Long-Term Management of TBI in Adolescents

Matt Silvis, MD, (Hershey) presented Nov. 3 at the PAFP Foundation’s Lancaster CME Conference on the Long-Term Management of TBI in Adolescents. Below are the tweets from that lecture. Heads up: the Winter issue of Keystone Physician magazine will include a Tip Sheet from Dr. Silvis’ lecture and the lecture will be archived as a CME webcast (free patient safety CME!).

Most info comes from sports med but the principles of tx and eval are the same
TBI used to a “silent epidemic” but recog/ID of TBI is much greater now
Cheerleading has the highest rates for TBI injury but any high-contact sport or activity puts kids at risk
Rates of TBI in women’s sports activities are relatively close to those for football
re: SCAT2: tailor TBI memory questions to sports because some folks really don’t know the name of the U.S. president
Assess balance in the clinic – both legs, arms out – if the pt can’t balance on both legs, there’s a problem
Amnesia with TBI as a component indicates a longer recovery. You can deflate pt concern by telling them they’ll never regain that memory
Inappropriate emotions - be attentive to the depression and anxiety that can accompany TBI
Grading a concussion as mild or severe is something that occurs in retrospect – in terms of pt communication, they either have a concussion or not
ImPACT test for TBI. Increasingly used tool so don’t be surprised to have a kid show up in your office and ask for help interpreting the test and to be cleared for play
There’s a training aspect to ImPACT b/c you typically don’t learn about it in residency. But the longer you use it, the easier to interpret it becomes
ImPACT for TBI isn’t perfect. Kids cheat, get distracted while testing (separate boys and girls, seriously), get anxious
Need to walk a fine line with “cocoon” TBI therapy. Avoid overstimulation but not be overly restrictive with adolescents
Complicated recovery is likely among recurrent concussion TBI
Kids will concuss with less and less impact with recurrent concussion TBI
Syndrome = symptomatic after 6 weeks
There is no randomized research for TBI med tx. Dr. Silvis uses a lot of Aleve during the 4 wks b/c it’s easier for kids (bfast and supper, nothing to take during school)
Dr. Silvis finds that Melatonin helps with teenage concussion patients’ sleep hygiene
It’s more important to get kids back to school than back to play. Advocate for accommodations if your school doesn’t have a protocol.
If your practice can’t provide a lot of post-concussive academic support, BrainSTEPS provides ed support during recovery. Especially impt for nonathletes
Dr. Silvis: PT can really help with balance. Kids love to go to PT after TBI b/c it helps them participate in their recovery
Memory disorders are likely after recurrent concussion
Kids take longer to get better but they’re not little adults
Equipment helps but does not make a kid concussion-proof. They need to be instructed to not lead with their heads.
Family docs can help instruct coaches and gym teaches understand
Look at websites before you send kids there b/c too much online TBI info is outdated. CDC site has good info.