Psychosocial Impact of Concussions

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Everett Little
5 years ago
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Concussions can occur from a bump, blow, or jolt to the head or neck that causes the brain to move inside of the skull.

1 Psychosocial Impact of Concussions Tammy Miller, COTA/L, MHS, CBIS, CCM Jillian Jones, DPT, CBIS, CCI Definition A concussion is an injury that affects the way the brain works or functions. It is also referred to by some as mild Traumatic Brain Injury (mtbi). Concussions can occur from a bump, blow, or jolt to the head or neck that causes the brain to move inside of the skull. Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth. Concussions are not always associated with a loss of consciousness or extreme injuries. 1

2 Etiology 5u5Ivx31og Common symptoms Physical Headache Nausea or vomiting Blurry or double vision Dizziness or difficulty with balance Sensitivity to light, noise, or lots of sensory stimulation Mental Confusion Difficulty concentrating Problems remembering Feeling foggy or slowed down 2

3 Common symptoms Emotional A strong emotional reaction to having been injured Feeling sad or down Decreased interest in hobbies Irritability or moodiness Nervousness A desire to be isolated from other people or a concern about participating in community activities Sleep Difficulty falling or staying asleep Sleeping more or less than usual Drowsiness Post concussion syndrome Delayed recovery from concussion occurs in 15-20% of individuals Post Concussion Syndrome (PCS) is diagnosed if symptoms persist past the 4 week mark Symptoms are the same as with acute concussion but may change in frequency and severity Diagnosed via symptom cluster and duration no diagnostic tests Symptoms may last for months to years beyond concussion event 3

4 Post concussion syndrome More research now on identifying predictors of PCS Evidence based predictors include: PMH anxiety, depression PMH migraine Concurrent significant life stressors Substance abuse Some also suggest female gender, hormonal imbalance (ie. puberty, menopause, thyroid issues) Challenges of PCS Invisible Injury Often increasing symptoms of anxiety and depression, even without previous diagnosis Symptoms include fatigue, dizziness, headache mimic those of the concussion itself As a therapist, how do we bring attention to deficits in order to understand and target with exercises, but not overwhelm and increase anxiety related to diagnosis? 4

Comprehensive Evaluation of Concussion Includes evaluation in the following areas: Autonomic function Oculomotor Cervical Cognition Vestibular Migraine Psychosocial PCS Headaches Fatigue Irritability

Nausea Pulsing in ear Numbness/Tingling Blurred vision Headaches Shortness of breath Decreased energy or fatigue Noise light sensitivity Anxiousness Chest pain Irritability Insomnia Heart palpitation

5 Comprehensive Evaluation of Concussion Includes evaluation in the following areas: Autonomic function Oculomotor Cervical Cognition Vestibular Migraine Psychosocial PCS Headaches Fatigue Irritability Anxiety Insomnia Loss of concentration/memory Dizziness Ringing in the ears Neck Tension Nausea Depression Anxiety Headaches Fatigue Irritability Insomnia Lack of Concentration Dizziness Neck tension Nausea Pulsing in ear Numbness/Tingling Blurred vision Headaches Shortness of breath Decreased energy or fatigue Noise light sensitivity Anxiousness Chest pain Irritability Insomnia Heart palpitation Weakness in legs Difficulty concentrating/remembering or making decisions Persistent sadness Feeling of hopelessness or pessimism Loss of interest Moving or talking slowly Feeling restless Appetite or weight changes Thoughts of death or suicide 5

6 Increase in PCS symptoms Decreased performance at school/work Increased psychosocial stressors Case Study #1 48 yo female who suffered a concussion in 2016 while at work First episode of care in 2017 Screen identified red/yellow flags including: Depression, anxiety, female, partial hysterectomy (hormonal changes), insomnia, change in employment, stress of memory impairments on paying rent and stressing relationship with spouse. Therapy included PT, OT and SP. At this time no counseling was available in Outpatient but she was referred to counseling outside of OWL. Significant improvement with balance and mobility confidence and utilizing appropriate strategies for memory and attention at work Second episode of care 2018 Had just lost her job Returned for re-evaluation from all three disciplines 6

7 Case Study #2 36 yo Female who sustained concussion during MVA in 2017 First episode of care in 2018 Screen identified red/yellow flags including: Litigation, PTSD, anxiety, depression, migraine, single mom worried about job Presented to therapy with only Speech Therapy orders Following evaluation, obtained OT and PT orders What we have learned Roll of therapy as a coach We expect these symptoms to get better Need to provide a positive outlook Present therapeutic interventions with red/yellow flags in mind Line up with appropriate resources Counseling Education Routine sleep/exercise/guided meditation De-escalation techniques weighted vest, brown noise etc. Initially provide but also teaching how to gradually move away from these techniques Take a step back and look at whole picture Multi-disciplinary team needs to be on the same page and providing the same education 7

8 Questions? Questions? 8

CONCUSSION PROTOCOL STEPS FOR RETURN TO PLAY

CONCUSSION PROTOCOL STEPS FOR RETURN TO PLAY Winnacunnet High School Concussion Protocol All coaches must take the NFHS Concussion course prior to working with students in their coaching season. Coaches must retake the course on even numbered years.