Many parents who bring children to the ED following a possible concussion are likely to expect comprehensive and definitive care, including imaging, a definitive diagnosis, a timeline for return to activity, and a signed return to play form. To manage these expectations, healthcare providers should continue to educate parents about the evaluation and management of concussion.
Post-traumatic headache “is an important health problem with a significant impact on long-term outcome of TBI patients. Several risk factors were identified, which can aid in early identification of subjects at risk for PTH.”
“In a preliminary study of middle school, high school, and collegiate student-athletes, SES [“socioeconomic status”] had no impact on the outcomes of symptom duration and missed practice. However, for individuals with private insurance, the return to school was slower than for those with public insurance. This pilot study reveals the complex relationship between SES and SRC [“sports-related concussion”] recovery, which demands further study with more accurate and validated assessments of SES.”
“The literature on clinical recovery from sport-related concussion has grown dramatically, is mostly mixed, but some factors have emerged as being related to outcome.”
“This systematic review recommends that in children: child and adolescent age specific paradigms should be applied; child-validated symptom rating scales should be used; the widespread routine use of baseline computerised neuropsychological tests (CNT) is not recommended; the expected duration of symptoms associated with sports-related concussion (SRC) is less than 4 weeks; prolonged recovery be defined as symptomatic for greater than 4 weeks; a brief period of cognitive and physical rest should be followed with gradual symptom-limited physical and cognitive activity; all schools be encouraged to have a concussion policy and should offer appropriate academic accommodations and support to students recovering from SRC; and children and adolescents should not return to sport (RTSp) until they have successfully returned to school, however early introduction of symptom-limited physical activity is appropriate”.
“Progress has been made to prevent motor-vehicle crashes, resulting in a decrease in the number of Traumatic Brain Injury (TBI)-related hospitalizations and deaths from 2007 to 2013. However, during the same time, the number and rate of older adult fall-related TBIs have increased substantially. Although considerable public interest has focused on sports-related concussion in youth, the findings in this report suggest that TBIs attributable to older adult falls, many of which result in hospitalization and death, should receive public health attention.”
“Many students do not receive return to learn (RTL) services upon return to academics following a concussion. Washington State [in the US] children have unmet needs upon returning to public schools after concussion. The student-centered RTL model and checklist for implementing RTL guidelines can help schools provide timely RTL services following concussion.”
The results of this study suggest that early follow-up of at risk patients can have a positive influence on patients’ well-being, and that low-intensive, low-cost telephone counseling is more effective than a psychological intervention at improving outcomes.
Among adolescent athletes, a high initial symptom burden (e.g. headache, nausea, vomiting) increases the odds of symptoms continuing beyond 28 days following injury.
“Predictors of outcomes after inpatient rehabilitation differed by sex, providing evidence for a sex-specific approach in planning and resource allocation for inpatient rehabilitation services for patients with TBI.”
“Our empirical data confirm that SBS [“Shaken Baby Syndrome”] and AHT [“Abusive Head Trauma”] are still generally accepted by physicians who frequently encounter suspected child abuse cases, and are considered likely sources of subdural hematoma, severe retinal hemorrhages, and coma or death in young children. Other than a high-velocity motor vehicle collision, no alternative theories of causation for these findings are generally accepted.”
“For the 5-15% of patients with mild traumatic brain injury (mTBI) who will have lingering physical, behavioral, or cognitive problems 3 to 6 months after their injury, identification of this at-risk population is essential for early intervention. Existing models used to predict poor outcomes after mTBI are unsatisfactory, according to a new study, and new, more relevant predictive factors are different than those used in cases of moderate or severe TBI, as described in the study published in Journal of Neurotrauma, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers.”
A research thesis on Traumatic Brain Injury entitled, “Traumatic Brain Injury Rehabilitation and Compensation: Survivors’ Perspectives.”
“The Queensland Brain Institute (QBI) aims to discover the fundamental mechanisms regulating brain function in health and disease, in particular understanding the brain circuitry underlying function.” At QBI, Dr Fatima Nasrallah’s research group studies brain injury.
“The Brain Foundation is a nationally registered charity dedicated to funding world-class research Australia-wide into neurological disorders, brain disease and brain injuries.”
“The National Trauma Research Institute (NTRI) conducts research into the care of injured people. The NTRI Forum is a three-year project that aims to improve the care of brain, spinal cord, or other major traumatic injuries. The Forum is authored by Dr Loretta Piccenna, and is supported by the Alfred Hospital, and Monash University.”
Brain Injury Australia provides links below to several Forum items (“Dialogues”) we think are relevant to brain injury:
Traumatic Brain Injury Cognitive Rehabilitation
This Forum provides evidence-based recommendations for Cognitive [thinking] Rehabilitation following Traumatic Brain Injury (TBI). Download Dialogue Summary.
Developing a Research Program to Address Behaviours of Concern Following Traumatic Brain Injury
This NTRI Forum offers a research program to address behaviours of concern that arise from TBI, such as aggression, agitation, sexual inappropriateness and lack of initiation. Download Dialogue Summary.
Discharge Planning Following Acquired Brain Injury
This NTRI Forum focuses on developing an individualised plan for a patient with a brain injury prior to leaving hospital for home (discharge planning). Download Dialogue Summary.
Outcomes of Acquired Brain Injury Rehabilitation
This NTRI Forum identifies key outcomes for brain injury rehabilitation, and provides ideas for developing a minimum dataset of brain injury rehabilitation outcomes for Victoria. Download Dialogue Summary.
Optimising Support for Informal Carers of the Long-Term Disabled to Enhance Resilience and Sustainability
This NTRI Forum offers strategies to informal carers that can help them to care for people with long-term disabilities. Download Dialogue Summary.
Management of Spasticity Following Traumatic Brain Injury
This NTRI Forum aims to provide a set of best-practices for treating and managing spasticity following TBI. Download Dialogue Summary.
Optimising Return-to-Work Practices Following Catastrophic Injury
This NTRI Forum provides return-to-work practices following traumatic brain and spinal cord injury, and identifies some of the factors that can help or hinder these practices. Download Dialogue Summary.
Optimising Self-Managed Funding for People with a Long Term Disability
This NTRI Forum describes the factors which influence self-directed funding by people with a long-term disability. Download Dialogue Summary.
Management of Post-Traumatic Epilepsy
This NTRI Forum provides information on post-traumatic epilepsy in people following traumatic brain injury. Download Dialogue Summary.
“The aim of the Monash-Epworth Rehabilitation Research Centre is to conduct ethical, innovative and internationally competitive research investigating outcomes and the effectiveness of intervention programs for individuals with brain injury or other injury sustained as a result of trauma, with the ultimate aim of maximising their functional, psychological and social outcomes.”
The Australasian Society for the Study of Brain Impairment (ASSBI) is “dedicated to improving the quality of life of people with brain impairment and their families.” ASSBI’s research activities include, enabling “all disciplines who work with people with brain impairment to meet, learn and discuss the latest clinical research initiatives in a scholarly environment,” and publishing scholarly research in ASSBI’s journal “Brain Impairment.”
“The Evidence-Based Review of Moderate To Severe Acquired Brain Injury (ERABI) is a joint project to develop an evidence-based review of the literature for rehabilitation or rehabilitation-related interventions for acquired brain injury (ABI). The principle of the ERABI is to improve the quality of ABI rehabilitation by synthesizing the current literature into a utilizable format and laying the foundation for effective knowledge transfer to improve programs and services.”
“Our internationally recognized experts are the most experienced in Western New York for treating patients with sports-related concussion, traumatic brain injuries and various concussion symptoms through the development of research, care, baseline testing, treatment and a safe return-to-activity program that fits the individual.” Professor Barry S Willer, Director of Research at the University at Buffalo Concussion Management Clinic, has presented on concussion at Brain Injury Australia events.
“The first of its kind when it opened its doors in 2000, the University of Pittsburg Medicine Center Sports Medicine Concussion Program is a global leader in testing, treating, and researching sports-related concussions.”
Psychological Database for Brain Impairment Treatment Efficacy (PsycBITE) is a “database that catalogues studies of cognitive, behavioural and other treatments for psychological problems and issues that occur as a result of acquired brain impairment.” PsycBITE rates these studies for their scientific quality.