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Articles Tagged with concussion

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traumatic-brain-injury-picture-1A concussion is a traumatic brain injury that affects the brain function. It is diagnosed quite frequently among children however its diagnosis remains challenging. Doctors often rely on symptoms and historical factors.

A recent study published by the “Minds Matter Concussion Program at the Children’s Hospital of Philadelphia” found that the Visio-Vestibular Examination is an easy and useful tool to distinguish to concussed from not concussed children following a head injury. The exam can also be conducted outside of the Emergency Department setting.

The Visio-Vestibular Examination (VVE) is a series of examinations that determine if the patient has some degree of visio-vestibular deficit such as impaired eye movements and pupil response. The following examinations are being done:

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child-head-injuy-1Because young children can’t express themselves proprely it can be challenging for doctors to diagnose a traumatic brain injury or concussion.  A recent article published in Pediatric Emergency Care suggests that using previous “Characteristics of Diagnosed Concussions in Children Aged 0 to 4 Years Presenting to a Large Pediatric Healthcare Network” might be helpful. The study was authored by Podolak, Olivia E. MD*; Chaudhary, Sofia MD*,†; Haarbauer-Krupa, Juliet PhD; Metzger, Kristina B. PhD, MPH*; Curry, Allison E. PhD, MPH*,†; Kessler, Ronni S. MEd*; Pfeiffer, Melissa R. MPH*; Breiding, Matthew J. PhD; Master, Christina L. MD, CAQSM, FACSM*,§,∥; Arbogast, Kristy B. PhD*,†,§

The researchers analyzed the medical data of 329 young patients aged 0 to 4 who visited the Children’s Hospital of Philadelphia healthcare network from October 1, 2013, to September 30, 2015 . They identified  the 3 top common mechanisms of injury.

The first one was fall and represented 64.4 % of all young patients who were diagnosed with a concussion with children younger than 2 year old being at a higher risk of sustaining a concussion in a fall than children from 2 to 4 year old.  Falling from furniture was the most common type of fall leading to traumatic brain injury, followed by tripping and hitting the ground and falling down the stairs.

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children at campConcussion is one of the most commonly sustained injuries by children and teenagers when they are at camp.  Therefore it is important that camps not only have specific requirements and guidelines to prevent traumatic brain injuries but also have a medical staff that is trained to recognize and treat concussions.

In regards to prevention, camps should always make sure that children wear proper helmets for activities involving motorized vehicles as well as activities such as skate boarding and skating.  Helmets also have to be mandatory when kids are involved in adventure activities such as climbing, spelunking or zip lining.  Children should also wear a helmet when bike riding as well as when horseback riding including pony riding.

Despite actively preventing concussions, accidents still happen and the camp medical team has to be ready.  The camp medical staff has to be able to recognize and evaluate a concussion sustained by a camp goer.  After  the camp clinician properly evaluates the young patient, he will have to communicate not only with the child but also with the parents to assure a proper recovery.

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 Electronic Health RecordThe Children’s Hospital of Philadelphia (CHOP)  released a study on Monday that looked at 14,527 traumatic brain injury-related primary care office visits for 7284 unique patients over a period of 4 years. They found out that after physicians used a concussion management tool provided to them through the Electronic Health Records (EHR) of their patients, they perform better diagnosis and treatment. 

82% of children suffering from concussion visit a primary care physician rather than a specialist to be treated. In the study, the researchers from the Children’s Hospital of Philadelphia (CHOP) found that many primary care physicians  then refer their young patients to specialists because they feel they are not properly equipped to manage Traumatic Brain Injury cases.

With the input of the primary care physicians, the researchers developed an electronic template guiding the physician through a step by step approach for diagnosis, treatment and follow-up of young patients suffering from concussion injuries. The electronic tool was integrated in the Electronic Health Record of the patient. The tool provided physicians with a “concussion Smartset” allowing them to document the evolution of the patient. Physicians were trained to used the tool at various seminars organized by CHOP researchers.

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young driverPeople who are driving after recovering from a concussion may be at higher risk of a car accident. A recent study lead by Julianne Schmidt, associate professor in the UGA College of Education’s department of kinesiology shows that despite being asymptomatic, people who recently suffered concussion may drive erratically. The study was recently published in the Journal of Neurotrauma.

During the study, Julianne Schmidt and her team compared the driving skills of 14 students who suffered concussion but were symptom free with the driving skills of 14 students who didn’t suffer from concussion. Participants were required to to complete a graded symptom checklist and a neuropsychological exam. Participants with concussion were asked to take a 20.5 km driving test within 48 hours of becoming asymptomatic. Healthy participants of the same age were required to complete the same driving test.

The study showed that participants who previously suffered concussion but were cleared of symptoms exhibited driving behavior similar to someone driving under the influence of alcohol.  The researchers compared the number of crashes between the two groups of students as well as the number of tickets, the number of lane excursion, the way they were driving in curves and their speed. They found out that concussed participants were not well controlling their vehicles especially when driving in the curves. They also swerved a lot more than healthy drivers putting themselves and other road users at a greater risk of accidents.

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will smithNFL players who suffer repetitive traumatic brain injury during their career have a high risk to develop Chronic Traumatic Encephalopathy (CTE).  CTE  is a progressive degenerative disease. Individuals affected by CTE often show symptoms of dementia such as loss of memory, confusion, depression and aggression.

Dr. Bennet Omalu, now the chief medical examiner, San Joaquin County in California, was one of the first doctors to detect CTE in NFL player’s brains.  Thirteen years ago as he was working at the Allegheny County Coroner’s Office in Pittsburgh he autopsied Mike Webster, a Hall of Fame center for the Steelers. Webster became so mentally ill that he ended up living in his pick up truck. During a dementia crisis, he pulled out his teeth and glued them back with superglue. He also shocked himself with a taser on a regular basis.

malu found that Webster’s brain was riddled with dark tangles of tau protein, which he explained had choked Webster from the inside out. He identified the condition as CTE and attribuDuring the autopsy, Dr Oted it to the estimated 70,000 hits to the head that Webster endured during his career. Dr Omalu then examined other players such as Terry Long, Justin Strezelczyk and Andre Waters and found they were afflicted by the same condition. When he showed the results of his research to the NFL they  publicly ridiculed him and intimidated him calling him a quack.

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cme-concussion-2015-std-canonicalEvery day students from elementary school to college are sustaining concussions during sport or playground activities.  A concussion is a type of traumatic brain injury that can affect the student’s cognitive, physical emotional and sleep functions.  Recent research has shown that knowledge of a concussion’s potential effects on a student and appropriate management of the return-to-school process is critical for helping students recover from a concussion.  Clinicians and school personnel who are  are involved in the management of care for students with concussion can attend a one day conference on this subject organized on May 9th by the Children Hospital of Philadelphia. Click here for more info and to register. For detailed information on Traumatic Brain Injury see the CDC related web page.