{"product_id":"coping-with-concussion-and-mild-traumatic-brain-injury-isbn-9781583334768","title":"Coping with Concussion and Mild Traumatic Brain Injury","description":"\u003cb\u003eA comprehensive guide for improving memory, focus, and quality of life in the aftermath of a concussion. \u003c\/b\u003e\u003cbr\u003e \u003cbr\u003eOften presenting itself after a head trauma, concussion— or mild traumatic brain injury (mTBI)— can cause chronic migraines, depression, memory, and sleep problems that can last for years, referred to as post concussion syndrome (PCS).\u003cbr\u003e \u003cbr\u003eNeuropsychologist and concussion survivor Dr. Diane Roberts Stoler is the authority on all aspects of the recovery process. \u003ci\u003eCoping with Concussion and Mild Traumatic Brain Injury \u003c\/i\u003eis a lifeline for patients, parents, and other caregivers. | Diane Roberts Stoler, Ed.D., is a neuropsychologist and a practicing board-certified health and sports psychologist. She is a sought-after international speaker and lives in Massachusetts. Barbara Albers Hill is the author or coauthor of six previous books. | \u003cb\u003ePART 1\u003cbr\u003eCONCUSSION\/MILD TRAUMATIC BRAIN INJURY: AN OVERVIEW\u003cbr\u003e\u003cbr\u003eINTRODUCTION\u003c\/b\u003e\u003cp\u003eLynn, a 26-year-old dental hygienist, was driving to work one morning when her car was rear-ended at a red light. The fifteen-mile-per-hour impact caused no damage to either vehicle, and the seat belt kept Lynn’s body in place. Only her head moved, quickly snapping forward and back. Lynn felt momentarily disoriented, but the feeling passed, and she went on her way without giving the matter much thought.\u003c\/p\u003e\u003cp\u003eBy lunchtime, Lynn had a severe headache. By evening, she also felt nauseated and extremely tired. At first, Lynn suspected a virus. But as the days passed, her headaches escalated and her fatigue increased. She also began to have problems sleeping, concentrating, expressing herself, and making decisions. To others, Lynn seemed uncharacteristically short-tempered and forgetful, and this led the puzzled young woman to see her physician. The eventual diagnosis? A concussion, also referred to as a mild traumatic brain injury(mTBI), a result of the now months-ago incident at the traffic light.\u003c\/p\u003e\u003cp\u003e• • •\u003c\/p\u003e\u003cp\u003eLYNN’S STORY is not at all unusual. In fact, each year millions of people worldwide are seen in hospitals, suffering from concussions. Many more visit doctors’ offices and walk-in clinics, or may not even report the event, which is why concussion has come to be called “the Silent Epidemic.” The principal causes of TBI are falls, motor vehicle accidents, blows, assaults, sports injuries, blast injuries, and violent movements such as whiplash. Like Lynn, a significant number of those who incur a concussion suffer debilitating aftereffects—post concussion syndrome (PCS)—for months or years afterward despite what is usually a perfectly normal outward appearance. Part 1 of this book will help you better understand this phenomenon by providing a detailed look at the brain and brain function as well as the causes, significance, and evaluation of concussion.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eCHAPTER 1\u003cbr\u003eWHAT IS A CONCUSSION\/MILD TRAUMATIC BRAIN INJURY?\u003c\/b\u003e\u003cbr\u003e \u003c\/p\u003e\u003cp\u003eIn the course of everyday life, you have little reason to think about the workings of your brain, even with television ads and magazine articles presenting the relationships between eating, sleeping, and brain health. However, if you have suffered a concussion, also calledmild traumatic brain injury (mTBI), or know someone who has, the subject takes on sudden importance. As with almost any injury, knowledge about the affected organ—the brain, in this case—will help you and your family to better understand your symptoms and maintain a sense of control over the recovery process.\u003c\/p\u003e\u003cp\u003eIt is likely that you’ve attempted an Internet search for answers to your questions about your injury, symptoms, and treatment, only to feel overwhelmed by the quantity of information available. If so, you have probably wondered where you can find information that is accurate and leads to the answers you need. This book is intended to provide just that: the most recent research, verified by experts and presented in a concise, easy-to-use format.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eA LOOK AT THE BRAIN\u003c\/b\u003e\u003c\/p\u003e\u003cp\u003eThe human brain weighs about three pounds and is the most complex of organs—an intricate network of some 200 billion nerve cells and a trillion supporting cells. It is nourished by a vast network of blood vessels that supply the oxygen and glucose needed to fuel the brain. Your diet, quality of sleep, degree of stress, hormonal factors, and general quality of life directly affect your brain function, impacting all bodily activity from heart rate and movement to emotion and learning. The brain’s complex components include veins, arteries, capillaries, threadlike nerve fibers, connective networks, neurotransmitters, neuromodulators, and hormones, which are involuntarily reactive to both internal and external events. Only a small portion of the brain operates in a voluntary, responsive manner; thus, brain function determines a person’s abilities, personality, and state of health, all the while creating a capacity for thinking, feeling, imagining, and planning.\u003c\/p\u003e\u003cp\u003eWhile the human skull is hard and bony, the brain within has been likened to custard in a bowl—soft, pliable, and slippery (Figure 1.1). Directly beneath the skull are three thin membranes called meninges that hold pockets of air and about a coffee-cupful of cerebrospinal fluid (CSF), which cushion the brain and its circulatory network.\u003c\/p\u003e\u003cp\u003eFigure 1.1. A cross-section of the brain.\u003c\/p\u003e\u003cp\u003eThis network, composed of arteries and veins (Figure 1.2), nourishes the brain, with each heartbeat providing oxygen and important nutrients as fuel. The countless small branches off the arteries and veins are called capillaries (Figure 1.3).\u003c\/p\u003e\u003cp\u003eFigure 1.2. The brain and its arteries.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eFigure 1.3. The brain and its veins and capillaries.\u003c\/b\u003e\u003c\/p\u003e\u003cp\u003eDirectly beneath the meninges is the brain’s wrinkled gray and white matter, made up of four distinct areas of brain functioning. These include the brain stem, midbrain, limbic system, and cerebral cortex. Of the four areas, the frontal area of the cerebral cortex is the most voluntary (responsive) to internal and external events.\u003c\/p\u003e\u003cp\u003eThe cerebral cortex, sometimes called the cerebrum, is the top layer of the brain and is its largest and most advanced part. It controls problem-solving, planning, and judgment, as well as movement and sensory activity. This area is divided into two halves, or hemispheres—the left and the right. One curious fact about brain function is that the right hemisphere, or the right side of the brain, controls the left side of the body, while the left hemisphere controls the right side of the body. In addition, the right hemisphere governs aspects of creativity, intuition, and nonverbal communication—gestures, facial expressions, and the like—and is referred to as the nonlinear mind. The left hemisphere, called the linear mind, is responsible for logical thinking, mathematics, and verbal and written expression.\u003c\/p\u003e\u003cp\u003eBoth of the hemispheres are subdivided into parts called lobes, each of which controls specific body functions (Figure 1.4). The frontal lobe, located closest to the forehead, controls emotions and behaviors, social and motor skills, abstract thinking, reasoning, planning, judgment, and memory. Broca’s area, situated at the base of the frontal lobe, helps to govern speech. This area of the brain, especially the prefrontal area, is the area that governs voluntary responsiveness. It is similar to a symphony conductor, instructing areas of the brain that are voluntary and reactive.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eFigure 1.4.\u003c\/b\u003e A look at the cerebrum.\u003c\/p\u003e\u003cp\u003eThe parietal lobe is located halfway between the front and back of the skull. This area is responsible for sensory and spatial awareness, giving feedback from and understanding of eye, hand, and arm movements during complex operations such as reading, writing, and numerical calculations. At the center of the parietal lobe is the angular gyrus, a fold in the surface of the brain where visual messages, such as words that are read, are matched with the sounds of spoken words. At the back of the head, behind the parietal lobe, is the occipital lobe, which controls vision and recognition.\u003c\/p\u003e\u003cp\u003eThe temporal lobe is located beneath the frontal and parietal lobes and has an influence on emotions. The temporal lobe plays a part in smelling, tasting, remembering information, noticing things, comprehending music, and categorizing objects. It also plays a role in aggressiveness and sexual behavior. At the back of the left temporal lobe is Wernicke’s area, which is responsible for hearing and interpreting language.\u003c\/p\u003e\u003cp\u003eBeneath the cerebrum are a number of internal brain structures (Figure 1.5). The thalamus acts as a nerve-impulse relay station for information coming into the brain, passing it to the cerebrum to be prioritized and transmitted throughout the body. The hypothalamus is located beneath the thalamus and influences sex drive, sleep, long-term memory, and the expression of emotion perceived by the brain, passing information to the pituitary gland that helps regulate and stabilize various hormones in your body—part of your neuroendocrine system.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eFigure 1.5.\u003c\/b\u003e The inner structures of the brain.\u003c\/p\u003e\u003cp\u003eThe limbic system and components such as the amygdala are the source of involuntary survival reactions to perceived danger. Other components include the endocrine and autonomic nervous systems, which reactively control your breathing, heart rate, and digestive and intestinal systems (Figure 1.6). The limbic system is the link between the cerebral cortex, midbrain, and brain stem. Its components help the hypothalamus prioritize incoming information and also play a vital part in controlling memory, pain, and emotions.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eFigure 1.6.\u003c\/b\u003e The limbic system.\u003c\/p\u003e\u003cp\u003eAt the central rear of the brain is the brain stem, which contains the midbrain, the pons, and the medulla oblongata. These structures control breathing and heartbeat and serve as a relay station for all motion and sensation. The cerebellum, a part of the brain situated in a cupped position slightly above the brain stem, oversees movement and balance, while the hippocampus, centrally located next to the temporal lobe near the base of the brain, is a key area in the creation of new memories and the transition of short-term memory to long-term.\u003c\/p\u003e\u003cp\u003eEach part of the brain is highly specialized and is able to do its job only because of a vast network of nerve connections through the white matter (Figure 1.7), which includes specific neurotransmitters, neuromodulators (chemical messengers), and neuroconnective hubs (electrical connectors) for clearly defined tasks, functions, and processing.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eFigure 1.7.\u003c\/b\u003e The white matter.\u003c\/p\u003e\u003cp\u003eIt is the electrical system of the brain that allows communication between the various parts of the brain. The brain contains over 100 billion neurons, or nerve cells. Each neuron consists of a cell body and conducting fibers called branches (Figure 1.8), similar to the vast network of roads that enable us to travel from one place to another. These branches can be as short as a fraction of an inch or as long as several feet and connect to a trillion other branches through specific hubs. As a comparison, consider a dirt road that leads to a cul de sac, or a superhighway that can take us across the country. The electrical impulse travels toward the end of a nerve fiber, also called the axon. Between the ends or along the sides of each branch are tiny gaps called synapses (Figure 1.9). Most synapses are at the end of a nerve, though there are additional types (Figure 1.10).\u003c\/p\u003e\u003cp\u003e\u003cb\u003eFigure 1.8.\u003c\/b\u003e The neurons and branches.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eFigure 1.9.\u003c\/b\u003e A synapse.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eFigure 1.10.\u003c\/b\u003e Additional types of synapses.\u003c\/p\u003e\u003cp\u003eWhen working properly, a neuron transmits electrical impulses to adjacent nerve cells at speeds of up to several hundred miles an hour. The electrical signal that is formed pulses at differing rates of speed, creating a push\/pull effect similar to the ebb and flow of the ocean. These electrical signals are called brain waves, and their speed is measured in electrical units called hertz (Hz). In 1940, W. Gray Walter was the first to identify that different brain waves have different effects on how we function. Table 1.3 shows different brain waves, their frequencies, and what they do. Individual brain waves work together as a team to send signals to different parts of the body, operating much as your car does when all the wheels are in alignment.\u003c\/p\u003e\u003cp\u003eThe synapses play a critical role in how the brain enables us to function, similar to the activity at a busy toll plaza. The brain’s nerves are not in direct contact with one another, and the synapse between each nerve regulates functioning through a burst of chemicals called neurotransmitters (Table 1.1) and neuromodulators (Table 1.2), each of which has a specific task. Neurotransmitters are similar to traffic lights that signal electrical impulses to stop (inhibit) or go (activate), controlling whether the impulses continue. Neuromodulators are similar to police officers controlling traffic at busy intersections, overseeing a gradual flow of traffic in all directions.\u003c\/p\u003e \u003cp\u003eNeurotransmitters are chemicals that allow the movement of information across the synapse, or gap, between one neuron and an adjacent neuron. A neurotransmitter functions similarly to a traffic light, or a driver putting a foot on either the accelerator or the brake in a car.\u003c\/p\u003e\u003cp\u003eNEUROTRANSMITTER\u003c\/p\u003e\u003cp\u003eBEHAVIOR\u003c\/p\u003e\u003cp\u003ePURPOSE\u003c\/p\u003e\u003cp\u003eGlutamate\u003c\/p\u003e\u003cp\u003eThis chemical acts like a green light or a car’s accelerator, telling the system to go. It permits the electrical signal and its purpose to communicate to the next nerve. Glutamate is called the excitatory neurotransmitter and . . .\u003c\/p\u003e\u003cp\u003eIs involved in most aspects of normal brain function including cognition, memory, and learning\u003c\/p\u003e\u003cp\u003eMediates a good deal of information, including that which regulates brain development and that which determines cellular survival\u003c\/p\u003e\u003cp\u003eGamma-Aminobutyric Acid (GABA)\u003c\/p\u003e\u003cp\u003eThis chemical acts like a red light or a car’s brakes, telling the system to stop. It stops the electrical signal from continuing to the next nerve. GABA is called the inhibitory neurotransmitter and . . .\u003c\/p\u003e\u003cp\u003eContributes to motor control, vision, and many other cortical functions\u003c\/p\u003e\u003cp\u003eRegulates anxiety\u003c\/p\u003e\u003cp\u003eHelps stimulate relaxation and sleep\u003c\/p\u003e\u003cp\u003eStabilizes the brain by preventing overexcitement\u003c\/p\u003e \u003cp\u003eNeuromodulators are chemicals that do not directly activate or inhibit; rather, they are similar to the police officer who regulates and coordinates traffic flow. Neuromodulators work together with neurotransmitters, enhancing the excitatory (“go,” or “go with caution”) or inhibitory (“stop,” or “slow down”) responses of the receptors. Each of the neuromodulators has specific functions, as seen below.\u003c\/p\u003e\u003cp\u003eNEUROMODULATOR\u003c\/p\u003e\u003cp\u003eFUNCTION\u003c\/p\u003e\u003cp\u003eDopamine\u003c\/p\u003e\u003cp\u003eRegulates and limits cortical and subcortical signals to the brain\u003c\/p\u003e\u003cp\u003eCan either activate or inhibit\u003c\/p\u003e\u003cp\u003eControls arousal levels in many parts of the brain\u003c\/p\u003e\u003cp\u003eIs vital to the provision of physical motivation\u003c\/p\u003e\u003cp\u003eGoverns internal control of sustained attention\u003c\/p\u003e\u003cp\u003eModulates attention to sensory input\u003c\/p\u003e\u003cp\u003eSerotonin\u003c\/p\u003e\u003cp\u003eActs as a feel-good chemical\u003c\/p\u003e\u003cp\u003eInfluences sustained arousal and electrical impulses in the brain, and controls the feeling of well-being\u003c\/p\u003e\u003cp\u003eHas multiple roles regarding sleep, temperature regulation, sexual behavior, appetite, learning, memory, anxiety, mood, and endocrine, muscular, and cardiovascular function\u003c\/p\u003e\u003cp\u003eImpacts the regulation of one’s pain threshold\u003c\/p\u003e\u003cp\u003eIs not connected to sensory input\u003c\/p\u003e\u003cp\u003eAcetylcholine\u003c\/p\u003e\u003cp\u003eActivates motor neurons that control skeletal muscles\u003c\/p\u003e\u003cp\u003eControls activity in the brain area connected with attention, learning, and memory\u003c\/p\u003e\u003cp\u003eIs involved in central nervous system responses, including wakefulness, attentiveness, anger, aggression, sexuality, and thirst\u003c\/p\u003e\u003cp\u003eHistamine\u003c\/p\u003e\u003cp\u003eHelps regulate and modulate the activation of electrical signals\u003c\/p\u003e\u003cp\u003eIs involved in the body’s inflammatory response\u003c\/p\u003e\u003cp\u003eNoradrenaline (also called norepinephrine):\u003c\/p\u003e\u003cp\u003eHelps regulate and modulate the activation of electrical signals\u003c\/p\u003e\u003cp\u003eIs active in the startle response\u003c\/p\u003e\u003cp\u003eEnhances emotional memory\u003c\/p\u003e\u003cp\u003eContributes to the modulation of mood and arousal\u003c\/p\u003e\u003cp\u003eIs critical to attentiveness, emotions, sleep, dreaming, and learning\u003c\/p\u003e\u003cp\u003eIs released as a hormone into the blood, where it causes contraction of blood vessels and increased heart rate\u003c\/p\u003e\u003cp\u003eAspartate\u003c\/p\u003e\u003cp\u003eHelps regulate and modulate the activation of electrical signals\u003c\/p\u003e\u003cp\u003eRegulates the metabolism of amino acids for kidney and central nervous system function\u003c\/p\u003e\u003cp\u003eGlycine\u003c\/p\u003e\u003cp\u003eHelps regulate and modulate the inhibiting of electrical signals\u003c\/p\u003e\u003cp\u003eHelps regulate the central nervous system, especially the brain stem\u003c\/p\u003e\u003cp\u003eThese electrical impulses combine with the chemicals to connect one branch to another, forming vast networks of neurons in the brain’s white matter. These networks meet at specific hubs to enable particular brain functions. For example, there is a hub for attention, and another for memory (Figure 1.11).\u003c\/p\u003e\u003cp\u003e\u003cb\u003eFigure 1.11.\u003c\/b\u003e White matter with various hubs.\u003c\/p\u003e\u003cp\u003eMany factors influence the push-and-pull activity of brain waves, including the aforementioned blood flow, quality of the nerve fiber, and impact of neurotransmitters, neuromodulators, and hormones. In 1929, Hans Berger first identified and named Alpha and Beta waves, while E. D. Andria and Brian Matthew named Delta and Theta waves in 1930. Since then, many others have identified additional waves seen below. Figure 1.12 illustrates a brain wave and shows its height and cycle duration. The height is the quantity of the wave being produced, or the amplitude. The duration reflects the time the cycle takes to repeat itself. The wave’s frequency, or number of cycles per second, is the inverse of the duration of one cycle in units of hertz.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eFigure 1.12.\u003c\/b\u003e A brain wave.\u003c\/p\u003e\u003cp\u003eThe brain and body systems are also strongly affected by hormones, chemicals that are released from cells and glands. These effects include:\u003c\/p\u003e\u003cul\u003e\n\u003cli\u003eStimulation or inhibition of growth\u003c\/li\u003e\n\u003cli\u003eMood swings\u003c\/li\u003e\n\u003cli\u003eSleep\u003c\/li\u003e\n\u003cli\u003eInduction or suppression of apoptosis, or programmed cell death\u003c\/li\u003e\n\u003cli\u003eActivation or inhibition of the immune system\u003c\/li\u003e\n\u003cli\u003eRegulation of metabolism\u003c\/li\u003e\n\u003cli\u003ePreparation of the body for mating, fighting, fleeing, and other responsive activity\u003c\/li\u003e\n\u003cli\u003ePreparation of the body for a new life phase, such as puberty, parenting, and menopause\u003c\/li\u003e\n\u003cli\u003eControl of the reproductive cycle\u003c\/li\u003e\n\u003cli\u003eHunger cravings\u003c\/li\u003e\n\u003cli\u003eSexual arousal\u003c\/li\u003e\n\u003c\/ul\u003e \u003cp\u003eBRAIN WAVE\u003c\/p\u003e\u003cp\u003eEFFECTS ON BRAIN FUNCTION\u003c\/p\u003e\u003cp\u003eDelta (0.5 to 4 Hz)\u003c\/p\u003e\u003cp\u003eAre predominant during sleep\u003c\/p\u003e\u003cp\u003eShould be low while awake\u003c\/p\u003e\u003cp\u003eRepair the brain\u003c\/p\u003e\u003cp\u003eServe as emotional radar\u003c\/p\u003e\u003cp\u003eAre responsible for intuition and unconscious thought\u003c\/p\u003e\u003cp\u003eIn abundance, can interfere with emotional or cognitive processing\u003c\/p\u003e\u003cp\u003eTheta (4 to 8 Hz)\u003c\/p\u003e\u003cp\u003ePresent during pre-sleep or trance state\u003c\/p\u003e\u003cp\u003ePromote insight and meditation\u003c\/p\u003e\u003cp\u003eIn abundance, can create inattentiveness, distractibility, and lack of focus\u003c\/p\u003e\u003cp\u003eAlpha (8 to 12 Hz)\u003c\/p\u003e\u003cp\u003ePromote relaxation\u003c\/p\u003e\u003cp\u003eServe as gateway for restorative sleep\u003c\/p\u003e\u003cp\u003eIn abundance, can make you spacey, unmotivated, inattentive, and depressed\u003c\/p\u003e\u003cp\u003eSMR (12 to 15 Hz)\u003c\/p\u003e\u003cp\u003eAre related to calm external attention\u003c\/p\u003e\u003cp\u003eRegulate impulsivity and hyperactivity\u003c\/p\u003e\u003cp\u003ePromote body awareness\u003c\/p\u003e\u003cp\u003eHelp control anxiety and anger\u003c\/p\u003e\u003cp\u003ePromote the inhibition of movement\u003c\/p\u003e\u003cp\u003eBeta (15 to 20 Hz)\u003c\/p\u003e\u003cp\u003eAre related to active external attention\u003c\/p\u003e\u003cp\u003eEnhance cognitive processing\u003c\/p\u003e\u003cp\u003eImprove concentration, attentiveness, and focus\u003c\/p\u003e\u003cp\u003eHigh Beta (20 to 36 Hz)\u003c\/p\u003e\u003cp\u003eAre related to body tension\u003c\/p\u003e\u003cp\u003ePromote a high state of arousal\u003c\/p\u003e\u003cp\u003eResult in excitement, anxiety, and stress\u003c\/p\u003e\u003cp\u003eRelated to post traumatic stress disorder (PTSD)\u003c\/p\u003e\u003cp\u003eGamma (36 to 64 Hz)\u003c\/p\u003e\u003cp\u003eAre linked to intellectual comprehension\u003c\/p\u003e\u003cp\u003eAre related to creativity\u003c\/p\u003e\u003cp\u003ePromote integrative thinking\u003c\/p\u003e\u003cp\u003eFor instance, melatonin is a chemical that helps you sleep at night. If your electrical system is working properly, it sends a message for this chemical to be released when it is dark and you are fatigued, thereby helping you sleep. As expected, there is ebb and flow present. If the electrical impulse can’t reach the cell or the melatonin can’t reach the proper area, the system doesn’t work properly and sleep patterns are disturbed.\u003c\/p\u003e\u003cp\u003eNow that you know how the brain functions under normal circumstances, we can look at what happens when a concussion causes dysregulation in the brain. Whether structural damage to the brain’s gray or white matter is apparent or not, the aftermath of a brain injury results in dysregulation in the function of the lobes, hormones, neurotransmitters, neuromodulators, or hub activity. This dysregulation is the underlying cause of the problems seen in post concussion syndrome (PCS) in areas such as mood, behavior, sleep, fatigue, or intellect. The following chapters explore the various causes of concussion and how the resulting dysregulation of the brain is diagnosed. In addition, information is provided on approaches to treating the symptoms of PCS.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eCHAPTER 2\u003cbr\u003eSYMPTOMS OF CONCUSSION\/MILD TRAUMATIC BRAIN INJURY\u003c\/b\u003e\u003cbr\u003e \u003c\/p\u003e\u003cp\u003eAs mentioned earlier, injury to the brain from an outside force is called a traumatic brain injury, or TBI. Most people who experience severe brain trauma display language, motor, or perceptual problems that can be traced to a particular incident or event that caused a specific type of brain damage. Mild traumatic brain injury (mTBI), also called concussion, is characterized by a loss of consciousness ranging from negligible up to an hour in length, along with a loss of memory of events before and\/or after the time of injury. Concussion can occur from a variety of causes. Automobile accidents account for the majority of cases, followed by, in order of prevalence, falls, assaults and other violence (including physical abuse), sports- and recreation-related accidents, and blast injury. The last three causes weren’t linked to TBI for years; thus, diagnosis and treatment have been almost completely overlooked until recently. Now it is clear that even a small dysregulation of the brain can have an enormous effect on one’s life.\u003c\/p\u003e\u003cp\u003eSome people suffer no ill effects at all following a concussion, while others encounter persistent problems and feel the effects of their injury in every aspect of life. In addition to suffering from head or neck pain, many people feel disoriented and experience memory loss immediately after the blow. These complaints often resolve within a few minutes, but over the next several hours it is common to experience an onset of dizziness, nausea, headache, and fatigue. Depending on the number of concussions experienced by an individual and the location of the brain injury, symptoms are frequently misdiagnosed or missed altogether.\u003c\/p\u003e\u003cp\u003eHowever, a week or two later, as the person attempts to resume normal responsibilities at home, school, or work, he or she may encounter another group of symptoms that have collectively come to be called post concussion syndrome (PCS). These complaints include persistent headaches; fatigue; impaired attention, concentration, and decision-making ability; sleep disturbances; dizziness; gait imbalance; loss of taste and smell; loss of sex drive; intolerance for alcohol; reading and communication difficulties; and emotional or behavioral problems. These symptoms may appear alone or in any combination. A concise list of common concussion aftereffects is presented in Table 2.1.\u003c\/p\u003e\u003cp\u003eIn 2009, the International Symposium on Concussion changed its labels of simple and complex concussion to acute concussion andpost concussion syndrome. Despite the change in terms, the core features of these conditions remain the same.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eACUTE CONCUSSION\u003c\/b\u003e\u003c\/p\u003e\u003cp\u003eAn acute concussion is a temporary disruption of brain function that results in an alteration or loss of consciousness, and one or more of the memory symptoms contained in Table 2.1. Acute concussions spontaneously resolve within a week or two with rest and proper diet. This occurs due to spontaneous healing, a re-regulation of brain and nerve tissue, or the formation of new nerve-cell pathways that bypass damaged circuits (which characterizes the brain’s neuroplasticity, or ability to change itself). With this type of concussion, symptoms can be treated by your primary care physician (PCP) or by a certified athletic trainer or coach working in conjunction with your PCP.\u003c\/p\u003e\u003cp\u003e\u003cb\u003ePOST CONCUSSION SYNDROME (PCS)\u003c\/b\u003e\u003c\/p\u003e\u003cp\u003eWhen concussion symptoms do not resolve within a week or two of disrupted brain function, the label post concussion syndrome (PCS) is applied. Along with the various symptoms contained in Table 2.1, PCS can also include convulsions. With this type of condition, it is important to be seen by a neurologist who has expertise in treating concussion.\u003c\/p\u003e \u003cp\u003ePHYSICAL DIFFICULTIES\u003c\/p\u003e\u003cp\u003eFatigue\u003c\/p\u003e\u003cp\u003eSleep disturbances\u003c\/p\u003e\u003cp\u003eSensitivity to light and\/or sound\u003c\/p\u003e\u003cp\u003eHeadaches\u003c\/p\u003e\u003cp\u003eFalling asleep unexpectedly\u003c\/p\u003e\u003cp\u003eDizziness\u003c\/p\u003e\u003cp\u003eNightmares or flashbacks\u003c\/p\u003e\u003cp\u003eNausea and vomiting\u003c\/p\u003e\u003cp\u003eAlertness upon waking, followed by exhaustion\u003c\/p\u003e\u003cp\u003eBlurred vision\u003c\/p\u003e\u003cp\u003eHand or leg tremors\u003c\/p\u003e\u003cp\u003eSexual dysfunction or loss of sex drive\u003c\/p\u003e\u003cp\u003eGait imbalance\u003c\/p\u003e\u003cp\u003eRinging in the ears\u003c\/p\u003e\u003cp\u003eLoss of taste and smell\u003c\/p\u003e\u003cp\u003eCOGNITIVE (THINKING) PROBLEMS\u003c\/p\u003e\u003cp\u003eDistractibility\u003c\/p\u003e\u003cp\u003eDisorientation\u003c\/p\u003e\u003cp\u003eTemporary amnesia\u003c\/p\u003e\u003cp\u003eLong- or short-term memory problems\u003c\/p\u003e\u003cp\u003ePoor judgment\u003c\/p\u003e\u003cp\u003eSlow thinking\u003c\/p\u003e\u003cp\u003eInability to focus attention\u003c\/p\u003e\u003cp\u003eProblems with speaking\u003c\/p\u003e\u003cp\u003eWord-finding problems\u003c\/p\u003e\u003cp\u003eFeelings of confusion\u003c\/p\u003e\u003cp\u003eEMOTIONAL DIFFICULTIES\u003c\/p\u003e\u003cp\u003eDepression\u003c\/p\u003e\u003cp\u003eAgitation\u003c\/p\u003e\u003cp\u003eApathy\u003c\/p\u003e\u003cp\u003eIrritability\u003c\/p\u003e\u003cp\u003eFear of “going crazy”\u003c\/p\u003e\u003cp\u003eFrustration or anger\u003c\/p\u003e\u003cp\u003eGuilt or shame\u003c\/p\u003e\u003cp\u003eFeelings of helplessness\u003c\/p\u003e\u003cp\u003eAnxiety\u003c\/p\u003e\u003cp\u003eFrequent mood changes\u003c\/p\u003e\u003cp\u003eBEHAVIORAL PROBLEMS\u003c\/p\u003e\u003cp\u003eConfrontational demeanor\u003c\/p\u003e\u003cp\u003eExplosive temper\u003c\/p\u003e\u003cp\u003eFearfulness\u003c\/p\u003e\u003cp\u003eImpatience\u003c\/p\u003e\u003cp\u003eThoughtlessness\u003c\/p\u003e\u003cp\u003eHypervigilance\u003c\/p\u003e\u003cp\u003e\u003cb\u003eMULTIPLE CONCUSSIONS\u003c\/b\u003e\u003c\/p\u003e\u003cp\u003eWhen an individual has had multiple concussions due to repeated impact to the brain, natural and spontaneous healing and regulation are unlikely. This phenomenon affects nearly 90 percent of people who experience a concussion. Repeated brain injuries, including multiple concussions, can have severe or even fatal outcomes, especially when the second injury occurs soon after the first and before recovery from the first has taken place.\u003c\/p\u003e\u003cp\u003eEach repeated injury causes further dysregulation and exponential exacerbation of symptoms. This means that each injury is not simply an additional injury, as in 1 concussion + 1 concussion = 2 concussions. Instead, each injury is a multiple of the others. Thus, the effects of a third concussion are many times worse than those of the original concussion. That is why a slight blow to the head months after an initial injury can result in more, more severe, and longer-lasting symptoms than accompanied the first concussion.\u003c\/p\u003e\u003cp\u003eMultiple concussions can result from many causes that may seem subtle or incapable of injuring the brain. Multiple concussions are divided into two categories: second impact syndrome and chronic traumatic encephalopathy.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eSECOND IMPACT SYNDROME (SIS)\u003c\/b\u003e\u003c\/p\u003e\u003cp\u003eSecond impact syndrome, or SIS, has been reported when a second concussion occurs within hours, days, or weeks of a previous brain injury. This happens frequently in sports and recreation participation, when a player suffers a concussion and resumes physical activity days later, only to receive another such injury. Yet many players, parents, and coaches have long felt that a concussion need not restrict continued involvement in a sport. Fortunately, this belief has changed with better understanding of brain injury’s long-term consequences, such as chronic headaches, fatigue, and difficulty concentrating.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eCHRONIC TRAUMATIC ENCEPHALOPATHY (CTE)\u003c\/b\u003e\u003c\/p\u003e\u003cp\u003eChronic traumatic encephalopathy, or CTE, is a progressive neurodegenerative brain disease that appears to be caused by brain trauma (Figure 2.1). CTE evolves slowly over decades. Research has shown that the protein tau, necessary to the integrity of nerve fibers, gradually falls apart and destroys both the white and gray matter of the brain. There are three stages of CTE:\u003c\/p\u003e\u003cp\u003eStage 1. Includes changes in mood, behavior, and cognition. An individual may become moody, angry, or combative, while his or her thinking doesn’t seem to make sense.\u003c\/p\u003e\u003cp\u003eStage 2. Includes problems with maintaining social activity, erratic behavior, and memory loss, as well as symptoms of Parkinson’s disease that include a mask-like look to the face and movement problems.\u003c\/p\u003e\u003cp\u003eStage 3. Characterized by progressive deterioration into dementia.\u003c\/p\u003e\u003cp\u003eCTE is most prevalent in boxers and football players who have suffered repeated blows to the head over an extended time period. CTE is also seen in individuals who served in the military. An in-depth explanation of sports, recreational, and blast injuries will be presented in Chapter 4.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eFigure 2.1.\u003c\/b\u003e A look at CTE.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eADDITIONAL SYMPTOMS\u003c\/b\u003e\u003c\/p\u003e\u003cp\u003eThe various physical, emotional, and behavioral symptoms that can follow a concussion are likely to be compounded by social and psychological factors. Because post concussion problems are often invisible to the casual observer, the injured person often hears such comments as “You look wonderful!” or “Thank goodness it was only a concussion!” or even “It’s great that you’re already back in the swing of things!” Of course, the person isn’t feeling wonderful at all and is painfully aware of not functioning as he or she used to. This causes many people with a concussion to feel anxiety and a loss of confidence, both of which can reveal themselves in out-of-character behavior such as self-involvement and extreme vulnerability to stress. Worse still is the fact that by the time concussion consequences begin to disrupt an individual’s life, he or she may not even connect the symptoms to the accident that caused them. It is no wonder, then, that after weeks of seeing little or no improvement in their symptoms, many people with a concussion find themselves facing another roadblock: persistent depression and underlying grief from the loss of self.\u003c\/p\u003e\u003cp\u003ePerhaps the greatest impact of concussion is psychological. An unexpected, unexplained inability to function can shake you to the core. Consider the insurance agent who suddenly struggles to remember clients’ names and navigate the office complex, or the student who can no longer stay focused on class work and note-taking, or the mechanic who can no longer reassemble an engine. None of these people look any different from before, but all are having difficulty at work or school and are quite likely also struggling to cope with everyday chores and concerns at home. Many people with PCS begin to second-guess their every move in an attempt to avoid failure and embarrassment. This sort of anxiety can easily initiate a vicious cycle, building to such proportions that it actually contributes to cognitive problems, which in turn make the anxiety worse, and so on. It is reassuring to know that there are methods of treatment that can help you recover from your symptoms.\u003c\/p\u003e\u003cp\u003e\u003cb\u003eCHAPTER 3\u003cbr\u003eTYPES OF CONCUSSION\/MILD TRAUMATIC BRAIN INJURY\u003c\/b\u003e\u003cbr\u003e \u003c\/p\u003e\u003cp\u003eThere are two types of traumatic brain injury: injury accompanied by visible external damage, and injury without visible evidence. In what was formerly called an open head injury, the skull is penetrated. Brain damage takes the form of a focal injury—that is, injury to a specific area of the brain—such as that from a gunshot wound or severe external trauma that causes the brain to swell. In a concussion without visible evidence, once called a closed head injury, the skull is not penetrated. Brain damage occurs as a result of an external force that causes the brain to move within the skull, producing\u003c\/p\u003e","brand":"Avery","offers":[{"title":"Default Title","offer_id":48338541707493,"sku":"NP9781583334768","price":24.0,"currency_code":"USD","in_stock":false}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/1842\/7735\/files\/9781583334768.jpg?v=1769572605","url":"https:\/\/k12savings.com\/products\/coping-with-concussion-and-mild-traumatic-brain-injury-isbn-9781583334768","provider":"K12savings","version":"1.0","type":"link"}