1 Concussion: Traumatic Brain Injuries

Concussion: Traumatic Brain Injuries

Written by: Mohamad Arshad Bin Rozfan Wahi

Date: 9/02/2016

Name: Mohamad Arshad Bin Rozfan Wahi

Course Code: SBI4U

Module No: Module 4

Activity No: Activity 11 (Evaluation Activity)

On behalf of Health Magazine, I am going to have an interview with an expertise in

neurological surgery and the topic that I would bring about is Concussion: Traumatic

Brain Injury. Dr. Roger Hartl and I would be discussing about the causes and

symptoms of this disorder, the methods of treatment this disorder and many more. A

concussion is a disorder that happens when a blow or an impact happens in the

head. This could cause the brain to experience shaking and the aftermath of

this disorders is where people with concussion will experience drowsiness,

difficulty in memorizing and also some might experience emotional changes. Further

details will be talked about in the interview. The followings are facts about

concussions and details about Dr. Roger Hartl.

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DR. ROGER HARTL BIOGRAPHY

Dr. Roger Hartl, M.D. is Professor of Neurological Surgery and Director

of Spinal Surgery and Neurotrauma at the Weill Cornell Brain and

Spine Centre in New York. Furthermore, he is the founder and Co-

director of the Weill Cornell Spine Centre and he works as the

neurosurgeon for the New York Giants Football Team. Dr. Hartl focuses

on simple and complex spine surgery, minimally invasive spine surgery

and computer assisted spinal navigation surgery. He is also involved in

improving neurosurgical care in developing country. Dr. Hartl received

his M.D. from the Ludwig Maximillians University in Munich, Germany.

He joined the Weill Cornell Medical College after he completed his

postdoctoral research and joined the Department of Surgery and Brain

Trauma Foundation.

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DR. ROGER HARTL ACHIEVEMENTS IN NEUROSURGERY

Dr. Hartl has been named in the lists of New York Super Doctors, America’s Top Surgeons, and

America’s Best Doctors. He has also been included on the list of New York’s Best Doctors in New

York magazine. He has wrote more than 150 scholarly articles in peer-reviewed journals and he

is also the editor of a recent book on minimally invasive spinal surgery. Dr. Hartl has also

appeared in a few television shows such as ABC, NBC and CBS where he provided commentary.

Dr. Hartl has also been interviewed by a few press companies such as the New York Times, The

New York Post, The New York Daily News and other media outlets.

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AN INTERVIEW WITH DR. ROGER HARTL REGARDING CONCUSSIONS

Writer: Hello Dr. Roger Hartl, nice to meet you! Could you please give an overview

of concussion is before we get deeper into this topic?

Dr. Roger Hartl: Hello Arshad, it’s a pleasure to meet you too. Basically, I will be

giving a brief but concise explanation regarding concussion. A concussion is a light

traumatic brain injury (TBI) that occurs after an impact that occurs in the head or

an injury in the brain which cause the brain to experience some shaking. This

sudden movement can cause the brain to experience a bounce or twist in the skull,

stretching and impairing the brain cells and generating chemical changes in the

brain. Concussions are not life-threatening but they can change the way a brain

functions and can even lead to unconsciousness. Other effects that concussions can

cause are heartaches, concentration problems, memory, balance and coordination.

Bruising, damage to the blood vessel and injury to the nerves are the effects of

concussions. Although concussions usually are caused by a blow to the head, they

can also happen when the head and upper body are strongly shaken. These injuries

can lead to a loss of consciousness, but most concussions do not. Because of this,

some people have concussions and do not realize it. Concussions are common,

particularly if we play a contact sport, such as football. This injury requires time

and rest to heal properly. Most concussive traumatic brain injuries are light, and

people usually recover fully. The Centers for Disease Control and Prevention (CDC)

estimate that in 2010 approximately 2.5 million people in the United States visited

the hospital with TBIs.

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Writer: Well, now that we have more information about concussion, what are the

potential causes that can lead to concussion and how does it happen?

Dr. Roger Hartl: Our brain has the consistency of gelatin. It is cushioned from

everyday jolts and bumps by cerebrospinal fluid inside our skull. A violent impact to

the head and neck or upper body can cause the brain to move back and forth

violently against the inner walls of the skull. Sudden acceleration or deceleration of

the head, resulting from certain events such as a car crash or being violently

shaken, also can cause brain injury. These injuries affect brain function, usually for

a short period, leading to signs and symptoms of concussion. This type of brain

injury may lead to bleeding in or around the brain, causing symptoms such as

prolonged lethargic feeling and confusion that may develop right away or later.

This is why anyone who experiences an injury in the brain needs monitoring in the

hours afterward and emergency care if symptoms worsen. Concussion also causes a

sudden disruption to part of the brain known as the reticular activating system

(RAS). The RAS is situated in the middle of the brain, and helps to monitor sense

of awareness and consciousness. It also performs filtering that allows us to ignore

unimportant information by focusing on details we need.

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Writer: How do people that experienced an injury in the head or got their

head knocked, know that they are having a concussion and what are the symptoms?

Dr. Roger Hartl: Symptoms of a concussion vary depending on both the severity of

the injury and the person injured. It is not true that a loss of consciousness always

occurs with a concussion. Some people do experience a loss of consciousness, but

others do not. The symptoms may start immediately, or they may not develop

for hours, days, weeks, or even months after the injury. The most common

symptoms of concussion are confusion, such as being unaware of the surroundings,

a delay in answering questions, or having a blank expression. Besides, headache,

dizziness, nausea, and loss of balance are also signs that people need to watch out

for after having a blow in their head because we might get a concussion.

Difficulties with memory can mean that a person is unable to remember events

that occurred before the concussion happened and this usually only affects the

minutes immediately leading up to the concussion, which is known as

retrograde amnesia. Another type is that a person is unable to remember any new

information or events after the concussion happened, which is known as

anterograde amnesia. However, both types of memory loss usually improve within a

few hours. Some symptoms of concussions may be immediate or delayed in onset by

hours or days after injury, such as concentration and memory complaints,

irritability and other personality changes, sensitivity to light and noise, sleep

disturbances, psychological adjustment problems and depression and disorders of

taste and smell.

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Writer: Suppose a person suspects that he or she is having a concussion, what are

the ways to diagnose or to detect concussion?

Dr. Roger Hartl: The person making the diagnosis will perform a thorough

physical examination to check if there are any conspicuous signs and symptoms of

a more serious brain injury, such as bleeding from the ears, while making sure

breathing is unaffected. If a person is conscious, the person will be questioned so

that his or her state of mind can be assessed. Possible questions include where are

we? What were you doing before the concussion? Can you repeat the months of the

year in reverse order? That person may be asked to try what is known as the

"finger-nose-finger" test. The person running the test will hold one of their

fingers in front of the injured person. This test is a good way of assessing what

effect the concussion has had on that person balance and co-ordination. If that

person is unconscious, as a precaution it is assumed that he or she has a serious

neck or spinal injury until proved otherwise. The person should therefore not be

moved until a specialist brace can be fitted around his or her neck and

spine to protect it. Similarly, if we see a person who is unconscious, make no

attempt to move them unless they are in immediate physical danger. In some

circumstances, further testing may be advised if there are any signs or symptoms

that suggest a more severe injury to the brain. The most widely used test for

suspected brain injury is a computerized tomography (CT) scan. However, if it is

thought a person may have damaged the bones in his or her neck, an X-ray may be

used to evaluate the damage quickly. CT scans are refrained from children under 10

where possible, but may be essential in some cases. A CT scan obtain series of X-

rays of the inside of the skull and puts them together using a computer. The image

that is created forms a cross-section of the inside of your skull and brain. A CT

scan is usually recommended in adults who have continuous difficulties in

speaking, carrying out instructions or opening their eyes, acquire signs and

symptoms that suggest the base of the skull is fractured, such as clear fluid

running from the nose or ears, or very dark blotches above and below the eyes

and have a convulsion or fit after the injury. Besides, if the person has vomited

more than once since the injury, is unable to remember events more than 30

minutes before the injury or acquire any signs of neurological problems, such

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as loss of feeling in certain parts of the body, problems with balance and walking,

and continuous changes in eyesight, they should perform a CT scan.

Figure 1: The figure above shows the advanced CT scan used in hospital for the

brain analysis. (Adapted from: Neuroimaging and Mental Illness: A Window into the

Brain. (n.d). Retrieved February 9, 2016 from:

http://www.nimh.nih.gov/health/publications/neuroimaging-and-mental-illness-a-

window-into-the-brain/index.shtml)

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Figure 2: The figure above shows the result of the brain structure and activity

from the CT scan used. (Adapted from: What is a CT scan. (n.d). Retrieved

February 9, 2016 from: http://www.wisegeek.org/what-is-a-cat-scan.htm)

10 Concussion: Traumatic Brain Injuries

Table 1: The table above shows the negative predictive values of clinical

parameters used to assess severity of head injury from the computer generated

data of CT scan. (Adapted from: West Indian med. j. vol.58 no.2 Mona Mar. 2009.

Retrieved February 9, 2016 from:

http://caribbean.scielo.org/scielo.php?script=sci_arttext&pid=S0043-

31442009000200014)

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Writer: I suppose there are treatments to treat concussion, right Dr.? So what

are the treatments and how are they carried out in order to treat concussion?

Dr. Roger Hartl: Treatment for a concussion depends on the complexity of the

symptoms. A person might need surgery or other medical procedures if she or he

has bleeding in the brain, swelling of the brain, or a severe injuries to the brain.

However, most concussions do not need surgery or any major medical treatment.

During the first 24 hours after the injury, the doctor may ask someone to wake

the person every two to three hours. This ensures that he or she has not gone into

a state of comatose and also allows someone to examine for signs of severe

confusion or abnormal behavior. If the concussion is causing headaches, the

doctor may recommend over-the-counter pain relievers such as ibuprofen (Advil) or

acetaminophen (Tylenol). The doctor will also probably ask the person to get

enough rest, avoid sports and other vigorous activities, and avoid driving a vehicle

or riding a bike for 24 hours or even few months, depending on the seriousness of

the injury. Rest is the most suitable way to enable the brain to recover from a

concussion. The doctor will recommend that the person to obtain physical and

mental rest to recover from a concussion. This means staying away from general

physical exertion, including sports or any strenuous activities, until a person has no

symptoms. This rest also includes restricting activities that involve thinking and

mental concentration, such as playing video games, watching TV, reading, texting or

using a computer. The doctor may recommend the person to have shortened school

day or workdays, take breaks during the day, or have reduced school workloads

or work assignments as he or she recovers from a concussion. As the

symptoms improve, the person may gradually add more activities that require

thinking, such as doing more schoolwork or work assignments, or increasing your

time spent at school or work. If a person or that person‘s child sustained a

concussion while playing competitive sports, ask the doctor or the child's doctor

when it is safe to return to play. Resuming sports too soon raises the risk of a

second concussion and of lasting, potentially brain injury that could lead to death.

Evidence is emerging that some people who have had multiple concussions over the

course of their lives are at greater risk of developing lasting, and even progressive,

impairment that limits their capability to function. No one should resume playing

vigorous activity while signs or symptoms of a concussion are present. Experts

recommend that adults, children and adolescents not to return to play on the same

day they received the impact.

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Figure 3: The figure above shows the Advil or ibuprofen which is used to treat

headaches as a result of brain concussion. (Adapted from: Advil Liquid Capsules.

(n.d). Retrieved February 9, 2016 from: https://advil.net.au/products/advil-liquid-

capsules.html)

Figure 4: The figure above shows the tablets of acetaminophen which is used as an

alternative to treat headaches which is caused by brain concussion. (Adapted from:

Andrei, M: Health ABC: Everything you wanted to know about acetaminophen (April,

13 Concussion: Traumatic Brain Injuries

4, 2013). Retrieved February, 9, 2016 from:

http://www.zmescience.com/other/science-abc/health-abc-acetaminophen-

040402013/)

Writer: What are the latest advancements and research in prevention and

treatment that are introduced to help in treating concussion?

Dr. Roger Hartl: In 2008, a Swedish neurosurgeon developed a new technology

called MIPS (Multi-Directional Impact Protection System). MIPS offered

something that previous helmets did not: a possibility of reducing concussions. The

helmet imitated the protective layer of cerebrospinal fluid that cushions the brain

by allowing it to move and therefore absorbs shock. Another technology is Angular

Impact Mitigation or AIM that uses a liner that floats within the helmet. Some

new liners are made with a vinyl substance that can absorb many shocks. The

Angular Impact Mitigation (AIM) is used in hockey and football helmets.

Consumers may be familiar of Xenith X2 football helmets that use shock

absorbers to "adjust to each knock at every impact level." Then, there are high

impact mouth guards like the X2 Impact model that observes a hit in real time

using a sensor system. They transmit a wireless signal to analyze how badly a player

has been injured. Finally, there is a one-size-fits-all helmet guard called a Guardian

Cap. It is an external cushion system produced to absorb helmet-to-helmet impact.

Moreover, the Ontario Brain Institute (OBI) has made many researches and has

even brought clinicians, industry, and patient advocacy groups to treat concussions.

The Ontario Brain Institute has planned to create an Ontario-wide database

where it studies acute and chronic concussion symptoms for all groups of

age. Besides, this group is also trying to search for new biomarkers, such as

things that can be seen on MRI, in order to determine the people who are risk

of suffering from concussions.

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Figure 5: The figure above shows the logo and motto of the Ontario Brain

Institute, Canada. (Adapted from: Ontario Brain Institute-Branding. (n.d).

Retrieved February, 9, 2016 from: http://www.stcstorytellers.com/tag/ontario-

brain-institute/)

Figure 6: The figure above shows the prototype of the futuristic helmet to protect

the brain maximally. (Adapted from: Futuristic Helmet Design. (n.d). Retrieved

February 9, 2016 from: www.realareal.com)

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Figure 7: The figure above shows the statistical data of number of injured players

reported for brain concussion from 2009 to 2013 in the United States of America.

(Adapted from: Breslow, J. What We’ve Learned from Two Years of Tracking NFL

Concussions. (February, 4, 2014). Retrieved February 9, 2016 from:

http://www.pbs.org/wgbh/frontline/article/what-weve-learned-from-two-years-

of-tracking-nfl-concussions/)

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WRITER: Before I end my interview, I would like to ask one more question

pertaining to concussions. How does this disorder affect the life of an individual

suffering from concussions, their family, the medical system and the society?

Dr. Roger Hartl: Concussion can affect individuals that suffer from

concussion by changing the way they behave and they would also experience

some personality changes. Some may experience an extent of neuropsychological

behavior problems and some may also forget details about their lives. A person who

recovered from concussion will also undergo some personality changes and this

person might feel frustrated, angry, or embarrassed. Some individuals might

also have a problem of concentrating on something and to an extent, some

might even lose the ability to write or read. Furthermore, due to concussion,

a person might lack emotional responses such as smiling, laughing, crying,

anger or enthusiasm. In addition, a person can experience emotional volatility

such as sudden tears, angry outbursts, or laughter. Meanwhile, the family of an

individual who suffers from concussion might find it hard to adapt to the changes

in that person. This could cause stress to arise in the family members

because sometimes they need to accept the change in behavior of an

individual. The family members must also learn to adjust with their

communication techniques, established relationships and the ability of that person

after he or she suffered from concussion. Family members should also come

with a solution to adapt to the changes in the individuals so that they can

improve the individuals functional and behavioral skills. Family members also

should be calm and patient in attending to the individuals as they are recovering

from concussion. Family members must also give supports, motivation, love and care

to help the individuals as they are trying to adapt to their changes and recover

their ability and skills in life. Moreover, the medical system has improved so much

and many researches have been made to help patients that suffer from concussion.

This disorder has also marked alteration in the medical system where a lot of

preventive measures and new treatments have been developed to treat patients

with concussion. Concussion has also changed the way society thinks about these

patients where society can now accept patients with this disorder and help them to

17 Concussion: Traumatic Brain Injuries

recover from concussion. Society has also contributed their support and help to

these patients, and awareness has risen in the society.

WRITER: Thank you very much Dr. Hartl for spending your time to talk and clarify

about this disorder, and to share your knowledge regarding this matter. I am very

pleased and honored to have this opportunity to talk to you, Dr. Hartl.

Dr. Roger Hartl: I am most welcomed by your invitation for this interview and it is

my pleasure to share and increase people’s awareness regarding this disorder.

-----------------------------------End of Interview---------------------------------------

18 Concussion: Traumatic Brain Injuries

SUMMARY OF THE INTERVIEW Based on my opinion, individuals who suffered from concussion have difficulties in

adapting to their changes in personality and behavior as they might have

emotional volatility. They will also find it hard to memorize things and there are

some memories that they might forget. This will cause them to be pressurized to

remember things and they will suffer from emotional outbreaks. They will also have

some difficulties in performing abilities such as reading and writing. They will need

some helps from their family members in performing everyday abilities and they

need some time to recover and adapt to their changes. This will restrict their

ability to perform daily activities as they need to get help from others to carry out

their activities. Thus, people with concussion must be positive in their life while

recovering from this disorder.

This disorder has affected the medical system where the medical system has

taken preventive measures and developed new treatments to cure this

disorder. A lot of research have been conducted in order to develop new

treatments and this has changed the medical system. The society is also affected

by this disorder where the society has learned more about this disorder and knows

how to deal with individuals that suffer from concussion. Society has also accepted

individuals with this disorder where they have given more care and support to

these individuals. The society has also grown more care towards these individuals

by doing charity and building foundations that help in treatments of concussion.

The foundations also raise money to aid in the research of this disorder.

Based on the research made and information that I have obtained, I think it would

be better if we focus on the future research to cure the disorder. This is because

people cannot predict when they would suffer from concussion or how should they

avoid from getting a blow in their heads. Sometimes, a person can accidentally

knock their head and suffers from concussion without realizing it in the first place.

Therefore, it is crucial to focus on the future research where more treatments

can be developed to improve the state or condition of these patients and to cure

this disorder. Moreover, this researches could improve the state of the patients

where they might recover faster and can obtain their abilities in a short period.

Hence, researchers and society should invest more on the future research so that

this disorder can be improved.

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FACTS ABOUT BRAIN CONCUSSION THAT WILL MAKE YOU STAY CURIOUS

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21 Concussion: Traumatic Brain Injuries

Reference for content:

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http://www.braininstitute.ca/sites/default/files/concussion_brainnovation_final.pdf

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http://www.webmd.com/brain/concussion-traumatic-brain-injury-symptoms-

causestreatments?page=1#3

Weill Cornell Brain and Spine Centre. (n.d.). Roger Hartl, M.D. Retrieved February 9,

2016 from: http://weillcornellbrainandspine.org/faculty/roger-h%C3%A4rtl-md

Reference for image:

Figure 1: Neuroimaging and Mental Illness: A Window into the Brain. (n.d). Retrieved

February 9, 2016 from: http://www.nimh.nih.gov/health/publications/neuroimaging-

and-mental-illness-a-window-into-the-brain/index.shtml

22 Concussion: Traumatic Brain Injuries

Figure 2: What is a CT scan. (n.d). Retrieved February 9, 2016 from:

http://www.wisegeek.org/what-is-a-cat-scan.htm

Figure 3: Advil Liquid Capsules. (n.d). Retrieved February 9, 2016 from:

https://advil.net.au/products/advil-liquid-capsules.html

Figure 4: Andrei, M: Health ABC: Everything you wanted to know about acetaminophen

(April, 4, 2013). Retrieved February, 9, 2016 from:

http://www.zmescience.com/other/science-abc/health-abc-acetaminophen-

040402013/

Figure 5: Ontario Brain Institute-Branding. (n.d) Retrieved February, 9, 2016 from:

http://www.stcstorytellers.com/tag/ontario-brain-institute/

Figure 6: Futuristic Helmet Design. (n.d). Retrieved February 9, 2016 from:

www.realareal.com

Figure 7: Breslow, J. What we’ve learned from Two Years of Tracking NFL Concussions.

(February, 4, 2014). Retrieved February 9, 2016 from:

http://www.pbs.org/wgbh/frontline/article/what-weve-learned-from-two-years-of-

tracking-nfl-concussions/

Reference for table:

Table 1: West Indian med. j. vol.58 no.2 Mona Mar. 2009. Retrieved February 9, 2016

from: http://caribbean.scielo.org/scielo.php?script=sci_arttext&pid=S0043-

31442009000200014