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�