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3. Standards for post-concussion care from diagnosis to the interdisciplinary concussion clinic

Standards for post-concussion care from diagnosis to the interdisciplinary concussion clinic 1 June 8, 2017 STANDARDS FOR POST- CONCUSSION CARE from diagnosis to the interdisciplinary concussion clinic ONF Standards for Post- Concussion Care 2 This report is submitted by the following: The Concussion Advisory Subcommittee of the Ontario Neurotrauma Foundation: Diana Velikonja, PhD, CPsych (Chair) - Hamilton Health Sciences & McMaster University Tara Baldisera, MD, CCFP - Sudbury Family Health (...) Organization, Health Sciences North, Northern Ontario School of Medicine Shannon Bauman, MD, CCFP, Dip. Sports Med - Concussion North, Royal Victoria Regional Health Centre Sheree Davis, MSW, CDR, CPF - Consultant, Health Systems Advisor Carol Di Salle, MSc(S), Reg CASLPO, S-LP (C) - Health Sciences North Melissa Freedman, MSW, RSW, Patient/Family Expert - Ontario Brain Injury Association Donna Ouchterlony, MD, CCFP - St. Michael's Hospital Deanna Quon, MD, FRCPC - Ottawa Hospital Rehabilitation Centre

2017 CPG Infobase

4. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Initial Management of Concussion/mTBI

Guideline for concussion/mild traumatic brain injury & persistent symptoms - Initial Management of Concussion/mTBI Initial Management of Concussion/mTBI // Brain Injury Guidelines Toggle navigation NAVIGATION > > > > > > > > > > > > > > > > > > Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition, for Adults over 18 years of age Initial Management of Concussion/mTBI Whether a patient first presents to the Emergency Department (ED) or to the primary care (...) to specialists should also be considered if symptoms exhibit an atypical pattern or cannot be linked to a concussion event, and/ or when there are other major comorbid conditions present (e.g., depression, PTSD). The majority of patients will be discharged home; it should be noted that a person who remains symptomatic post mTBI should not drive for at least 24 hours. 3-6 Even asymptomatic patients after 48 hours exhibited poorer vehicle control, especially when navigating curves suggesting that driving

2018 Ontario Neurotrauma Foundation

5. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Sport-Related Concussion/mTBI

Guideline for concussion/mild traumatic brain injury & persistent symptoms - Sport-Related Concussion/mTBI Sport-Related Concussion/mTBI // Brain Injury Guidelines Toggle navigation NAVIGATION > > > > > > > > > > > > > > > > > > Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition, for Adults over 18 years of age Sport-Related Concussion/mTBI In the sports literature, the effects of traumatic biomechanical forces on the brain have traditionally been referred (...) to as a concussion. In this Guideline, the term concussion/mTBI will be used to maintain consistency within this document. A sport-related concussion/mTBI is a traumatic brain injury that may be caused by either a direct blow to the head, face, neck or elsewhere on the body as an indirect force being transmitted to the head during sports activity. A sport-related concussion/mTBI can result in a range of clinical signs and symptoms that may or may not involve a loss of consciousness. While the injury may result

2018 Ontario Neurotrauma Foundation

6. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Diagnosis/Assessment of Concussion/mTBI

Guideline for concussion/mild traumatic brain injury & persistent symptoms - Diagnosis/Assessment of Concussion/mTBI Diagnosis/Assessment of Concussion/mTBI // Brain Injury Guidelines Toggle navigation NAVIGATION > > > > > > > > > > > > > > > > > > Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition, for Adults over 18 years of age Diagnosis/Assessment of Concussion/mTBI Diagnosis of mTBI/concussion (Table B) is the first critical step in successful management (...) leading to improved outcomes and prevention of further injury. Patients commonly present to the Emergency Department (ED) or their Primary Care Provider’s (PCP’s) office following trauma and may be unaware that they have sustained concussion/mTBI. A high level of suspicion is required particularly when there is evidence of direct trauma to the head or mechanism of injury 1 that is frequently associated with mTBI, such as motor vehicle collision, falls, assaults and nonintentional strike by/against

2018 Ontario Neurotrauma Foundation

7. Guidelines for diagnosing and managing pediatric concussion

Guidelines for diagnosing and managing pediatric concussion Guidelines for Diagnosing and Managing Pediatric Concussion First edition, June 2014, v1.1 Recommendations for Health Care Professionals This document is intended to guide health care professionals in diagnosing and managing pediatric—not adult—concussion. It is not for self-diagnosis or treatment. Parents and/or caregivers may bring it to the attention of their child/adolescent’s health care professionals. The best knowledge available (...) or damage arising from any claims made by a third party. Also, as the sponsor of this document, the Ontario Neurotrauma Foundation assumes no responsibility or liability whatsoever for changes made to the guidelines without its consent. Any changes must be accompanied by the statement: “Adapted from Guidelines for Diagnosing and Managing Pediatric Concussion with/without permission,” according to whether or not permission was sought and/or given. About the Ontario Neurotrauma Foundation The Ontario

2019 CPG Infobase

8. Assessment of easy bruising

Assessment of easy bruising Assessment of easy bruising - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Assessment of easy bruising Last reviewed: February 2019 Last updated: September 2018 Summary A bruise (ecchymosis) is caused by bleeding beneath the skin as a result of extravasation of blood from surrounding blood vessels. It may develop due to abnormalities in haemostasis or alteration in the structural (...) integrity of the blood vessel wall and surrounding subcutaneous tissue. Easy bruising implies that no significant trauma has occurred to the skin or soft tissue to cause the bruise, and the bruises are larger and/or more frequent than what would normally be seen. It is a common complaint of patients seen in a medical practice. Surveys of normal healthy individuals report the frequency of easy bruising to range from 12% to 55%. Srámek A, Eikenboom JC, Briët E, et al. Usefulness of patient interview

2018 BMJ Best Practice

9. Concussion

Concussion Concussion - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Concussion Last reviewed: February 2019 Last updated: March 2018 Summary A closed head injury due to a direct blow to the head or deceleration of the head from an impulsive force, resulting in a transient change in mental status. Most common causes are motor vehicle accidents, sports, assaults, and falls. Diagnosing concussion (mild traumatic brain (...) injury) is difficult based on acute injury characteristics and presenting signs and symptoms. Headache, mental slowing and fogginess, and memory difficulties are typical symptoms. Symptoms may fluctuate, but typically subside after 1 week to 1 month. Loss of consciousness is not necessary for a positive diagnosis. CT scan and MRI are typically normal in concussive injury. For uncomplicated cases, physical and cognitive rest is usually sufficient. Definition Concussion (mild traumatic brain injury

2018 BMJ Best Practice

10. Assessment of easy bruising

Assessment of easy bruising Assessment of easy bruising - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Assessment of easy bruising Last reviewed: February 2019 Last updated: September 2018 Summary A bruise (ecchymosis) is caused by bleeding beneath the skin as a result of extravasation of blood from surrounding blood vessels. It may develop due to abnormalities in haemostasis or alteration in the structural (...) integrity of the blood vessel wall and surrounding subcutaneous tissue. Easy bruising implies that no significant trauma has occurred to the skin or soft tissue to cause the bruise, and the bruises are larger and/or more frequent than what would normally be seen. It is a common complaint of patients seen in a medical practice. Surveys of normal healthy individuals report the frequency of easy bruising to range from 12% to 55%. Srámek A, Eikenboom JC, Briët E, et al. Usefulness of patient interview

2018 BMJ Best Practice

11. Artificial intelligence for understanding concussion: Retrospective cluster analysis on the balance and vestibular diagnostic data of concussion patients. Full Text available with Trip Pro

Artificial intelligence for understanding concussion: Retrospective cluster analysis on the balance and vestibular diagnostic data of concussion patients. We propose a bottom-up, machine-learning approach, for the objective vestibular and balance diagnostic data of concussion patients, to provide insight into the differences in patients' phenotypes, independent of existing diagnoses (unsupervised learning).Diagnostic data from a battery of validated balance and vestibular assessments were (...) extracted from the database of the Swiss Concussion Center. The desired number of clusters within the patient database was estimated using Calinski-Harabasz criteria. Complex (self-organizing map, SOM) and standard (k-means) clustering tools were used, and the formed clusters were compared.A total of 96 patients (81.3% male, age (median [IQR]): 25.0[10.8]) who were expected to suffer from sports-related concussion or post-concussive syndrome (52[140] days between diagnostic testing and the concussive

2019 PLoS ONE

12. A novel technique to develop thoracic spinal laminectomy and a methodology to assess the functionality and welfare of the contusion spinal cord injury (SCI) rat model. Full Text available with Trip Pro

A novel technique to develop thoracic spinal laminectomy and a methodology to assess the functionality and welfare of the contusion spinal cord injury (SCI) rat model. This study reports the advantage of a novel technique employing a motorised dental burr to assist laminectomy over the conventional manual technique at T10-T11 vertebra level in a rat model of spinal cord injury. Twenty-four female rats were randomly assigned to four groups: (1) conventionally laminectomised, (2) dental burr (...) assisted laminectomised, (3) conventionally laminectomised with spinal cord contusion and (4) dental burr assisted laminectomised with spinal cord contusion. Basso Beattie Bresnahan (BBB) score, postoperative body weights, rat grimace scale (RGS), open cage activity and rearing was studied at 1, 7, 14, 21 and 28 days postoperatively, and area of spinal tissue affected was evaluated histologically. Laminectomised and spinal cord injured rats from dental burr groups showed significantly more weight gain

2019 PLoS ONE

15. Living Guideline for Diagnosing and Managing Pediatric Concussion

Living Guideline for Diagnosing and Managing Pediatric Concussion LIVING GUIDELINE FOR DIAGNOSING AND MANAGING PEDIATRIC CONCUSSION Reed, N.*, Zemek, R.*, Dawson, J., Ledoux, AA., et al. (2019). Living Guideline for Diagnosing and Managing Pediatric Concussion. Toronto, ON: Ontario Neurotrauma Foundation * These authors contributed equally. 1 Guideline for Diagnosing and Managing Pediatric Concussion – Recommendations / Tools TABLE OF CONTENTS Disclaimer…………………………………………………………………………. 2 Guideline (...) Overview……………………………………………………… 3 List of Recommendations……………………………………………….. 4 Recommendations……………………………………………….………….. 12 List of Tools……….…………………………………….……………………….. 55 References……………………………………………………………………….. 56 2 Guideline for Diagnosing and Managing Pediatric Concussion – Recommendations / Tools DISCLAIMER: The recommendations and resources found within the Living Guideline for Diagnosing and Managing Pediatric Concussion are intended to inform and instruct care providers and other stakeholders who

2019 Ontario Neurotrauma Foundation

16. Effects of ursolic acid on sub-lesional muscle pathology in a contusion model of spinal cord injury. Full Text available with Trip Pro

Effects of ursolic acid on sub-lesional muscle pathology in a contusion model of spinal cord injury. Spinal Cord Injury (SCI) results in severe sub-lesional muscle atrophy and fiber type transformation from slow oxidative to fast glycolytic, both contributing to functional deficits and maladaptive metabolic profiles. Therapeutic countermeasures have had limited success and muscle-related pathology remains a clinical priority. mTOR signaling is known to play a critical role in skeletal muscle

2018 PLoS ONE

17. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Cognitive Difficulties

Guideline for concussion/mild traumatic brain injury & persistent symptoms - Cognitive Difficulties Cognitive Difficulties // Brain Injury Guidelines Toggle navigation NAVIGATION > > > > > > > > > > > > > > > > > > Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition, for Adults over 18 years of age Cognitive Difficulties The presence and persistence of cognitive symptoms following concussion/mTBI can affect an individual’s ability to function in everyday life (...) , including work, academic and social activities. 1,2 Mild TBI/concussion is associated with disruptions in cognitive skills that include difficulties with attention/concentration, processing speed, learning/memory and executive function. 3-6 In the acute phase of injury there are changes in cerebral metabolic activity and perfusion, particularly in the frontal lobes associated with cognitive changes. 7-12 Generally, the expected recovery from cognitive-based symptoms following concussion/mTBI ranges from

2018 Ontario Neurotrauma Foundation

18. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Vestibular (Balance/ Dizziness) & Vision Dysfunction

Guideline for concussion/mild traumatic brain injury & persistent symptoms - Vestibular (Balance/ Dizziness) & Vision Dysfunction Vestibular (Balance/ Dizziness) & Vision Dysfunction // Brain Injury Guidelines Toggle navigation NAVIGATION > > > > > > > > > > > > > > > > > > Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition, for Adults over 18 years of age Vestibular (Balance/ Dizziness) & Vision Dysfunction Vestibular (Balance/Dizziness) Dysfunction (...) Persistent vertigo, dizziness, imbalance and visual disturbance are common symptoms of patients with concussion/mTBI and are often associated with objective impairments of the vestibular system. 1,2 Vestibular impairments can occur peripherally in the inner ear, or centrally in nuclei that integrate vestibular signals in order to maintain balance and posture. The vestibular system also affects eye movement through a variety of mechanisms including the vestibulo-occular reflex (VOR). The most common cause

2018 Ontario Neurotrauma Foundation

19. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Fatigue

Guideline for concussion/mild traumatic brain injury & persistent symptoms - Fatigue Fatigue // Brain Injury Guidelines Toggle navigation NAVIGATION > > > > > > > > > > > > > > > > > > Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition, for Adults over 18 years of age Fatigue Fatigue has been conceptualized as an experience of weariness or tiredness following mental or physical exertion, often resulting in a reduced capacity for work and limited efficiency (...) to respond to stimuli. Fatigue can be caused by psychological or physiological forces 1 and can be central or peripheral, which in lay terms is experienced as cognitive fatigue and physical fatigue or weariness. 2-4 Fatigue is one of the most pervasive symptoms following concussion/mTBI, with 27.8% of individuals experiencing persistent fatigue at 3 months post-injury. 5 The perception of fatigue can be out of proportion to exertion or may even occur without any exertion. 6 One study reported a level

2018 Ontario Neurotrauma Foundation

20. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Post-Traumatic Headache

Guideline for concussion/mild traumatic brain injury & persistent symptoms - Post-Traumatic Headache Post-Traumatic Headache // Brain Injury Guidelines Toggle navigation NAVIGATION > > > > > > > > > > > > > > > > > > Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition, for Adults over 18 years of age Post-Traumatic Headache Headache is the most common and among the most prevalent persistent symptoms following mTBI. 1-4 Studies to date have documented (...) that anywhere from 30-90% of individuals who sustain a mTBI develop post-traumatic headache. 2,5 Interestingly, several researchers have reported that post-traumatic headache is more common after concussion/mTBI than after severe TBI. 5-17 Notably, post-traumatic headache is associated with a high degree of disability 1 and is more chronic and persistent than previously thought. 18 The vast majority of people with post-traumatic headache improve within days or weeks; however, for some individuals, headaches

2018 Ontario Neurotrauma Foundation

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