1. Concussion Update Wayne A. Gordon, Ph.D., ABPP Jack Nash Professor & Vice Chair Department of Rehabilitation Medicine wayne.gordon@mssm.edu 1

2. Goals Define concussion.Define concussion. Review symptoms of concussion.Review symptoms of concussion. Review prevalence of concussion in children.Review prevalence of concussion in children. 2

3. What is concussion? 3

4. Concussion is a brain injury and is defined as a complex physiological process affecting the brain.Concussion is a brain injury and is defined as a complex physiological process affecting the brain. (Consensus statement on concussion in sport: 4 th International Conference on Sport held in Zurich, November, 2012. McCory, P. et al. British Journal of Sports Medicine, 2013) 4

5. TBI is an alteration in brain function caused by an external force.TBI is an alteration in brain function caused by an external force. (Menon, et al. Arch. Phys. Med. Rehabil., 2010) 5

6. Symptoms of a concussion may appear immediately or emerge over time.Symptoms of a concussion may appear immediately or emerge over time. Learning or behavioral difficulties may not emerge until school becomes more demanding.Learning or behavioral difficulties may not emerge until school becomes more demanding. 6

7. What do we know about the prevalence of 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-concussion syndrome. -7.4 days of school missed (+/-) 13.9 days. Most common symptom reported was headache followed by fatigue, frustration, dizziness, concentration and memory difficulties.Most common symptom reported was headache followed by fatigue, frustration, dizziness, concentration and memory difficulties. (Butler et al. JAMA, Neurology, 2013) 7

8. 20% of Ontario students in grades 7-12 sustained a TBI (LOC > 5 minutes) at some point in their life.20% of Ontario students in grades 7-12 sustained a 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) 8

9. Screening of 134 kids at 12-19 in 3 NYC schools 9% high probability of TBI.9% high probability of TBI. 80% of the 9% had neuropsychological evidence of TBI.80% of the 9% had neuropsychological evidence of TBI. (Cantor, Gordon, Ashman, JHTR, 2006) 9

10. Screening of 692 1-5 graders in Nebraska 7.66% positive screen.Screening of 692 1-5 graders in Nebraska 7.66% positive screen. 25% of positive screens kids receiving Special Ed.25% of positive screens kids receiving Special Ed. (Hux, et al. Brain Injury, 2013) 10

11. A recent longitudinal cohort study found that 17% of children tracked from birth experience a TBI requiring medical attention by the age of 15.A recent longitudinal cohort study found that 17% of children tracked from birth experience a TBI 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) 11

12. Nearly 500,000 children under the age of 15 visit ERs each year reporting a TBI and an additional 35,000 are hospitalized. (Faul, et. al, CDC, 2010) 12

13. CDC estimates that about 3,000,000 children under the age of 19 sustain a concussion each year.CDC estimates that about 3,000,000 children under the age of 19 sustain a concussion each year. While most recover about 20% do not.While most recover about 20% do not. (Alexander, 1995) 13

14. Numbers are an undercount because they do not include kids who did not seek medical attention.Numbers are an undercount because they do not include kids who did not seek medical attention. Those injured when there was no adult present.Those injured when there was no adult present. Or the responsible adult may be reluctant to disclose/report the injury.Or the responsible adult may be reluctant to disclose/report the injury. (Langlois et. al, CDC, 2004) 14

15. Mount Sinai Play Safe Program Departments of Rehabilitation Medicine, Pediatrics, Emergency Medicine, Neurology, Neurosurgery, Orthopedic Surgery Mount Sinai Medical Center 15

16. Our Team ▶ Emergency Medicine ▶ Neurology ▶ Neuropsychology ▶ Neurosurgery ▶ Orthopedic Surgery ▶ Pediatrics ▶ Rehabilitation Medicine 16

17. The Mount Sinai Play Safe Program provides Multidisciplinary care to injured athletes.Multidisciplinary care to injured athletes. Technical assistance & education to families and school personnel.Technical assistance & education to families and school personnel. 17 (800) 283-8481

18. Thank you. 18