Heads Up! Adam Kleeburger , 2011 Dr . Brian Christie , Division of - - PowerPoint PPT Presentation

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Heads Up! Adam Kleeburger , 2011 Dr . Brian Christie , Division of - - PowerPoint PPT Presentation

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Division of Medical Sciences Heads Up! Adam Kleeburger , 2011 Dr . Brian Christie , Division of Medical Sciences, University of Victoria Island Medical Program, University of British Columbia Director , UVic Concussion Lab, Rm 194 McKinnon

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Division of Medical Sciences

Heads Up!

Adam Kleeburger , 2011 Dr . Brian Christie, Division of Medical Sciences, University of Victoria Island Medical Program, University of British Columbia Director , UVic Concussion Lab, Rm 194 McKinnon Building Phone: 250‐472‐5997; Email: brainlab@uvic.ca Online appointment booking: https://instant‐scheduling.com/sch.php?kn=1905924

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Division of Medical Sciences

  • G. Courtnall
  • M. Richter

Media portrayal of concussions

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Think of three sports you expect to see concussions in:

Football Hockey Boxing

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Famous athletes with concussions you don’t hear as much about:

Bonus Question: What famous Canadian sports figure suffered a severe head injury on March 28,1950?

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Roger Staubach, Age 71 Joe Frazier , Age 66 Gordie Howe, Age 86

Gordie Howe had brain surgery to relieve fluid build up after a hit in 1950.

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Learning Objectives:

  • 1. What is a concussion?
  • 2. Concussion incidence in BC
  • 3. Concussion Diagnoses in Adults and Children
  • 4. Standardized Concussion Assessment T
  • ol (SCA

T).

  • 5. Management of Symptoms
  • 6. Return to Play/Return to Academics
  • 7. New Vistas in Concussion Assessment and Treatment
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What are ConcussionS?

  • 1. From Latin Concutere “to shake violently” or concussus “striking together”
  • 2. Mild Traumatic Brain Injury – widely accepted clinical medical term
  • 3. Muhammad ibn Zakariya Razi: Persian physician may have been first to use the

term “cerebral concussion” and defined it as “a transient loss of function with no physical damage” 4. Modern Definition can vary depending upon the health professional: No loss of consciousness ‐ loss of consciousness <30 minutes Post‐traumatic amnesia for <30 minutes ‐ >24 hours Dizziness/nausea/mental confusion <24 hours – 2‐3 weeks

  • 5. Headache is the most common physical symptom (others include: dizziness,

vomiting, balance issues, light and/or sound sensitivity, vision problems, <2% convulsions from motor function impairments.

  • 6. Cognitive symptoms include confusion, lack of focus, amnesia, confusion,

irritability, slow to respond, confusion, loss of interest, lethargy, sleep problems.

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Concussions are caused by the movement of the brain inside the skull.

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Concussions are caused by the movement of the brain inside the skull.

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Helmets help prevent localized head injuries, like skull fractures. Fit and comfort are what is important. Helmets don’t prevent concussions.

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Concussions in BC

Data is from the BC Injury and Prevention report from January 2013.

From 2001‐2010, for children and youth ages 0‐19 years, there were: 268 head injury deaths Majority were transport‐related (91%) 1,619 concussion‐related hospitalizations (in patient) Leading causes were falls, transport related, and struck by/against an object In a one year period there were: 6,675 concussion‐related emergency department visits in the Lower Mainland (out patient) Leading causes were falls, sports and recreational activities, and struck by/against an object Males account for 60‐70 percent of head injuries resulting in death, and concussion‐related hospitalizations and emergency department visits

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Sports Related Concussions in BC

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Cause of TBI varies with age: 0‐4 (child abuse / assault) 10‐14 (sports injury) 15‐19 (motor vehicle accidents) 65 and older (falls) High risk groups:

  • Alcohol/substance abuse
  • High risk behaviour
  • Male gender (2:1)
  • History of prior TBI
  • Psychiatric illness
  • ADHD
  • Lower socio‐economic status
  • Lower levels of education
  • Unemployment

There are different ways to look at incidence rates

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Is Concussion data in BC accurate?

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When players are surveyed AFTER the season about symptoms they had during the season, without using the word concussion, the incidence rate increases 10 – 50 times the reported rate by medical professionals.

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Assessing a concussion

– Best current practice is to have some sort of baseline.

  • SCA

T3 Sport Concussion Assessment T

  • ol 3 (Free test)

– Glasgow coma scale, Sideline Assessment Maddocks Score, Symptom evaluation – Standard Assessment of Concussion SAC (cognitive), Balance Error Scoring System BESS – Coordination Examination (finger to nose test) – There is a childrens version of the test

  • ImPACT Immediate Post‐Concussion Assessment Cognitive T

est ($25‐$40 up front, more later)

  • Computerized cognitive tests, Attention, working memory

, processing speed, response variability , nonverbal problem solving.

  • Quantitative Measures (King‐Devick, Neurotracker

, Reaction Time, Olfaction, etc.)

  • The future of concussion testing?
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Division of Medical Sciences

http://physicians.cattonline.com/scat

Any child suspected of having a concussion should be removed from play, and then seek medical evaluation. The child must NO T return to play or sport on the same day as the suspected concussion. The child is not to return to play or sport until he / she has successfully returned to school / learning, without worsening of symptoms. Medical clearance should be given before return to play.

Released in 2013 Main Components: Glasgow coma scale (Sideline assessment) Symptom Evaluation (Child and Parent) Cognitive and Physical Evaluation Neck Exam Balance Exam Coordination Exam Delayed Recall

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Page 1: Information for

  • nsite/sideline assessment.

GCS < 15 Indicator of more serious injury and need for Medical Assessment

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Page 2. Symptom Evaluation Memory assessment Focus/mental agility Neck Balance

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Standardized Instructions for test administration and interpretation.

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ical Sciences Division of Med

Post‐injury alerts, return to play guidelines, px advice.

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Primary Care

History – Baselines? Physical examination Diagnosis Monitoring Reassurance

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Cognitive Performance Cognitive Performance

TBI TBI

Motivation Motivation Lack of restorative sleep Lack of restorative sleep Mood Mood Pain (e.g., headaches) Pain (e.g., headaches) Pre‐injury problems (ADHD & LD) Pre‐injury problems (ADHD & LD)

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  • 3. Management of Symptoms

The first 24 hours

REST REST REST If progression of symptoms or worsening then reassessment.

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  • 4. Supervised return to play
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  • 4. Return to academics
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Slower recovery is common in children

  • 30% of children have persistant symptoms

(Yeates, 2012)

  • Understanding the child brain is particularly

challenging due to ongoing developmental changes

  • Outcomes can be worse after injury in

infancy / preschool years

  • Delayed consequences
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Misattribution bias

  • belief that one has a “permanent brain

damage”

  • pre‐occupation with minor physiological

symptoms

  • causes a vicious cycle between physical

complaints and emotional arousal

Neuropsych Assessment?

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  • 5. New Vistas in Concussion Assessment

Neurotracker; King‐Devick

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MOT as an Indicator of Awareness

  • Can the person track motion throughout the visual field?
  • Motion tracking is the foundation of awareness.
  • Motion tracking does not require a high level of visual acuity.

MOT as an Indicator of Attention

  • Can the person prioritize key stimuli while ignoring less important stimuli?
  • (Selective attention)
  • Can the person focus and maintain attention on objects in motion?
  • (Dynamic attention)
  • Can the person predict motion paths of objects hidden from view?
  • Can the person predict altered motion paths from collisions?
  • Can the person spread attention between multiple key points?
  • (Distributed attention)
  • Can the person sustain attention for several seconds without interruption?
  • (Sustained attention)
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Neurotracker is a high performance athlete training tool to enhance sports vision and awareness. Dr . Jocelyn Faubert, Creator “We’ d like to show that using the neurotracker alters brain chemistry and enhances brain plasticity.” Dr . Len Zaichkowsky “The players love it, but if they have some sort of head injury they find it difficult to play.”

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LOC = Loss of conciousness

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Comparing King‐Devick, SCA T3, Neurotracker King‐Devick requires about 2 minutes as opposed to 20 minutes for the SCA T3 and Neurotracker . Sensitivity may be lacking as the test is based on reading speed alone. Other senses? Olfaction discrimination declines over time from concussion Results from the study showed a decline in odour identification, but not in

  • dour sensitivity, as the length from the player’s last concussion

increased over time. The Sniffin’ Sticks Inventory T

  • ol (SSIT), which contains an odour list
  • f 16 “common odours”

. i.e. Coffee, fish, etc.

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Learning Objectives:

  • 1. Concussion Diagnoses in Adults and Children

Effects may persist for longer in children

  • 2. Standardized Concussion Assessment T
  • ol (SCA

T).

Can provide both baseline and post‐concussion general assessment.

  • 3. Management of Symptoms

Rest is the main initial treatment tool, but early return to light physical / mental activity may facilitate recovery

  • 4. Return to Play/Return to Academics

A graduated plan for re‐entry to physical / academic environments facilitates recovery.

  • 5. New Vistas in Concussion Assessment and Treatment

Saccadic eye movements, dynamic attention, olfaction may provide more quantitative measures in the future than current subjective ones.

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HAVE YOU OR SOMEONE YOU KNOW HAD A RECENT CONCUSSION OR HEAD INJURY?

If yes, we have an exciting research opportunity for you! Study Title: The Vancouver Island Concussion Project – Canada Pediatric and Youth CDE Study As a study participant you will:

  • Be followed for six months by a team of experts involved in Canada‐wide concussion

research!

  • Have your symptoms monitored
  • Receive a tailored physical assessment
  • Complete tests of your cognitive, social & emotional well‐being.

If you are interested in learning more about this research , please contact the project coordinator , Dr . Kristina Kowalski:

Email: brainlab@uvic.ca/ Office: (250) 472‐5997/ Lab cell: (250)634‐4471

February 23, 2015

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VOLUNTEERS NEEDED FOR CONCUSSION RESEARCH

  • Are you an athlete?
  • Do you play a sport where there is a high risk of concussion?
  • Are you interested in participating in baseline and/or post‐injury concussion

testing?

Study title: The Vancouver Island Concussion Project – NeuroTracker Study

Dr . Brian Christie and his colleagues at the University of Victoria are conducting a study to determine how effective multiple object tracking and related neurocognitive tools are for assessing concussions and return to play/academia status. We are seeking individuals of all ages. Participants will have the ability to complete pre‐injury baseline testing and/or will receive post‐injury concussion assessments.

For details, please contact the Project Coordinator Dr . Kristina Kowalski

Email: brainlab@uvic.ca/ Office: (250) 472‐5997/Lab cell: (250)634‐4471

February 23, 2015