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CDC Provides Free Concussion "Tool Kit" to Those Involved in Youth Sports

Concussions are caused when the brain is jostled inside the head and normal function is disrupted.  Among other symptoms, affected individuals may feel sick or disoriented or may lose consciousness.  Depending on the severity of the impact and the constitution of the affected individual, concussions can be fatal absent proper treatment.  By now the majority of the general public is probably aware that with participation in competitive sports comes the risk of concussion.  That risk is only magnified when we are talking about younger athletes.  Moreover, recognizing a concussion in a youth athlete is not a simple task.  A concussion need not be accompanied by an open wound, nor does it require a particularly violent collision.  Fortunately, more and more high school coaches and athletic trainers are being educated to the warning signs of a concussion.  To that end, the CDC has recently released a free concussion “tool kit” for use by athletic coaches, trainers, parents, and even participants.  The “tool kit” explains the symptoms one might expect to see from a concussed person.  Above all, the “tool kit” advocates common sense caution.  A concussed athlete cannot be allowed back on to a field of competition without being cleared by a medical professional.  The old adage of “walk it off” simply does not apply where a concussion is suspected.   We need look no further than our local high schools and youth leagues for tragic examples of what happens when the dangers presented by even minor concussions are not fully appreciated.

New Emergency Room Diagnosis Guidelines for Mild Traumatic Brain Injury

The American College of Emergency Room Physicians (ACEP) in collaboration with the Centers for Disease Control and Prevention (CDC) revised the clinical diagnosis guidelines for mild traumatic brain injury (MTBI).  These guidelines are designed to improve patient outcomes for the more than one million people who visit emergency departments every year for mild traumatic brain injury.

"People with traumatic brain injuries may appear to be normal and their symptoms may be mild, but there can be hidden dangers," said Richard C. Hunt, MD, Director of the Division of Injury Response at the Centers for Disease Control and Prevention.  "TBI's can also lead to significant, life-long impairments that prevent a person's ability to function both physically and mentally.  These revised guidelines can help ensure that patients with even mild TBI's are identified early and receive the care they need."

The real incidence of traumatic brain injury (TBI) is unknown since many patients who sustain an injury never seek medical care. The majority of these injuries are classified as mild, meaning the patient is alert, oriented and functional when they are assessed in the emergency department. It is estimated that 10 percent of patients with a mild TBI have evidence of an intracranial injury on head computed tomography (CT), and that approximately one percent of patients with mild TBI harbor a life-threatening neurosurgical lesion. The challenge for the emergency physician is to identify which patients with a head injury have an acute traumatic intracranial injury, and which patients can be safely sent home.

ACEP and CDC recogize in the revised guidelines that MTBI results from direct trauma to the head or from an acceleration/deceleration stress to the brain, and that MTBI poses a risk for short-term difficulties with symptoms such as headache, difficulty with balance, thinking, concentrating and sleeping. Up to 80 percent of patients report some symptoms related to the injury at three months. If MTBI results in long-term problems, it is often referred to as post-concussive syndrome.

For more information on traumatic brain injury (TBI), visit CDC on the Web at: www.cdc.gov/Injury.

Cognitive Rehabilitation Helps People With Acquired Brain Injury

Researchers at the University of South Alabama and the University of North Carolina at Charlotte analyzed and updated the data found in systematic reviews of several hundred studies of cognitive rehabilitation. The researchers took those studies whose samples and methods were most amenable to rigorous statistical techniques and documented the extent to which various treatments improve the language, attention, memory and other cognitive problems that appear after acquired brain injury.

The meta-analysis examined 97 articles, comprising 115 studied treatment samples and 45 control samples. These samples collectively included 2,014 individuals who underwent cognitive rehabilitation after brain injury and 870 individuals in a variety of control conditions. The authors of the initial reviews had concluded there was enough evidence to generally support the use of a variety of rehabilitative treatments. To develop specific treatment guidelines, this new analysis documented the extent to which treatment type and timing, origin of the injury, recovery level, and participant age affected the odds of success.

Given the patterns they found, the authors offered initial treatment guidelines:

• Generally, it is better to start treating patients as early as possible, rather than waiting for a more complete neurological recovery.
• Even older patients (age 55 and up) may benefit from cognitive rehabilitation, particularly if the brain injury is due to stroke.
• Clinicians should focus their efforts on direct cognitive skills training in specific cognitive domains (such as attention or visuospatial processing). More holistic, non-targeted interventions appear to be less effective.

Especially if they were treated soon after the event, language training helped older people after stroke with aphasia, problems producing and/or comprehending language. However, language training was still effective, just not as much, when it started more than a year after the stroke.

Attention training helped people with acquired brain injury and seemed to work best with younger patients less than a year after injury. It was the most specific treatment, improving nothing but attention.

Visuospatial training helped stroke patients with visuospatial neglect, the inability to respond or orient to something shown on the side opposite to the site of the injury. Visuospatial training also tended to improve performance in other cognitive domains.

Memory treatment did not produce clear results. Nor did comprehensive treatments that attempted to treat cognitive problems holistically.

The authors also found that patients treated less than a year after injury did better than those treated more than a year later.

Think Twice About Holding Your Cell Phone to Your Ear

The lead researchers believe that the findings indicate that microwave radiation from cell phones can affect the so-called blood-brain barrier. This is a barrier that protects the brain by preventing substances circulating in the blood from penetrating into the brain tissue and damaging nerve cells.  The bottom line is the rats in the experiments suffered brain damage  from the microwave radiation, and the brain damage caused memory problems.

The research team also found certain nerve damage in the form of damaged nerve cells in the cerebral cortex and in the hippocampus, the memory center of the brain.  Moreover, they have discovered alterations in the activity of a large number of genes, not in individual genes but in groups that are functionally related.

Henrietta Nittby, one of the researchers, has cell phone herself, but never holds it to her ear, using hands-free equipment instead.

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