Concussions

 in  Higher  
Education
Laine  Blankenburg
Graduate  Intern  for  Student  Disability  Services
Supervised  by  Carolyn  R.  Fallahi,  Ph.  D.
 Types  of  Brain  Injuries
• Traumatic  Brain  Injury  (TBI)-­‐ describes  head  injuries  from  external  causes.
• This  includes  open  head  injuries  (i.e.  gunshot  wounds)  and  closed  head  
injuries  (wounds  without  visible  signs).

• Acquired  Brain  Injury  –describes  head  injuries  from  internal  causes.  

• This  includes  injuries  from  anoxia,  stroke  and  neurological  diseases  like  
encephalitis.
 Concussion  Definition
• A  TBI  can  be  caused  by  a  blow,  jolt,  or  bump  to  the  head,  neck,  or  
body,  which  disrupts  the  normal  function  of  the  brain.  

• A  TBI  can  range  in  severity  from  “mild,”  which  is  a  brief  change  in  
mental  cognition  or  consciousness,  to  “severe”,  which  can  be  memory  
loss  after  the  injury  or  a  prolonged  period  of  unconsciousness.  

• The  most  common  form  of  TBI  are  mild  and  are  known  as  
concussions.
 Four  Requirements  to  Define  a  Concussion  
1. A concussion  can  occur  from  a  blunt  force  trauma  to  the  body,  
neck,  face  or  head.
2. A  concussion  is  an  impairment  in  neurological  function  that  is  
usually  short  lived,  but  some  symptoms  could  last  longer.    
3. Not  all  concussions  cause  structural  damage  that  can  be  seen  on  
neuroimaging  techniques,  yet  concussions  usually  result  in  
neurological  disruption.  
4. An  individual  does  not  have  to  lose  consciousness  to  sustain  a  
concussion.  
 Concussion  Pathophysiology
• The  initial  impact  causes  neurometabolic  changes  within  the  brain.

• The  force  of  the  impact  triggers  a  chemical  cascade  within  the  brain.

• Why  7  to  10  days  are  necessary  for  recovery.

• Second  Impact  Syndrome

 Post-­‐Concussive  Syndrome  (PCS)
• Prolonged  symptomology  although,  the  accepted  time  frame  for  
recovery  is  not  yet  scientifically  established.  
• PCS  is  influenced  by  factors  such  as  age,  sex,  and  history  of  prior  
concussions.
• Symptoms  include:  migraine  headaches,  depression,  mood  
disturbance,  chronic  pain,  vestibular  dysfunction,  visual  dysfunction,  
speech  impairment  or  some  combination  of  symptoms.  
• Approximately  10%  of  individuals  have  persistent  signs  and  symptoms  
of  concussion  beyond  2  weeks.
 Initial  Days  of  Injury
• “Shut  Down”  is  cognitive  rest.  
• The  “cornerstone”  of  concussion  management.  
• Shut  Down  includes:
• No  electronics,  minimal  visual  and  audio  stimulation,  no  
driving  
• The  more  cognitive  activity  one  engages  in,  the  longer  the  
potential  recovery  period.  
• Concussions  are  snowflakes.  
 Effects  of  Brain  Injuries
• Life  altering!
• The  condition  can  improve,  but  may  produce  permanent  disabilities.
• Damage  to  the  brain  can  disrupt  pathways  that  are  necessary  for  
recovery.
• Executive  functioning  can  be  greatly  impaired  especially  if  there  is  
frontal  lobe  damage.
• Daily  planning  and  long-­‐term  planning
• Time  management  skills
• Self  monitoring  (i.e.  money)
 Treatment
• There  is  no  set  treatment  plan  to  follow  for  concussions.  
• Pain  management  (i.e.  medications)
• Biofeedback
• Vestibular  Therapy  
• Hypnosis
• Chiropractic
• Acupuncture    
• Naturopathic
 Cognitive  Impairments
• Impaired  memory  or  retrieval  of  information*
• Impaired  comprehension
• Slow  thought  processing  
• Impulsive  decision  making  
• Reduced  attention  span
• Geographic  or  temporal  disorientation  
• Difficulty  following  a  schedule  or  sequence  
 Physical  and  Sensory  Impairments
• Chronic  pain  
• Slurred  speech  and  other  speech  impairments
• Hormonal  changes
• Fatigue  or  decreased  stamina
• Blindness  or  visual  impairments
• Hearing  loss
• Impaired  motor  skills  (delayed  reaction  times,  tremors,  etc.)
• Seizures  
• Cranial-­‐facial  injuries
 *Psychosocial  Impairments*
• Depression
• Loneliness
• Isolation
• Loss  of  self-­‐esteem  and  confidence  
• Decrease  in  liability  (inability  to  control  emotions)
• A  sense  of  disconnection  from  peers
• Inability  to  manage  stress
• Embarrassment  from  forgetting  important  information  (assignments,  
dates,  schedules,  etc.)
 How  it  Impacts  the  Learning  Process
• There  can  be  erratic  academic  performances.  
• They  can  experience  extreme  difficulty  processing  and  remembering  
complex  information.
• Previously  learned  material  may  be  forgotten  (i.e.  math  skills;  
historical  facts)
• Those  who  had  good  study  habits  prior  to  the  injury  may  have  a  
better  transition  post  injury.  
• Keep  their  personal  interest  in  mind  when  choosing  classes  or  a  
major.  
 Suggestions  for  Instructors
• Students  with  a  brain  injury  have  different  needs  than  students  with  a  
learning  disability  or  other  types  of  disabilities.
• May  need  some  extra  support  while  transitioning  back  into  the  
classroom.  
• Encourage  students  to  be  their  own  advocates  and  be  understanding  
that  it  can  be  difficult  talking  about  the  experience  at  first.  
• Don’t  minimize  the  injury.
• Be  patient!
 Types  of  Accommodations  for  Brain  Injuries
• Livescribe pen  
• Audio/Visual  Aids
• PowerPoints  prior  to  class
• Text  to  speech  programing
• Index  cards  to  prompt  memory  
• Extended  time  on  quizzes  and  exams
• Advanced  notice  for  oral  presentations
• Note  cards/sheet  for  presentations
 Resources  
• http://www.connecticutchildrens.org/our-­‐care/elite-­‐sports-­‐medicine/programs-­‐services/concussion-­‐management/
• http://www.biact.org/
• https://www.cdc.gov/traumaticbraininjury/index.html
• https://www.cdc.gov/headsup/index.html
• http://www.massgeneral.org/children/services/treatmentprograms.aspx?id=1689&display=doctors
• http://www.ncaa.org/health-­‐and-­‐safety/medical-­‐conditions/ssi-­‐task-­‐force-­‐explores-­‐issues-­‐challenges-­‐around-­‐concussions
 References
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