Concussions & Seizure Disorders

• Brain Injury includes concussion, contusions, and seizures
• FT400 CNS Tx is a treatment for brain injury

Traumatic Brain Injury (TBI)

• Concussion (mTBI) is a mild TBI with functional changes, but no structural damage
• Contusion is more serious than a concussion and involves bruising or bleeding along the brain surface
• The extent of damage from a contusion depends size and location
• Seizure Disorders (Epilepsy) are explosive episodes of uncontrolled and excessive electrical activity in the brain, leading to sudden changes in behavior or level of consciousness

Severity Classification of Traumatic Brain Injuries

• Mild TBI involves <30 Minutes of unconsciousness, a Glasgow Coma Scale ranking of 13-15, and <24 Hours of amnesia
• Moderate TBI involves 30 Minutes-24 Hours of unconsciousness, a Glasgow Coma Scale ranking of 9-12, and 1-7 Days of amnesia
• Severe TBI involves >24 Hours of unconsciousness, a Glasgow Coma Scale ranking of 3-8, and >7 Days of amnesia

Glasgow Coma Scale

• Objectively describes the extent of impaired consciousness in all types of traumatic brain injuries
• The lower the score, the worse the injury
• A score of 15 means you're fully awake, responsive, and have no problems with thinking ability or memory
• A score of 13-14 means a mild head injury
• A score of 9-12 would indicate a moderate head injury
• A score of 3-8 means you're in a coma and have a severe brain injury and immediate emergency care is required

Concussion (mTBI)

• A traumatic brain injury caused by a direct blow to the head, neck, or body resulting in an impulsive force being transmitted to the brain
• This initiates a neurotransmitter and metabolic cascade, with possible axonal injury, blood flow change, and inflammation affecting the brain
• Symptoms and signs may present immediately, or evolve over minutes or hours, and commonly resolve within days, but may be prolonged
• The neurometabolic cascade following concussion should normally resolve within 4-6 weeks
• If symptoms persist beyond that time (and cannot be explained by other means), the person is said to be experiencing persistent post-concussion syndrome
• PPCS symptoms develop in 20-30% of concussed patients
• Coup injury occurs under the site of impact and a contrecoup injury occurs on the side opposite the area that was hit
• One does not need to lose consciousness to have a concussion
• The primary cause is the initial load to the brain at the moment of impact
• Rotational force is the most likely to lead to loss of consciousness and persistent post concussion symptoms
• Concussion and whiplash often occur together
• People who suffer a concussion, in the majority of cases, also suffer a whiplash injury and it has been recommended that the guidelines for the care of both are amalgamated

Concussion Treatment

• Imaging can be done to rule out structural damage
• A MRI and CT scan can be done to rule out structural damage
• Rest, sleep at night, take naps throughout the day if needed, and rest breaks during the day
• Avoiding vigorous activity
• NSAIDs to control headaches
• Avoid bright lights and electronics
• Limit activities that require heavy concentration or intense focus
• In severe cases, physical therapy, speech therapy, recreation therapy, and occupational therapy may be needed

Sport Related Concussion (SRC)

• Area of research on concussion treatment
• Recommending strict rest until the complete resolution of concussion-related symptoms is not beneficial following SRC
• Relative (not strict) rest, which includes activities of daily living and reduced screen time, is indicated immediately and for up to the first 2 days after injury
• Individuals can return to light-intensity physical activity (PA), such as walking that does not more than mildly exacerbate symptoms, during the initial 24-48 hours following a concussion
• Clinicians are encouraged to recommend early (after 24-48 hours) return to PA as tolerated
• Reduced screen use in the first 48 hours after injury is warranted but may not be effective beyond that
• Individuals can systematically advance their exercise intensity based on the degree of symptom exacerbation experienced during the prior bout of aerobic exercise
• HCPs with access to exercise testing can safely prescribe subsymptom threshold aerobic exercise treatment within 2-10 days after SRC, based on the individual's heart rate threshold (HRt) that does not elicit more than mild symptom exacerbation during the exercise test

Post Concussion Syndrome

• Occurs after the concussion has occurred
• Signs and Symptoms include autonomic dysfunction, headaches, dizziness, loss of concentration and memory, ringing of the ears, emotional and psychological changes, sleep changes, and vision changes

Concussion and PPCS massage considerations

• Remove noxious stimuli and position and pillow for comfort while being aware of dizziness and/or onset of symptoms with neck movement (cervicogenic dizziness)
• Avoid rocking/shaking, promote relaxation, and encourage and support light aerobic exercise
• Refer to chiro/physio/MD that are well trained in concussion assessment and treatment (BTT, VOM)

2 Main Types of Seizures

• Focal (partial) Seizures are limited to a single area of the brain (60% of cases)
• Without loss of consciousness means may experience changes in the way things looks, feel, smell, taste or sound, and can result in involuntary movements or abnormal sensations like dizziness
• With impaired awareness means there is change or loss of consciousness and appear to have a blank stare or have a repetitive movements like hand rubbing or smacking, or start walking in circles
• Generalized Seizures involves more of a diffuse area is seen approximately 30% of cases
• Absence (petit mal) – brief loss of awareness and often facial movements lasting up to 10 seconds where often people have no memory of what happens during the seizure
• Tonic-clonic (grand mal) – intermittent contract-relax pattern in muscles that are associated with loss of consciousness and can last for several minutes

Treatment of Seizures

• Antiseizure medication and cannabinoids are used to reduce the frequency of seizures
• Mild sedatives aid in relieving symptoms
• Understanding triggers if there are any (flashing lights, smells/odors)

Seizures & Massage

• Understand and remove triggers
• If a client appears to be having a seizure, understand and follow first aid measures
• Remain calm and begin to time the seizure
• Clear the area of objects
• If possible, gently place the person on the floor
• Place a cushion or soft material under the person's head and lift the chin slightly to open the airway
• Remain with the person until the seizure has ended
• After a seizure, a number of things can be expected: grogginess or fatigue, confusion, disorientation, or even embarrassment, headache, and/or general soreness
• Call 911 if this is the client's first seizure, if one does not know whether they have a seizure previously, if they have seizure disorder and the seizure lasts more than 5 minutes or immediately repeats, or if they are injured or they vomit
• Document the event in an incident report
• It is sensible to work from a template of gentle, relaxing massage techniques

Seizures & Massage Considerations

• Adjust face rest to ensure comfort
• Limit position changes if client is experiencing dizziness
• If client has difficulty communicating establish a form of communicating
• Avoid techniques that cause the client to rock or shake

This quiz covers massage therapy considerations for clients with concussions and seizure disorders. It addresses appropriate modifications, symptom management, technique selection, and support for recovery through massage.