Chester County Medicine Summer 2018 - 12

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Mild Tramautic Brain Injury
continued from page 11
physical and mental) which does not trigger or worsen symptoms.
For example, patients may need to avoid screen time or reading
temporarily, or they may be able to return to work or school with
or without modifications to their schedules. In Pennsylvania, a
program offered by the Department of Health, the Department
of Education, and the Brain Injury Association of PA called
BrainSTEPS assists in supporting student learning needs following
an acquired brain injury. BrainSTEPS stands for Strategies Teaching
Educators, Parents, and Students and has been in place for over a
decade to ensure that students with an acquired brain injury have
the educational supports they need for success. In Chester County,
parents, teachers, school district staff, and medical or service
providers can learn more about BrainSTEPS, including how to
refer a student, through the Chester County Intermediate Unit at
https://www.cciu.org/brainsteps.

Returning Athletes to Play
A graduated return to play protocol has been developed in
order to safely allow athletes to get back to the sports they love.
The risks of resuming sports too soon are well documented, and
include second impact syndrome, post-concussive syndrome, and

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12 CHESTER COUNT Y Medicine | SUMMER 2018

dementia. Second impact syndrome is generalized brain
swelling due to a second concussion when the brain has
not fully healed from an initial concussion. Although little
data exists to clearly elucidate mechanism and risk factors,
it is prudent to allow enough time for complete healing in
order to prevent this potentially fatal complication. The basic
pathway for return to play is a gradual increase in activity
as long as the patient is asymptomatic; if a given level of
activity prompts symptoms, the patient goes back to the prior
asymptomatic level and tries again after 24 hours. Children
and adolescents, and anyone with prior TBI, appear to be
at greater risk for sequelae and therefore need a conservative
approach. The most widely used return to play protocol has 6
levels of activity separated by 24 hours each; thus the soonest
an athlete can safely return to full competition would be 5
days. Many people need weeks, and some require months
in order to ensure full recovery. The Chester County Health
Department partners with the Pennsylvania Athletic Trainers'
Society (www.gopats.org) to provide educational sessions for
the prevention and management of concussions.

Sequelae
A majority of patients recover completely from mild TBI.
However, other patients have some complications following
TBI. Post-concussion syndrome refers to a constellation
of symptoms which often begins 7-10 days after mild TBI
and resolves by one month in most people; however, signs
and symptoms may persist substantially longer. The most
common complaints are: headaches, dizziness, fatigue,
mood disturbance, insomnia, difficulty concentrating or
remembering, and sensitivity to noise. Some people have
isolated headaches, sleep disturbance, or vertigo. Mild TBI is
http://chestercms.org/index.html https://www.cciu.org/brainsteps http://www.gopats.org http://www.DVGRR.org http://www.DVGRR.org
Chester County Medicine Summer 2018

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