Concussion Update
Wayne A. Gordon, Ph.D., ABPP
Jack Nash Professor & Vice Chair
Department of Rehabilitation Medicine
wayne.gordon@mssm.edu
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Goals
• Define concussion.
• Review symptoms of concussion.
• Review prevalence of concussion in
children.
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What is concussion?
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• Concussion is a brain injury and is
defined as a complex physiological
process affecting the brain.
(Consensus statement on concussion in sport: 4th
International Conference on Sport held in Zurich,
November, 2012. McCory, P. et al. British Journal of
Sports Medicine, 2013)
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• TBI is an alteration in brain function
caused by an external force.
(Menon, et al. Arch. Phys. Med. Rehabil., 2010)
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• Symptoms of a concussion may appear
immediately or emerge over time.
• Learning or behavioral difficulties may not
emerge until school becomes more
demanding.
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What do we know about the prevalence of
concussion in children?
•
3 month follow up of 406 children seen in the ED
-
At 3 months post-injury 29% had post-concussion
syndrome.
-
•
7.4 days of school missed (+/-) 13.9 days.
Most common symptom reported was headache
followed by fatigue, frustration, dizziness,
concentration and memory difficulties.
(Butler et al. JAMA, Neurology, 2013)
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• 20% of Ontario students in grades 7-12 sustained a
TBI (LOC > 5 minutes) at some point in their life.
• 5.6% sustained a TBI last year.
(Ilie, et al JAMA, 2013)
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Screening of 134 kids at 12-19 in 3 NYC
schools
•
9% high probability of TBI.
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80% of the 9% had neuropsychological evidence of
TBI.
(Cantor, Gordon, Ashman, JHTR, 2006)
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•
Screening of 692 1-5 graders in Nebraska 7.66%
positive screen.
•
25% of positive screens kids receiving Special Ed.
(Hux, et al. Brain Injury, 2013)
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• A recent longitudinal cohort study found that 17%
of children tracked from birth experience a TBI
requiring medical attention by the age of 15.
• Of these 29% had a second injury.
• 23% of those with two had three.
• 33% of those with three had four or more.
(McKinlay, et. al, 2008)
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Nearly 500,000 children under the age of 15
visit ERs each year reporting a TBI and an
additional 35,000 are hospitalized.
(Faul, et. al, CDC, 2010)
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• CDC estimates that about 3,000,000
children under the age of 19 sustain a
concussion each year.
• While most recover about 20% do not.
(Alexander, 1995)
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• Numbers are an undercount because they
do not include kids who did not seek medical
attention.
• Those injured when there was no adult
present.
• Or the responsible adult may be reluctant to
disclose/report the injury.
(Langlois et. al, CDC, 2004)
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Mount Sinai
Play Safe Program
Departments of Rehabilitation Medicine,
Pediatrics, Emergency Medicine, Neurology,
Neurosurgery, Orthopedic Surgery
Mount Sinai Medical Center
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Our Team
▶
Emergency Medicine
▶
Neurology
▶
Neuropsychology
▶
Neurosurgery
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Orthopedic Surgery
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Pediatrics
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Rehabilitation Medicine
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The Mount Sinai Play Safe Program
provides
• Multidisciplinary care to injured athletes.
• Technical assistance & education to
families and school personnel.
(800) 283-8481
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Thank you.
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