Multiple Concussions:

What healthcare professionals need to know

Objective

Awareness has grown about the potential seriousness of
concussions, particularly on developing brains

There is still so much we do not understand

This PowerPoint will introduce the most recent information
obtained on concussions
Introduction
Long term effects of concussions are currently being studied by
researchers around the globe

Managing concussions requires specialized comprehensive and
state of the art approaches

Neuropsychological testing is the standard for monitoring
cognitive recovery after a concussion
Introduction cont.

The effects of single or multiple TBIs in later-life are poorly
understood

mTBI can lead to an increased risk of cognitive impairment
and neurodegenerative disease

The risk of neurodegenerative disease and other
complications are worse when dealing with repeated injuries

More research is needed to better understand the chronic
catastrophic effects of repeated concussions



Long term effects
If a subsequent concussion occurs during a time of
recovery it can:
Risk longer recovery time
Increase symptom severity
Risk second impact syndrome

Its been suspected that repeated concussions can
result in chronic traumatic encephalopathy (CTE)

Post-Concussion Syndrome (PCS) can also result from
prolonged presence of concussive symptoms

Psychological symptoms can arise that have a negative
effect on daily functioning if unmanaged


Evaluations
The evaluation of a patient for a concussion should include:
Complete history
Physical examination
Cognitive examination

In the acute phases, intracranial bleeding and head/neck injuries
should be ruled out

The patients symptoms, behavior symptoms, and sleep
disturbances should also be assessed

Evaluations cont.
Gathering a complete history of the patient:
Builds a rapport
Allows identification of any symptoms and their severity levels
Allows an opportunity for the documentation of the mechanism
of the injury

Baseline testing is crucial and should be used if available when
evaluating patients who have suffered a concussion
Tests
In recent years there has been a significant effort towards the
creation of new imaging agents that selectively accumulate at sites
of interest

They emit a signal that can be detected by positron emission
tomography (PET) or single-photon emission computed tomography
(SPECT)

Unlike CT and MRI sequences these provide information on changes
occurring at the cellular or molecular level

For now, the gold standard is computerized neurocognitive tests in
conjunction with vestibular screening






Management
Managing concussion symptoms requires more
than just monitoring, because athletes can hide
symptoms

State of the art concussion management
includes:
Integrated acute care
Neuropsychological testing
Symptom monitoring
Evaluation of balance abilities

The athlete must then pass through a protocol
of graded exertion before being cleared to play


Legislation
Since 2008 many states have enacted legislation intended to
address the concern with concussions

Legislation is still pending

This legislation includes:
Goals to educate coaches, athletes, and parents
Removal of athlete immediately after suspected concussions
Athletes require clearance from a licensed health care
professional trained in the management of concussions before
returning to play

References

American Physical Therapy Association (2013). Concussions. Retrieved from http://
www.apta.org/StateIssues/Concussions/

Healthline (2013). Study: Concussions May Lead to Alzheimers Brain Plaques. Retrieved
from http://www.healthline.com/health-news/mental-concussions-linked-to-
alzheimers-plaques-122613

Medscape (2014). Repetitive Head Injury Syndrome. Retrieved from http://
emedicine.medscape.com/article/92189-overview

National Center for Biotechnology Information (2014). Consequences of Repetitive Head
Impacts and Multiple Concussions. Retrieved from http://www.ncbi.nlm.nih.gov/
books/NBK185336/

Sport Concussion Institute (2012). Concussion Facts. Retrieved from http://
www.concussiontreatment.com/concussionfacts.html#sfaq8

Sport Concussion Institute (2012). Concussion Resources for Healthcare Professionals.
Retrieved from http://www.concussiontreatment.com/forprofessionals.html

The Buffalo News (2014). UB, with NFL help, pioneers concussion test, treatment. Retrieved from
http://www.buffalonews.com/apps/pbcs.dll/article?aid=/20121025/cityandregion/
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