Concussion UpdateConcussion Update

Wayne A. Gordon, Ph.D., ABPPWayne A. Gordon, Ph.D., ABPPJack Nash Professor & Vice ChairJack Nash Professor & Vice Chair

Department of Rehabilitation MedicineDepartment of Rehabilitation Medicinewayne.gordon@mssm.eduwayne.gordon@mssm.edu

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GoalsGoals

• Define concussion.Define concussion.

• Review symptoms of concussion.Review symptoms of concussion.

• Review prevalence of concussion in Review prevalence of concussion in

children.children.

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What is concussion?What is concussion?

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• Concussion is a brain injury and is Concussion is a brain injury and is

defined as a complex physiological defined as a complex physiological

process affecting the brain.process affecting the brain.

(Consensus statement on concussion in sport: 4(Consensus statement on concussion in sport: 4thth

International Conference on Sport held in Zurich, International Conference on Sport held in Zurich,

November, 2012. McCory, P. et al. British Journal of November, 2012. McCory, P. et al. British Journal of

Sports Medicine, 2013)Sports Medicine, 2013)

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• TBI is an alteration in brain function TBI is an alteration in brain function

caused by an external force. caused by an external force.

(Menon, et al. Arch. Phys. Med. Rehabil., 2010)(Menon, et al. Arch. Phys. Med. Rehabil., 2010)

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• Symptoms of a concussion may appear Symptoms of a concussion may appear immediately or emerge over time.immediately or emerge over time.

• Learning or behavioral difficulties may not Learning or behavioral difficulties may not emerge until school becomes more emerge until school becomes more demanding.demanding.

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What do we know about the prevalence of What do we know about the prevalence of concussion in children?concussion in children?

• 3 month follow up of 406 children seen in the ED3 month follow up of 406 children seen in the ED

-- At 3 months post-injury 29% had post-At 3 months post-injury 29% had post-

concussion concussion syndrome.syndrome.

-- 7.4 days of school missed (+/-) 13.9 days.7.4 days of school missed (+/-) 13.9 days.

• Most common symptom reported was headache Most common symptom reported was headache

followed by fatigue, frustration, dizziness, followed by fatigue, frustration, dizziness,

concentration and memory difficulties.concentration and memory difficulties.

(Butler et al. JAMA, Neurology, 2013)(Butler et al. JAMA, Neurology, 2013)

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• 20% of Ontario students in grades 7-12 sustained a 20% of Ontario students in grades 7-12 sustained a

TBI (LOC > 5 minutes) at some point in their life.TBI (LOC > 5 minutes) at some point in their life.

• 5.6% sustained a TBI last year.5.6% sustained a TBI last year.

(Ilie, et al JAMA, 2013)(Ilie, et al JAMA, 2013)

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Screening of 134 kids at 12-19 in 3 NYC Screening of 134 kids at 12-19 in 3 NYC schoolsschools

• 9% high probability of TBI.9% high probability of TBI.

• 80% of the 9% had neuropsychological evidence of 80% of the 9% had neuropsychological evidence of

TBI.TBI.

(Cantor, Gordon, Ashman, JHTR, 2006)(Cantor, Gordon, Ashman, JHTR, 2006)

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• Screening of 692 1-5 graders in Nebraska 7.66% Screening of 692 1-5 graders in Nebraska 7.66%

positive screen.positive screen.

• 25% of positive screens kids receiving Special Ed.25% of positive screens kids receiving Special Ed.

(Hux, et al. Brain Injury, 2013)(Hux, et al. Brain Injury, 2013)

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• A recent longitudinal cohort study found that 17% A recent longitudinal cohort study found that 17%

of children tracked from birth experience a TBI of children tracked from birth experience a TBI

requiring medical attention by the age of 15.requiring medical attention by the age of 15.

• Of these 29% had a second injury.Of these 29% had a second injury.

• 23% of those with two had three.23% of those with two had three.

• 33% of those with three had four or more.33% of those with three had four or more.

(McKinlay, et. al, 2008)(McKinlay, et. al, 2008)

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Nearly 500,000 children under the age of 15 Nearly 500,000 children under the age of 15

visit ERs each year reporting a TBI and an visit ERs each year reporting a TBI and an

additional 35,000 are hospitalized. additional 35,000 are hospitalized.

(Faul, et. al, CDC, 2010)(Faul, et. al, CDC, 2010)

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• CDC estimates that about 3,000,000 CDC estimates that about 3,000,000

children under the age of 19 sustain a children under the age of 19 sustain a

concussion each year.concussion each year.

• While most recover about 20% do not.While most recover about 20% do not.

(Alexander, 1995)(Alexander, 1995)

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• Numbers are an undercount because they Numbers are an undercount because they

do not include kids who did not seek medical do not include kids who did not seek medical

attention.attention.

• Those injured when there was no adult Those injured when there was no adult

present.present.

• Or the responsible adult may be reluctant to Or the responsible adult may be reluctant to

disclose/report the injury.disclose/report the injury.

(Langlois et. al, CDC, 2004)(Langlois et. al, CDC, 2004)

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Mount SinaiMount SinaiPlay Safe ProgramPlay Safe ProgramDepartments of Rehabilitation Medicine, Departments of Rehabilitation Medicine,

Pediatrics, Emergency Medicine, Neurology, Pediatrics, Emergency Medicine, Neurology,

Neurosurgery, Orthopedic SurgeryNeurosurgery, Orthopedic Surgery

Mount Sinai Medical Center Mount Sinai Medical Center

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Our TeamOur Team

▶ Emergency MedicineEmergency Medicine

▶ NeurologyNeurology

▶ NeuropsychologyNeuropsychology

▶ NeurosurgeryNeurosurgery

▶ Orthopedic SurgeryOrthopedic Surgery

▶ PediatricsPediatrics

▶ Rehabilitation MedicineRehabilitation Medicine

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The Mount Sinai Play Safe Program The Mount Sinai Play Safe Program providesprovides

• Multidisciplinary care to injured athletes.Multidisciplinary care to injured athletes.

• Technical assistance & education to Technical assistance & education to

families and school personnel.families and school personnel.

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(800) 283-8481(800) 283-8481

Thank you.Thank you.

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