Author: Sana Rehman
A concussion is the most prevalent type of mild traumatic brain injury and might cause adverse consequences (Tator, 2013). Concussion occurs frequently in all age groups, and different settings as well, but contradiction for age groups has been seen in the literature (Abrahams et al.: 2014; Marar et al., 2012). The concussion is defined as a serious pathological process, adversely impact the brain functioning due to abnormal biomechanical factors (Sharp, & Jenkins, 2015).
The epidemiological studies have demonstrated that the
prevalence rate for concussion has increased twice with recent years and the
situation is growing more alarming day by day — the current clinical case
reasoning following the three component of cycle considering a case of a girl.
The three components of the cycle include the situation of the patients, cues
& information and process or information.
Current Situation of
the Patient
A 12-year-old girl named Mia Roberts, studying in grade six came
in hospital emergency mainly with the complaints of headache, nausea, loss of
appetite and fatigue. Her playmate also noticed that she was not eating well
during that day and found to be silent during most of the day. At night,
behavioural changes and fluctuations in mood have also been noticed as she was
crying without any particular reason and felt confused. It was reported that
Mia had a head injury in that morning during the play of the basketball
tournament. During play she got stuck and headed down in the left side of her
frontal bone. Her reported symptoms depicted that she might be having a
concussion. Mild traumatic brain injury that dislocates the brain functions to
abnormal way is termed as a concussion.
In 2015, Coronado et al., surveyed on nearly 3.42 million emergency departments for studying the sport’s concussion and reported that 70% concussion occurred during playing football, soccer, basketball and ice-hockey like games by collisions of players who were between the age of 12 to 19 years (Coronado et al., 2015). A substantial body of researchers reported a significant number of cases for developing concussion due to football, basketball and hockey (Abrahams, Fie, Patricios, Posthumus, September 2014; Marar et al., 2012).
Concussions symptoms such as dizziness, sleeplessness,
headache, behavioural and emotional changes (McCrory et al., 2017) were similar
to her symptoms. Some researches resulted that the majority of athletes
experienced these symptoms within days that is due to the structural anatomical
changes of the brain during the injury. Mia Roberts also had an injury in the
left side of the frontal lobe that’s why she is feeling symptoms like a
concussion.
Cues and
Information
Risk factors related to the occurrence of concussion were also important to be in view. Gender plays an important role in playing games, and it is one of the major risk factors in concussion. Being a female player is a potential risk factor of the concussion, which indicated that Mia Robert might have a concussion during that play (Abrahams et al.: 2014; Marar et al., 2012). Comparatively, males found to be least on the risk of developing concussion while playing games.
The place of the injury is another risk factor of the
concussion. In 2016, Caccese & Kaminski studied that aerial collision of
the athletes with injury in the left side of the brain is the major risk factor
of the concussion. Researches on the age limits also conclude that with the
increase of age concussion’s risk factor decreases that was also assimilated
with her age as she was only 12 years old that was her major risk factor of being
concussion (Marar et al., 2012). Currently, from the profile of the Mia
Roberts, her gender, age and place of injury, all were the major risk factors
of the occurrence on concussion.
As far as with the concern of the patient’s diagnosis, it cannot be diagnosed only on the risk factors of the problems. The patient would be medically examined properly with the interview by the doctors. Mia Roberts interviewed by the doctor, and her initial notes were taken as objective data of the patient that were as blood pressure as 105/87, temperature 36.7°C, Pulse 81, Respiratory Rate 20 and SpO2 was 98%. In a clinical interview, patient subjectively reported that she had blurred feelings, experiencing dizziness, headache and did not feel well after injury.
The ratings of the patient on the
pain scale of headache are 4 out of 10. There would be a detailed examination
of the patient would be suggested that contains many domains like injury
mechanism, signs and symptoms, the neurological and cognitive functioning of the
patient that includes balance testing (Caccese & Kaminski, 2016).
Besides the clinical interview, neurological tests like PET
scan, MMRI, functional MRI or SCAT3 would also be implemented in the assessment
so that the structural changes could be seen in that tests and with better
understanding diagnosis could be made (Coronado et al., 2015). The sign and
symptoms of the patient clearly indicated the concussion symptoms. Studies
indicated that neurochemical changes linked with the concussion problem effectively
detected by the magnetic resonance spectroscopy (MRS) rather than diffusion
tensor imaging and positron emission tomography (PET) scanning (Abrahams, Fie,
Patricios, Posthumus, September 2014; Marar et al., 2012). Functional MRI is
also effective to see the functional changes of the concussion after two months
of the injury (Finch, Clapperton & McCrory, 2013).
To give the concussion diagnosis is much more difficult due to
the results of the neurological tests. It is more rely on the clinical interview
and the behavioural and emotional functioning that can be seen in the case of
Mia Robert as she had started emotional and behavioural problems like crying
without any reason that was another sign of the concussion symptoms of the
patient (Marar et al., 2013).
Process and
Information
In the case of Mia Robert was a 12 years old girl, which is the
developing age of the brain as well. Studies described that developing brain
responded differently as compared to the adult brain to any traumatic injuries and
are most prone to have a concussion and highly vulnerable to the damages
(Caccese & Kaminski, 2016). Same happened in the case of Mia; she got an
injury in her growing age. Therefore more risk and damages have been found to
be associated with her condition. It was also assessed that Mia’s injury
occurred at the frontal lobe of the brain and the frontal and temporal lobes
were responsible to the sensory inputs that might be affected her in long term
effects of the brain (Caccese & Kaminski, 2016).
Due to the frontal lobe injury, she had the problems related to the sleeplessness, dizziness and fatigue. Brain injuries alarmingly effects the learning of the children between age five to 18. The recent studies found that children who had a concussion during play had no significant difference in the learning performances with other peer mates (Finch, Clapperton & McCrory, 2013). In contrast, Mia experienced issues in multiple areas to function well.
Age and gender were also found to be strong determinants for developing
functional, emotional, behavioural, and sensory and health issues. More
assessment and management are needed in the case to achieve desirable results.
From the above case clinical case reasoning, it can be hypothesized that Mia
might get recover soon with the proper assessment and regular treatment plan.