Brain Injury - Concussion, Contusions, Seizures PDF

Brain Injury Concussion, Contusions, Seizures FT400 CNS Tx Traumatic Brain Injury Conditions Traumatic Brain Injury (TBI) Concussion (mTBI): a mild TBI with functional changes but without structural damage Contusion: more serious than a concussion. Involves bruising or bleeding...

Brain Injury Concussion, Contusions, Seizures FT400 CNS Tx Traumatic Brain Injury Conditions Traumatic Brain Injury (TBI) Concussion (mTBI): a mild TBI with functional changes but without structural damage Contusion: more serious than a concussion. Involves bruising or bleeding along the brain surface. Extent of damage depends on size and location of the contusion Seizure Disorders (Epilepsy): explosive episodes of uncontrolled and excessive electrical activity in the brain leading to sudden change of behavior or level of consciousness. Severity of Traumatic Brain Injuries Glasgow Coma Scale Used to objectively describe 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 Having a score of 3 - 8 means you’re in a coma and have a severe brain injury. Immediate emergency care is required Concussion (mTBI) 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. Concussion (mTBI) 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 Concussion (mTBI) MOI Coup-contrecoup a coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was hit. You do not need to lose consciousness to have a concussion Concussion (mTBI) MOI Primary cause is the initial load to the brain at the moment of impact https://www.youtube.com/watch?v=XMgTQCmgQ2U Rotational force is the most likely to lead to loss of consciousness and is the most likely to lead to persistent post concussion symptoms Concussion (mTBI) MOI Concussion and whiplash often occur together People who suffer a concussion, in the majority of cases, also suffer a whiplash injury. Some researchers are recommending that guidelines for the care of both are amalgamated. Concussion Treatment Imaging can be done to rule out structural damage MRI, and CT scans Rest Sleep at night and naps throughout the day if needed 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  SRC research Sport Related Concussion (SRC) is an area of much research on concussion treatment Taken from: Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022 (Free article: https://bjsm.bmj.com/content/57/11/695) Post Concussion Syndrome Occurs after the concussion has occurred: Signs and Symptoms: Autonomic dysfunction Headaches Dizziness Loss of concentration and memory Ringing of the ears Emotional and psychological changes Sleep changes Vision changes Concussion and PPCS Massage considerations Remove noxious stimuli Position and pillow for comfort (be aware of dizziness and/or onset of symptoms with neck movement (cervicogenic dizziness)) Avoid rocking/shaking Promote relaxation Encourage and support light aerobic exercise Refer to chiro/physio/MD that are well trained in concussion assessment and treatment (BTT, VOM) Seizure disorders (Epilepsy) 2 main types of seizures Focal (partial) Seizures: Seizure is limited to a single area of the brain (60% of cases) 2 categories of focal seizures: Without loss of consciousness May experience changes in the way thing look, feel, smell, taste or sound. Can result in involuntary movements or abnormal sensations like dizziness With impaired awareness Change or loss of consciousness Appear to have a blank stare or have a repetitive movements like hand rubbing or smacking, or start walking in circles 2 main types of seizures Generalized Seizures: Involves more of a diffuse area and is seen approximately 30% of cases 2 types Absence (petit mal) – brief loss of awareness and often facial movements lasting up to 10 seconds Often people have no memory of what happens during the seizure Tonic-clonic (grand mal) – intermittent contract-relax pattern in muscles and are associated with loss of consciousness Can last for several minutes Treatment of seizures Antiseizure medication and cannabinoids are used to reduce the frequency of seizures Mild sedatives Understanding triggers if there are any (flashing lights, smells/odors) Seizures - Massage considerations Understand and remove triggers Follow first aid (left) if seizure occurs 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