationalbrain.org
 International Brain Injury Assoc.:
www.internationalbrain.org
 Lash & Associates Publishing/
Training, Inc.:
www.lapublishing.com
 Medline Plus (TBI):
http://www.nlm.nih.gov/medline
plus/traumaticbraininjury.html
 National Resource Center for TBI:
http://www.tbinrc.com
 Neurotrauma Registry:
www.neure.com
 Ohio Valley Center for Brain Injury
Prevention and Rehab:
www.ohiovalley.org

36. Arciniegas, D.B., Harris, SN, Brousseau, K.M. (2003). Psychosis following traumatic brain injury. International
Review of Psychiatry, 15(4), 328-340.
Centers for Disease Control and Prevention (CDC). Sports-related recurrent brain injuries—United States.
Morbidity and Mortality Weekly Reports 1997;46(10):224–227.
Coetzer, R. (2007). Psychotherapy following traumatic brain injury: Integrating theory and practice. Journal of
Head Trauma Rehabilitation, 22(1), 39-47.
Folzer, S. (2001). Psychotherapy with “mild” brain-injured patients. America Journal of Orthopsychiatry, 71(2),
245-251.
Gedye, A., Beattie, B.L., Tuokko, H., Horton, A, & Korsarek, E. (1989). Severe head injury hastens age of onset of
Alzheimer’s disease. Journal of American Geriatrics Society, 37(10), 970-973.
Hesdorffer, D.C., Rauch, S.L, &Tamminga, C.A. (2009). Long-term psychiatric outcomes following traumatic
brain injury: A review of the literature. Journal of Head Trauma Rehabilitation, 24(6), 452–459.
Kim, E., Lauterbach, E., Reeve, A., Arciniegas, D., Coburn, K., Mendez, M., Rummans, T., & Coffey, E. (2006).
Neuropsychiatric complications of traumatic brain injury: A critical review of the literature, Journal
of Neuropsychiatry and Clinical Neurosciences, 19, 106–127.
Langlois J.A., Rutland-Brown, W., & Thomas ,K.E. (2006). Traumatic brain injury in the United States: emergency
department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention,
Nation Center for Injury Prevention and Control.
References
Myths & Facts Diagnosis & TxSigns &
Symptoms

37. McColl, M.A., Bickenbach, J., Johnston, J., Nishihama, S., Schumacher, M., Smith, K., Smith, M., & Yealland, B.
(2000). Changes in spiritual beliefs after traumatic disability. Archives of Physical Medicine and
Rehabilitation, 81(6), 17-823.
McGee, J. (2004). Insight: Neuroanatomy of behavior after brain injury or you don’t like my behavior? You’ll
have to discuss that with my brain directly. Premier Outlook. 4(2).
Prowe, G. (2010). Successfully surviving a brain injury: A family guidebook. Brain Injury Success Books:
Gainesville, FL.
Rohling, M.L., Faust, M.E., Beverly, B., & Demakis, G. (2009). Effectiveness of cognitive rehabilitation
following traumatic brain injury: A meta-analytic reexamination of Cicerone et al. (2000, 2005) systematic
reviews. Neuropsychology, 23(1), 20-39.
Thurman, D., Alverson, C., Dunn, K., Guerrero, J, Sniezek J. (1999). Traumatic brain injury in the United States: A
public health perspective. Journal of Head Trauma Rehabilitation, 14(6), 602–15.
Vaishnavi, S., Rao, V., & Fann, J.R. (2009). Neuropsychiatric problems after traumatic brain injury: Unraveling the
silent epidemic. Psychosomatics, 50(3), 198-205.
Whelan-Goodinson, R., Ponsford, J., Johnston, L, & Grant, F. (2009). Psychiatric disorders following traumatic
Brain injury: Their nature and frequency. Journal of Head Trauma Rehabilitation, 24(5), 324–332.
Myths & Facts Diagnosis & TxSigns &
Symptoms
References (cont.)