Concussion

SPORTS INJURY RELATED TO
LONG-TERM EFFECTS
ON MENTAL STATUS
Natalee Bommer
Tracy Geiselman
Stephanie Hawkins
Brianna Triplett
ABSTRACT
Current
nursing research explores

how concussions can lead to longterm changes in mental status
Focus on
Diagnosed traumatic brain injuries (TBIs)
Changes in behavior
Psychological changes
Development of chronic traumatic
encephalopathy
ABSTRACT
Recent
research into nursing

assessment tools for concussions and
traumatic brain injury
Assessment techniques and tools
Adequate use and documentation
Pinpoint specific signs and symptoms
ABSTRACT
Identify
recent strides of research
Identify
gaps which could be

improved
Desire
for improved outcomes and

assessments
SUSCEPTIBILITY
Assumed
children and adolescents were less

susceptible to concussion than adults
More force needed to injure a young brain
Generally more plasticity
Untrue
youth sports players are more

susceptible to head injuries that can lead to
chronic mental illness (Norton, Feltz, Brocker,
and Granitto, 2013)
HEAD INJURIES
Term
that can be associated with

several types of injuries
Important
to define specific types
CONCUSSION
A
traumatically induced transient

disturbance of brain function and
involves a complex pathophysiological
process (British Journal of Sports
Medicine, p. 15)
Can
be used interchangeably with

minor traumatic brain injury (mTBI),
or just traumatic brain injury (TBI)
TRAUMATIC BRAIN
INJURY (TBI)
An
injury that results from a forceful

jolt to the head causing the brain to
collide with the skull (Norton et al.,
2013)
SPORTS
Mostly
happens during sports where

contact and injury is applauded such
as:
Football
Boxing
Effect
of injury may not be readily

recognized
Especially in less physical sports
WHEN TBIs OCCUR

May
or may not be signs or symptoms

of neurological injury
Patient
may or may not lose

consciousness
May
report feeling fine after a few

minutes
Information
is subjective
WHEN TBIs OCCUR

Repeated
TBIs can cause neurological
deficit
Brain
injury may or may not show

immediately on brain scans
ASSESSMENT
Professionally
assessed by skilled
professional
Baseline
assessment is cornerstone of
nursing care
Needs
follow up assessment with

medical professional
ASSESSMENT
Important
to have a standard for

assessment skills related to acute
TBIs
Nurses
use the nursing process as

the framework for assessment,
prevention and education (Norton et
al., 2013)
RESEARCH &
ASSESSMENT NEEDS
Need
to determine if there is research

proving the seriousness of chronic
mental illness related to repeat TBIs
Also
a need to identify what

assessment tools are available for use
in order to recognize and document
acute injury
CONCUSSION
SYMPTOMS
Memory
problems
Vertigo
Dizziness
Headaches
Most commonly reported
THE HEADACHE ELECTRONIC

DIARY FOR CHILDREN WITH
CONCUSSIONS
Article
written by a team of nurses
Explores
Created
a new assessment tool

an electronic diary
ELECTRONIC DIARY
The
prototype
Uses
iPad technology
Headache
Electronic Diary for

Children With Concussion (HED-CC)
(Pasek, Locasto, Reichard, Sumrok,
Johnson, & Kontos, 2015)
HED-CC
While
neurocognitive testing is
imperative to managing postconcussion symptoms (eg, difficulty
with concentration, feeling slow)
during recovery and return to play,
clinicians must realize that self-report
remains criterion standard for pain
assessment (Pasek et al., pg. 87)
HED-CC
Assessment
tool that could track

post-concussion symptoms accurately
and in real time
Offers calendar view of

When symptoms started
Their progression
Possible regression of symptoms
HED-CC LIMITATIONS
We
assumed that the participants

provided thorough responses to the
interview questions about their headache
pain and honest feedback. Twice during
interviewing, two sets of parents
commented that they could feel their
childs frustration with searching for words.
During these times, the parents tried to
help their child articulate thoughts (Pasek
et al., 2015)
HED-CC CHILD
RESPONSES
This
is pretty cool actually. It would

help doctors understand their
patients lots of kids are getting
concussions these days (Pasek et al.,
pg. 86)
When
I come to the doctor, I report

how I feel now, not over the past days
or months. This requires less talking.
You could come to your appointment
HED-CC PARENT
OPINIONS
This
supports these stages the

doctor gave me (referring to a
stepwise return to play standard of
care). Its not totally up to me now
(Pasek et al., pg. 86)
When
I come in here (clinic), I cant

remember anything about her
headache, when she went to school,
whole days or half days due the
RESEARCH GAP
The
HED-CC [the prototype] did not

adequately handle time and
headache trending, nor did it provide
for the correlation of headache with
activities of daily living. Further
reliability testing will be conducted
with a larger sample of children to
establish clinical application benefits
(Pasek et al., 2015)
STATISTICS
1.7
million Americans report TBIs

yearly (Kimbler, Murphy, &
Dhandapani, 2013)
Most
common among 0-4 years of

age and 15-19 years (Kimbler,
Murphy, & Dhandapani, 2013)
Concussion
cases among 14-19 years

of age requiring emergency treatment
INCREASE IN
CONCUSSIONS AND
TBIs
Federal
government push for

increased physical activity
Increased
number of competitive
sports programs
Popularity
of professional contact
sports
Increases
participation in combative
TBIs
Not
to be taken lightly
Symptoms
can seem mild, leading to

complacency among youth athletes,
parents, and coaches
Can
lead to a second brain injury,

compounding previous damage, but
permanent damage that could have
been prevented with early diagnosis
RETIRED NFL PLAYERS

Prime
candidates for the study of the

long-term effects of contact sportrelated TBIs
Reported
symptoms of
neuropsychiatric disorders including
Increased aggression
Erratic behavior
Suicidal thoughts
Suicidal actions
MILD TRAUMATIC
BRAIN INJURY (mTBI)
COMMITTEE
Formed
in 1994 by the NFL

Study long-term effects of of
concussion in professional football
players
Lead to
Redesign of NFL helmets
Mouthpieces
Ban on helmet-to-helmet contact
(Kimbler, Murphy, & Dhandapani, 2013)
CHRONIC TRAUMATIC
ENCEPHALOPATHY (CTE)
Repetitive
TBIs over the course of

years, may result in CTE
Progressive
degenerative brain
disease
Study
of post-mortem brain tissue

donated by former NFL and NHL
athletes found CTE in over a dozen
retired athletes
FURTHER RESEARCH
Adolescent
athletes are not exempt

from the type of combative contact
that can occur during game-play in
competitive sports
Need
for life-long study of TBI is

critical and relevant
Accurate
and skilled assessment is

important
CONCLUSION
Relationship
does exist between

repeated TBIs and long-term effects
on mental status
Usually
Can
sports-related
be prevented with proper head

protection and non-biased, on field
assessment
CONCLUSION
Effects
of TBIs are usually chronic and

can happen insidiously
Not
always accurate to rely on

subjective data provided by
concussed patient
Lack of sufficient data useful for patient
care if worsening situation or additional

head injury
CONCLUSION
Headache
Electronic Diary for

Children with Concussion (HED-CC)
Track childrens cognitive symptoms over
time
Extremely useful assessment tool
Could possibly fill the gap between data
collection and contribute to finding more
specific precipitating factors of mental
health issues in patients with TBIs
CONCLUSION
There
has been more, although still

insufficient, research into improved
tools for post-concussion assessment
Post-concussion
assessment tools are
necessary
If
post-concussion assessment
becomes more accurate, better
treatment can be provided, leading to
CONCLUSSION
The
best prevention for increased

long-term effects of sports-injury
related to TBIs is not only proper head
protection but improved nursing
assessments, better tools for those
assessments, and further research of
post-TBI patients over the life span
REFERENCES
Harmon,
K.G., Drenzer, J.A.,

Gammons, M., Guskiewicz, K.M.,
Halstead, M., Herring, S.A., Roberts,
W.O. (2013). American medical
society for sports medicine position
statement: Concussion in sport.
British Journal of Sports Medicine, 47
(1), 15. Retrieved from
http://search.proquest.com/docview/1
239853894?accountid=29141

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SPORTS INJURY RELATED TO

nursing research explores

research into nursing

recent strides of research

gaps which could be

for improved outcomes and

children and adolescents were less

youth sports players are more

that can be associated with

to define specific types

traumatically induced transient

be used interchangeably with

injury that results from a forceful

happens during sports where

of injury may not be readily

WHEN TBIs OCCUR

or may not be signs or symptoms

may or may not lose

report feeling fine after a few

WHEN TBIs OCCUR

TBIs can cause neurological

injury may or may not show

follow up assessment with

to have a standard for

use the nursing process as

to determine if there is research

a need to identify what

THE HEADACHE ELECTRONIC

written by a team of nurses

a new assessment tool

Electronic Diary for

tool that could track

Offers calendar view of

assumed that the participants

is pretty cool actually. It would

I come to the doctor, I report

supports these stages the

I come in here (clinic), I cant

HED-CC [the prototype] did not

million Americans report TBIs

common among 0-4 years of

cases among 14-19 years

government push for

can seem mild, leading to

lead to a second brain injury,

RETIRED NFL PLAYERS

candidates for the study of the

in 1994 by the NFL

(Kimbler, Murphy, & Dhandapani, 2013)

TBIs over the course of

of post-mortem brain tissue

athletes are not exempt

for life-long study of TBI is

and skilled assessment is

does exist between

be prevented with proper head

of TBIs are usually chronic and

always accurate to rely on

care if worsening situation or additional