Charles TatorApril 23, 2015Niagara Falls
WHAT IS NEW IN CONCUSSION?
SUMMIT 2015NIAGARA
PARACHUTE CANADA
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Professor of Neurosurgery, University of Toronto
Project Leader, Canadian Sports Concussion Project, Krembil Neuroscience Centre, Toronto Western Hospital
Founder, ThinkFirst CanadaBoard Member, Parachute Canada
MY AFFILIATIONS
THE CONCUSSION SPECTRUM OF DISORDERS-FROM ACUTE
CONCUSSION TO CTE
Charles Tator
Canadian Sports
Concussion Project
Toronto Western
Hospital and University of
Toronto
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
CONCUSSION TOPICS FOR TODAY
1. Definition of Concussion and the Concussion Spectrum of Disorders
2. Mechanisms of Concussion3. The Problems of Recognition and Diagnosis
of Concussions 4. Return to Play, Work or School Guidelines5. The Major Consequences of Concussion such
as Second Impact Syndrome, Post Concussion Syndrome and Brain Degeneration
6. Prevention of Concussions
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
These are Epidemics!!!
HOW BAD IS THE TRAUMA PROBLEM IN GENERAL?
Trauma
Brain Injuries
Concussions
WE SHOULD BE DOING SOMETHING ABOUT IT
Animated Slide
Click for next slide!
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Concussion is the most frequent brain injury. In North America, there are HUNDREDS OF THOUSANDS per year.
25% of players on a Junior B hockey team, average age 18, are concussed each season Echlin et al 2010 Neurosurgery Focus
In football, probably 50% of players each season
WHERE DOES CONCUSSION FIT IN THE OVERALL PICTURE OF BRAIN INJURIES?
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Concussion or mild traumatic brain injury (mTBI) (THE MOST COMMON)
Bruising or ContusionTearing or LacerationBleeding and Blood Clots
(Intracerebral, subdural and extradural)
TYPES OF BRAIN INJURIES
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
THE IMPORTANCE OF BRAIN INJURIES
Half of trauma deaths are due to brain injuries
Brain injuries account for most cases of permanent disability after trauma
Kraus JF Epidemiology of Head Injury.
In Head Injuries. 3rd Ed. Cooper, P.R. (Ed), 1993
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
CONCUSSION - FOR MORE INFORMATION
OUR Website parachutecanada.org
Also Good: CDC Website cdc.gov
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
THE CONCUSSION SPECTRUM OF
DISORDERS Acute Concussion Second Impact Syndrome Post Concussion Syndrome Psychological Consequences -Depression/Anxiety
Brain Degeneration - Chronic Traumatic Encephalopathy (CTE), Movement Disorders, Etc.
PREVENTION
CLINICAL
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Immediate and temporary alteration of mental functioning due to trauma
The trauma does not have to be directly to the head, and can be due to a whiplash effect on the brain from a blow elsewhere on the body
DEFINITION OF CONCUSSION
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
(OLD Terms: “Bell Ringer”,
“Ding”, “Seeing
stars” were allconcussions)
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
CONCUSSION IS THE MOST COMMON TYPE OF MILD TRAUMATIC BRAIN INJURY (MTBI)
Concussion is a better term
1.Concussion is now widely recognized by the public 2.The consequences of concussions are often not mild3.More Homogeneous-no admixture of clots and bruises
in mTBI, GCS=13-15
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
WHAT IS THE MECHANISM OF CONCUSSION?
Exact mechanism unknownRotational acceleration more important
than linear acceleration–the “jiggle” of the brain within the skull causes concussion
Axonal injury may occurProbably, the first concussion is a
biochemical injuryNOT DUE TO BleedingNOT DUE TO Tearing or Bruising of the brain
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
BRAIN MOVES WITHIN SKULL
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Concussion may be a biochemical injury. Mouse cursor on centre of diagram to start movie.CLINICA
LPREVENTIO
NMANAGEME
NTCOMPLICATIO
NS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
SCIENTIFIC EXPLANATION OF CONCUSSION
A genetic predisposition has been suspected, but is unproven. If there is a genetic predisposition, then screening might be feasible and would be desirable
UNKNOWN
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
CAUSES OF CONCUSSION
Motor vehicle crashesFalls at homeWork related injuriesSports and recreation – e.g. football, hockey, rugby, soccer, lacrosse, etc.Military actionSpousal abuse
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
CONCUSSION IN SPORTS ARE IMPORTANT
Concussions in sports are especially common in collision sports such as hockey and football
Players often have repetitive concussions
Repetitive concussions can have major consequences – brain degeneration
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
FEATURES OF CONCUSSIONS
1. Mild injury - usually, especially the first concussion, usually with complete recovery
2. Diffuse injury without focal neurological deficits in cranial nerves, movement or sensation
3. Causes subtle deficits- eg dizziness, nausea4. Major cumulative effects from repetitive
injury
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Activity- Hockey Football
Age-especially adolescents
Gender-women
Number of Previous Concussions
Genetic Effects- runs in some families
Effects of Pre-Existing Conditions: migraine, ADD, ADHD, Depression
FACTORS AFFECTING THE INCIDENCE OF CONCUSSION
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Initial SymptomsAmnesia Loss of Consciousness*Headaches Nausea/VomitingDizziness Loss of VisionPoor Concentration Etc.
SYMPTOMS AFTER SYMPTOMS AFTER CONCUSSIONCONCUSSION
*NOTE – SYMPTOMS VARY AMONG PATIENTS**NOTE – SYMPTOMS VARY AMONG PATIENTS*
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
HOURS-DAYS
1 2
Later symptomsMemory Loss Fatigue InsomniaBlurred Vision VertigoPersonality ChangeDouble Vision Seizures Sensitivity to Light Ringing in Ears Sleepiness Irritability
Etc.
Late symptomsDementiaDepression/AnxietySuicide Homicide Etc.
3
YEARS
Animated Slide
Click to continue!Click to continue!Click to continue!Click for next slide!
Can You Diagnose a
Concussion on a CT Scan or
MRI?NO!
Animated Slide
Click to continue!Click for next slide!
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Routine CT and MRI are always
normal after concussion
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
If there is a lesion
identified, it is more than a concussion
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Clinical Exam (SCAT3) YES
Routine CT and MRI- NO!!!!!
Functional MRI ??DTI MRI ??BOLD MRI ??MRS ??Mini-Neuropsych Tests NO!!Maxi-Neuropsych Tests USEFUL
PET ??Event Related
Potentials (ERP) ??Electrical Connectivity
??MEG ??Blood Biomarkers NOCSF Biomarkers NOMechanical Tests NO
POTENTIAL BIOMARKERS OF ACUTE CONCUSSION, POST-CONCUSSION
SYNDROME,SECOND IMPACT SYNDROME
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
CONCUSSION DIAGNOSIS
The diagnosis of concussion is made CLINICALLY
The diagnosis depends on a knowledgeable doctor and a compliant patient
Therefore, BIG PROBLEMS!!!! because of uninformed docs and non-compliant patients
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
INTERNATIONAL CONSENSUS STATEMENTS ON CONCUSSION IN
SPORT
Consensus Statements based on International Sport Concussion Conferences among Leading
Concussion Experts.Last conference in Zurich in 2012 and
statement was published in 2013
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
CONSENSUS STATEMENTS - MANAGEMENT
A. First StepsIf there is loss of consciousness – Initiate Emergency Action Plan. Call 911 to get an ambulance. Assume possible neck injury.Assess ABCs: Airway, Breathing and CirculationImportant acute management principles (next slide)
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
CONSENSUS STATEMENTS – MANAGEMENT (CONT’D)
1. Remove the player from the current game or practice (if event occurred during sport)
2. Do not leave the player alone; monitor signs and symptoms
3. Do not administer medication4. Inform parent or guardian5. The player should be evaluated by a medical doctor6. The player must not return to play in that game or
practice
.
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
CONSENSUS STATEMENTS – MANAGEMENT (CONT’D)
B. Later ManagementThe 6-step Graduated Return to Play ProtocolStep 1 - physical and mental rest.
No return to activity until all symptoms have resolved, and do not recur even after provocative exercise during Steps 2-5.
If any Symptoms or Signs Return, Stop the Process, and Return to Step 1
.
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
Never return to play if symptoms persist or recur with exercise!
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Step 2 - Light aerobic exercise, such as walking or stationary cycling. Monitor for symptoms and signs. No resistance training or weight lifting.
Step 3 - Sport specific activities and training (e.g. skating).
Step 4. Drills without body contact. May add light resistance training and progress to heavier weights.
Step 5. Begin drills with body contact. Step 6. Game play.
.
CONSENSUS STATEMENTS – MANAGEMENT (CONT’D)
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
The time needed to progress from non-contact to contact exercise (45) will vary with the severity of the concussion and the player. Only go to step 5 after medical clearance. Again, go back to Step 1 if symptoms recur.
Animated Slide
Click to continue!Click to continue!Click for next slide!
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
MANAGEMENT – CLINICAL SUMMARY
The return to play process is gradual, and begins after a doctor has given the player clearance to return to activity.
If any symptoms/signs return during this process, the player must be re-evaluated by a physician. No return to play if any symptoms or signs persist.
Remember, symptoms may return later that day or the next, not necessarily when exercising!
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
Each step should take at least one day. Therefore, the minimum time for return is one week, and double that for children
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
INDICATIONS FOR CONCERN
Permanent Termination “Modifiers”
Continuing neurological symptoms and signs, especially cognitive deficitsMultiple concussions over short period of timeLong duration to recover e.g. monthsLesions seen on imaging-CT or MRI
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
RETURN TO PLAY GUIDELINES IN SPORTS
Two aspects:
1.When to Return2.When to Never Return or Terminate?
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Criteria Can Return To Play
Never Return to Play
1. Neurological Examination
No neurological deficits Presence of any neurological deficits or significant symptoms
2. Number, pattern and severity of previous concussions
Small number, dispersed in time, low severity and complete recovery
Multiple, over a short period of time, high severity
3. Length of time to achieve recovery
Short duration (days) Long duration (several months or years)
4. Neuropsychological
evaluation- detailed
No cognitive deficits Presence of cognitive deficits
5. MR/CT findings No abnormalities Presence of lesions
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
CRITERIA AND GUIDELINES FOR RETURN OR NEVER RETURN TO PLAY
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Much More Complex than RTPNeeds to be Individualized“Accomodations” are Usually NecessaryTeam Interaction/CommunicationBased On Clinical EvaluationNO HELP FROM ANY IMAGING BIOMARKER!!!Very time-consuming-provision of
notes/feedback to schools/employers
RETURN TO LEARN AND RETURN TO WORK GUIDELINES
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
THE CONCUSSION SPECTRUM - SUBSEQUENT AND LATE
EFFECTSSecond Impact SyndromePost concussion SyndromePsychosocial problems – Depression, Anxiety, Behaviour Change, Suicide
EpilepsyCognitive Deficits and Dementia
Chronic Traumatic Encephalopathy (CTE)
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Results from a second head hit a few days later when there has not been full recovery from the first head hit
Can be catastrophic, and even fatal.Exact mechanism unknown (?loss of autoregulation
leading to cerebrovascular congestion, brain swelling, increased intracranial pressure, herniation of the brain).
Is completely preventable.Treatment is poor.Can also occur without an identifiable first injury.
SECOND IMPACT SYNDROME ORMALIGNANT BRAIN SWELLING
Death of a young hockey player due to second impact syndrome
Fekete, JF in CMAJ, 1968
Hemorrhages in brainstem due to herniation of the brain
Animated Slide
Click to continue!Click for next slide!
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
POSTCONCUSSION POSTCONCUSSION SYNDROMESYNDROME
1. Debilitating condition affecting a large number of people, difficult to diagnose, with no clear pathophysiology and with only symptomatic treatment available.
2. Does PCS lead to CTE??
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
PATIENT CHARACTERISTICS IN OUR SERIES OF 221 PATIENTS WITH PCS
Mean age: 27.0 yearsRange 10-74 years123 (55.7%) of all patients were ages 10-22
Sex ratio: 127 (57.5%)male: 94 (42.5%) female
Can occur after any cause of concussion: sports, work, MVC, etc
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
AGE OF PATIENTS WITH PCS (AT LAST CONCUSSION). (N=221)
M=27.0
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
PERSISTENT SYMPTOMS
Mean number: 8.1 Range of 3-23 symptoms
Most common symptoms:1.Headaches (89.1%)2.Memory Problems (61.5%)3.Concentration Problems (54.8%)4.Balance problems (52.0%)5.Dizziness (51.6)6.Fatigue (45.7%)7.Nausea (43.0%)8.Sensitivity to light (38.9%)9.Irritability (31.7%)10.Depression (30.8%)
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
# OF CONCUSSIONS PERPATIENT (INCLUDING MOST RECENT). (N=221)
M= 3.3
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
DURATION OF PCS. (N=221) M=7 MONTHS,
RANGE: 1 MONTH TO 26 YEARS
(In most patients, the actual duration is longer as PCS had not resolved at time of last examination.)
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
TREATMENT OF PCS
1.No proven therapy2.Graduated Return to
school, play, work3.Thus, prevention is
essential.
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
CHRONIC TRAUMATIC ENCEPHALOPATHY (CTE)
Was called Dementia Pugilistica because it was first described in boxers by Martland, HS (JAMA, 1928)
Also known as the “punch drunk syndrome” because of intellectual decline, balance impairment, slurred speech, tremor
Variable latency after repetitive concussions Too many “dings”, cumulative effects of
“mild concussions”
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
CTE PATHOPHYSIOLOGY
CTE Is a tauopathy due to repeated blows to the brain
Accumulation of tau protein in neuronal cell bodies.
Tau is normally present in axons and functions to stabilize microtubules
In CTE, deposition of tau damages neurons CTE has been seen in boxers and football,
soccer and hockey players Research needed to determine its
prevalenceCLINICA
LPREVENTIO
NMANAGEME
NTCOMPLICATIO
NS
CTE Pathophysiology (continued)
NormalNerveCells
AbnormalNerve Cells
First CFL Brain Donation to the Canadian Sports Concussion ProjectKrembil Neuroscience Centre, Toronto Western Hospital
Diagnosis of CTE *Arrows indicate nerve cells filled with Tau protein*
Jay Roberts (age 67), Ottawa Rough Riders
Animated Slide
Click to continue!Click for next slide!
Jay Roberts,Ottawa Rough Riders
Age 67
First CFL Brain Donation To The Canadian Sports Concussion
Project,Krembil Neuroscience Centre.
Toronto Western Hospital
NormalNerveCells
AbnormalNerve Cells
Nerve CellsFilled
with Tau Protein
DIAGNOSIS:C.T.E.
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Clinical Exam Non-Specific
Routine CT and MRI Non-Specific Atrophy
Functional MRI ??DTI MRI ??BOLD MRI ??MRS ??Maxi-Neuropsych Tests
Non-Specific
PET ??Event Related
Potentials (ERP) ??Electrical
Connectivity ??MEG ??Blood Biomarkers ??CSF Biomarkers TauMechanical Tests ??AUTOPSY-
TAUOPATHY-the only proven Biomarker!!!!!!!!
POTENTIAL BIOMARKERS FOR CONCUSSION INDUCED BRAIN DEGENERATION SUCH AS CTE
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
THE YOUNG BRAIN - IS IT MOREVULNERABLE TO INJURY?
Modern Research Says, YES!Therefore, the emphasis must be on prevention To prevent long-term deficits such as permanent memory loss
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
CONCUSSION PREVENTION STRATEGIES IN SPORTS AND RECREATION
Concussions are serious injuries - can end careers and cause permanent brain injury
Follow the established guidelines for management
Promote safer play and respect – get rid of fights, elbows, illegal play and the “enforcer” role
Reduce head contact in football practicesKnow that helmets do not prevent
concussionCLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
PREVENTION OF CONCUSSIONS AND THEIR COMPLICATIONS
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
PrimaryPreventi
on
•Prevent the concussion from occurring
SecondaryPreven
tion
•Recognize and manage the concussion properly
TertiaryPreventi
on
•Prevent the long-term complications
• No Hits/Checks to the Head Rule, No Hits from Behind Rule, No Fighting Rule, and their Enforcement. Teach Respect.
• Diagnose and manage concussions properly to prevent worsening e.g. Second Impact Syndrome
• Prevent the long-term complications. Termination. Advise “Never return to play” to prevent CTE
EXAMPLES IN HOCKEY
Animated Slide
Click to continue!Click for next slide!
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
PREVENTION OF CONCUSSIONS OF CONCUSSIONS IN HOCKEY (CONT’D)IN HOCKEY (CONT’D)
MULTIFACETED APPROACH:EducationCoaching - Attitude, Prevention StrategiesTrainingRefereeingRules Changes - NO HITS TO THE HEAD, NO HITS FROM BEHIND, NO FIGHTINGEquipment – Helmets, MouthguardsRemoval from Play and Terminating
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS
Download free at thinkfirst.ca
HELMETS PREVENT SKULL FRACTURES, BRAIN CONTUSIONS AND LACERATIONS,AND BLOOD CLOTS IN AND AROUND THE BRAIN
HOCKEY and FOOTBALL PLAYERS ARE CONCUSSED WHILE WEARING HELMETS!
Protective equipment is essential… But helmets do not protect against all concussions
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Now in all of the 50 US states
Includes two main elements: 1.mandatory education about concussion for participants in
collision sports in schools or in community leagues, their families, coaches, and teachers
2.Mandatory management of concussion, especially removal from the game or practice, advice to see a doctor, and no return until a signed approval from a doctor
Bill 39 introduced in Ontario in 2012 for schools received 1st reading but died when the legislature was prorogued.
CONCUSSION LEGISLATION
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Ontario Ministry of Education: Announced in March, 2014 and implemented in Jan. 2015
Directs School Boards to have concussion education, management and prevention policies
For players, parents, teachers, coaches, referees, etc.
Well written and resourced.Will save brains and livesFirst of its kind in CanadaBravo!!!
POLICY AND PROCEDURES MEMORANDUM 158
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
Concussions can be prevented by helmetsConcussions can be diagnosed by CT and MRIThere is a proven treatment for concussionsResume your activities as soon as possible, and you will get
better quickly It’s just a concussion, and everybody gets betterBaseline testing prevents concussionBaseline testing is good treatment for concussionPostconcussion syndrome is what malingerers get and only
occurs when liability is an issueDepression and anxiety after a concussion are psychogenic,
and due to sadness
CONCUSSION MYTHOLOGY
OBJECTIVES
INTRODUCTION/BRAIN INJURIES
CONCUSSION
CONCLUSIONS
The term “Mild Traumatic Brain Injury” or mTBI is an oxymoron
Concussions can produce lasting symptoms, especially repetitive concussions
Prevention is the only cure. There is no drug or other therapy to accelerate recovery from concussion or to prevent the next concussion, or to prevent the long term consequences of concussion.
More concussion research is necessary
CLINICAL
PREVENTION
MANAGEMENT
COMPLICATIONS