Concussion learning by experts

Amid growing evidence that repeated concussions and blows to the head can have long-term, possibly fatal outcomes, local concussion experts are working to better inform people about head injuries.

Specialists at Cape Regional Medical Center’s Concussion Center are gearing up for fall sports season injuries, typically to student athletes — although adults and seniors can have such injuries all year.

More awareness about head injuries is needed.

“There’s a misconception that concussions are strictly due to sports injuries, but we have a program and treatments that serve kids and adults who get concussions just as much from falls and car accidents, too,” said A.J. Weiss, concussion center rehabilitation and treatment manager.

Gov. Chris Christie earlier this year signed a law designating the third Thursday of September as Concussion Awareness Day in New Jersey. Legislators said they hoped awareness would lead to education about the serious consequences of concussions, treatment and resources.

Of the 2.8 million traumatic brain injury-related emergency department visits and hospitalizations in 2013, most were concussions, according to the federal Centers for Disease Control and Prevention, and about 300,000 children who were treated in a single year for a concussion or brain injury got hurt while playing sports or in recreation.

Scientists have explored more about concussions in recent years, especially as high rates of head injuries are found in sports such as football. Researchers have looked into how repeated head injuries and concussions could lead to chronic traumatic encephalopathy, a degenerative brain disease.

A report published in July in the Journal of the American Medical Association by Dr. Ann McKee, chief neurologist of VA Boston Healthcare System and director of the CTE Center at Boston University, said 110 of 111 brains of deceased National Football League players were found to have CTE.

“Part of what we do for education is informing people about second impact syndrome, which can be fatal,” Weiss said. “It happens when someone sustains a second concussion before the first one heals, and that could lead to weeks or months of therapy, permanent damage, or worst case, death.”

Concussion symptoms include dizziness, headache, vision trouble, sometimes brief unconsciousness, fatigue, poor balance, sensitivity to light, vomiting and disorientation, among others.

Cape Regional’s center, established in January 2016, encourages people to see a physician as soon as possible if they suspect a concussion. When a physician or other medical expert refers patients to the center, Weiss said, they will see that patient in less than 48 hours.

Some patients who come in with head injuries from sports, falls or car accidents come through the emergency department, he said, where they may be prescribed a CT scan, which can detect brain bleeds or skull fractures.

Though they are necessary in many cases, experts from the New Jersey Council of Children’s Hospitals and the New Jersey Hospital Association created the Safe CT Imaging Collaborate, which works to standardize protocols for head CT scans in children to decrease radiation exposure.

“Diagnostic radiation is very, very useful when used appropriately,” said Dr. Ernest Leva, associate professor and director of the Rutgers Robert Wood Johnson Medical Center’s Division of Pediatric Emergency Medicine. “But if it’s not used appropriately, it can be dangerous.”

Dori Davidson, 19, of Dennis Township, got a concussion not from sports, but from a slip and fall in August.

She visited a Cape Regional urgent care associated with the emergency department for a laceration on her head and was referred to the concussion center, where she got baseline testing, concussion care education and a treatment plan.

Davidson worked with experts in a combination of physical therapy and occupational therapy exercise Friday to strengthen her motor and cognitive capabilities. She worked with the Dynavision D2, a computerized board that tested her motor, physical and neurological skills.

The center, which has seven certified brain injury/concussion specialists trained in physical and occupational therapy, also works with a network of nearby pediatricians to reach children who may see their primary care doctors for head injuries.

Weiss said the center also works with neurologists who attend to patients with more complicated neurological issues stemming from a concussion.

No single test can diagnose someone with a concussion, but experts hope there will be one someday. In the meantime, they said, the best they can do is educate people on how serious concussion can be, the signs and symptoms and the available resources, such as Cape Regional’s specialized center.

“We emphasize everyone to get in early if they suspect a concussion injury,” Weiss said. “The last thing we want to see is people who don’t address their symptoms immediately, they get worse and we have a worse case on our hands.”

Can I prevent a concussion?

By its very nature, a concussion is unexpected, so it is tough to prevent. But there are several common-sense precautions you can take to lessen the possibility of traumatic brain injury.
  • Wear protective equipment. Participation in high-contact, high-risk sports such as football, hockey, boxing, and soccer can increase the likelihood of a concussion. Skateboarding, snowboarding, horseback riding, and roller blading are also a threat to your brain’s health. Wearing headgear, padding, and mouth and eye guards can help safeguard against traumatic head injuries. Wearing a bike helmet can lower the risk of traumatic head injury by 85%. Ensure that the equipment is properly fitted, well maintained, and worn consistently.
  • Drive and ride smart. Always wear a seatbelt, obey posted speed limits, and don’t use drugs or alcohol, because they can impair reaction time.
  • Don’t fight. Concussions are often sustained during an assault, and more males than females report traumatic head injuries.

WHAT CAN HAPPEN?

There many things that can be affected by a concussion.  The damage can affect Cognitive, Physical, Emotional, or Sleep elements.  Please see the diagram to the right for more, and click on it for more.

There’s an excellent book written about Concussions.  It focusses on the prevention, gives help to cope if you receive one, and “real stories” to help you understand that if you receive one, you’re not alone.

ABI vs. TBI

ABI vs. TBI
What’s the Difference?

Acquired Brain Injury (ABI)

The position of the Brain Injury Network is that acquired brain injury (ABI) includes traumatic brain injuries (TBI’s), strokes, brain illness, and any other kind of brain injury acquired after birth. However, ABI does not include what are classified as degenerative brain conditions such as Alzheimer’s Disease or Parkinson’s Disease.

Traumatic Brain Injury (TBI)

“A traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force that is indicated by new onset or worsening of at least one of the following clinical signs, immediately following the event:

  • Any period of loss of or a decreased level of consciousness;
  • Any loss of memory for events immediately before or after the injury;
  • Any alternation in mental state at the time of the injury (confusion, disorientation, slowed thinking, etc.);
  • Neurological deficits (weakness, loss of balance,  change in vision, praxis, paresis/plegia, sensory loss, aphasia, etc.) that may or may not be transient;
  • Intracranial lesion.
  • External forces may include any of the following events: the head being struck by an object, the head striking an object, the brain undergoing an acceleration/deceleration movement without direct external trauma to the head, a foreign body penetrating the brain forces generated from events such as a blast or explosion, or other force yet to be defined.”

Birth Trauma and Brain Injury

There is one subject regarding forms of TBI that is the source of some disagreement and that is with regard to the subject of brain injury produced by birth trauma. Generally speaking, brain trauma produced by the process of birth has been specifically excluded from being classified as a form of TBI by medical definitions. However, there are many mothers of babies being born with these birth brain injuries who are upset by that exclusion.

They see birth complications that result in these brain injuries as being forms of TBI. Some of these mothers see their children as being survivors of TBI, and they do not like that their children are excluded from this category.

Click the logo to read what does the OBIA (Ontario Brain Injury Association) say about the difference?

Types of facilities for long-term health

Long-term care is provided in different places by different caregivers, depending on a person's needs. Most long-term care is provided at home by unpaid family members and friends. It can also be given in a facility such as a nursing home or in the community, for example, in an adult day care center.
For the most part, and more often than not, people who'd consider "unsupported living" remain at home for as long as they can. A decline of their self-support skills would necessitate the move into a long-term facility. Basically, they need some help with what's done every day.
Independent Living Apartments
Independent living apartments are ideal for seniors who do not need personal or medical care but who would like to live with other seniors who share similar interests. In most independent living facilities seniors can take advantage of planned community events, field trips, shopping excursions and on-premise projects.
Adult Homes
Adult homes are licensed and regulated for temporary or long-term residence by adults unable to live independently. They usually include supervision, personal care, housekeeping, and three meals a day.
Assisted Living Program (ALP)
An excellent alternative to nursing homes for seniors who need help with their daily routines, but who do not need 24-hour care. Room, board, case management, and skilled nursing services come from an outside agency.
Nursing Home (Skilled Nursing Facility)
Nursing homes offer 24-hour-a-day care for those who can no longer live independently. In nursing homes, trained medical professionals provide specialized care to seniors with severe illnesses or injuries. Specially trained staff assist residents with daily activities such as bathing, eating, laundry and housekeeping. They may specialize in short-term or acute nursing care, intermediate care or long-term skilled nursing care.
What it comes down to is that whatever you need, is available. The more that you'd get, the more that it will cost. If you want to be happy, and not worried about the cost, trust me, you'll find something.