Mild Traumatic Brain Injury (mTBI) / Concussion

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Mild Traumatic Brain Injury (mTBI) / Concussion�
Concussion Facts�

In Canada 94,000 people had a concussion over the 2009-2010 period (Statistics Canada)

mTBI constitutes 80% to 90% of TBI cases in the United States

  • ~ 2.3 million cases in the United States
  • Annual incidence estimated to be 100-300 per 100,000 (0.1-0.3%)

Most people with a concussion recover quickly and fully.

  • For some people, symptoms can last for days, weeks, or longer.
  • In general, recovery may be slower among older adults, young children, and teens.
  • Therapy targets the individual symptoms.

For the majority of people who sustain a concussion, a full recovery is possible with appropriate diagnosis and management.

  • *This is because the brain is surrounded by shock-absorbing liquid and is covered by the skull, which usually is enough to protect the brain from any damage.*�
What is a Concussion?�

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 normally works.

A concussion can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth or to undergo acceleration/deceleration without a direct external trauma to the head.

Shearing forces generated within the brain may disrupt the axons and associated small blood vessels causing diffuse axonal injury.

Concussion Diagnostic Criteria�

The American Congress of Rehabilitation (1995) has defined mTBI as a traumatically induced physiologic disruption of brain function with ≥1 of 4 manifestations:

  • Loss of consciousness (≤ 30 min)
  • Loss of memory for events immediately before or after the accident (≤ 24 hrs)
  • Alteration of mental state at the time of the accident:
    • Feeling dazed, disoriented, or confused
    • Glasgow Coma Scale (GCS) score (< 13 after 30 min)
  • Focal neurological deficit(s) that may or may not be transient

CT and MRI are the most frequent imaging modalities used in acute diagnosis and management.

  • Fewer than 10% of individuals with mTBI have a positive CT scan.
What is a Post-Concussive Syndrome?�

Most mTBI patients have a good recovery with symptoms clearing within the first few weeks or months post-injury

In some patients, symptoms persist and are associated with:

  • Social and vocational difficulties that appear to be out of proportion to the severity of the neurologic insult.
  • This condition has been termed post-concussive syndrome (PCS)�
mTBI Common Symptoms�

Common Cause of Symptoms After mTBI

Are mTBI Symptoms Permanent?�

Approximately 80% of people with a mTBI will experience some physical, cognitive, and behavioral symptoms after injury

The manifestation of these symptoms does not indicate that there is permanent damage to the brain.

  • Instead, the symptoms are considered part of the normal recovery process.
  • Symptoms may disappear without treatment.

The majority of patients will gradually recover within 3 to 6 months following a mild traumatic brain injury

Approximately 10% - 15% of people with a mTBI continue to experience some symptoms at 12 months.

Frequently reported symptoms are:

  • Chronic pain, fatigue, emotional distress (e.g., anxiety, depression)�
Clinical Recovery Pathway for Post-Concussive Symptoms�

Risk Factors for Symptom Prolongation After mTBI�

  1. LOC = loss of consciousness; 2) PTA = posttraumatic amnesia�
Impact of Risk Factors on Recovery From mTBI�

The presence of one or more of the risk factors does not predict a poor or incomplete recovery

  • Provides an indication for closer monitoring and medical interventions during the recovery process

Individuals with one or more risk factors

  • Appear more vulnerable to persisting symptoms
  • May suffer long-term effects for a variety of reasons
  • May have more severe or diffuse injury
  • May suffer from the additive effect of brain injury on top of pre-existing brain dysfunction due to injury, disease, or depression
  • May have coping difficulties post-injury due to intrinsic expectations or external factors.�
mTBI Early Interventions�

mTBI injuries can result in distress and disability for people who develop persistent post-concussion symptoms.

Early intervention significantly reduces social morbidity and severity of post-concussion symptoms.

Early interventions include:

  • Referral to rehabilitation services and medical specialists: support for guided resumption of activities
  • Information/education and reassurance
  • Short-term medical management of symptoms
  • Apply relaxation techniques
  • Restore and maximize function both at home and at work despite symptoms�
Coping & Support�

Write things down

  • Keep a record of important events, people's names, tasks or other things that are difficult to remember.

Follow a routine

  • Establish sleep hygiene
  • Keep a consistent schedule
  • Keep things in designated places to avoid confusion
  • Take the same routes when going to frequently visited destinations

Take breaks

  • Make arrangements to take breaks as needed
  • Apply energy conservation techniques

Alter work expectations or tasks

  • Allow more time to complete tasks or breaking down tasks into smaller steps.

Stay focused and avoid distractions

  • Apply cognitive remedial strategies, as needed
  • Minimize distractions such as loud background noise from a television or radio.
  • Work on one task at a time.
  • Pace self
  • Get organized�
Prevention Strategies�

Driving

  • Always wear a seat belt in a motor vehicle.
  • Don't drive under the influence of alcohol or drugs, including prescription medications that can impair the ability to drive.

Helmets

  • Wear a helmet while riding a bicycle, skateboard, motorcycle, snowmobile or all-terrain vehicle.
  • Wear appropriate head protection when playing baseball or contact sports, skiing, skating, snowboarding or riding a horse.

Preventing falls

  • Install handrails in bathrooms
  • Put a nonslip mat in the bathtub or shower
  • Remove area rugs
  • Install handrails on both sides of staircases
  • Improve lighting in the home
  • Keep stairs and floors clear of clutter
  • Get regular vision checkups
  • Get regular exercise�