12 CONCUSSION MANAGEMENT Flashcards
CONCUSSION
Type of traumatic brain injury.
A complex pathophysiological process affecting the brain, induced by biomechanical forces.
Comes from an energy crisis.
WHY AN ENERGY CRISIS?
Decreased cerebral blood flow, reducing supply of energy/glucose.
7-14 days for adults.
Up to 30 days for kids.
WHAT TO DO AFTER CONCUSSION
No screen time, reading, TV.
Visual system: makes up 70% of sensory processing. Visual acuity (clearness) not affected.
VESTIBULAR SYSTEM
Highly susceptible to injury following concussion.
Peripheral: injury to vestibular organ, inner ear.
Central: affecting central integration, and organization of vestibular stimuli.
CONCUSSION RECOGNITION
Headache.
Dizziness.
Balance problems.
WHAT TO DO WITH PATIENTS
Recognize it early.
Educate your patients.
Objective evaluation.
Provide recommendations.
WHAT DON’T THEY DO WITH DIAGNOSING CONCUSSION
No longer appropriate to grade concussion.
HIGH RISK FOR NEUROLOGICAL INTERVENTION
- GCS Score less than 15 at 2 hours after injury.
- Suspected open or depressed skull fracture.
- Any sign of basal skull fracture.
- Vomiting, more than 2 times.
- Age, over 65 years.
MEDIUM RISK FOR BRAIN INJURY ON CT
- Amnesia, not remembering what happened before accident.
- Dangerous mechanism.
NEUROLOGICAL SCREEN
Cranial nerves, extremity tone, strength and reflexes, balance, gait.
CLINICAL EVALUATION TOOLS
Acute Concussion Evaluation (ACE).
Sport Concussion Assessment Tool 5 (SCAT5).
VOMS
Vestibular-Oculomotor Screening.
Assesses:
Smooth Pursuits.
Saccades.
Convergence.
Vestibulo-Ocular Reflex.
Visual Motion Sensitivity.
SMOOTH PURSUITS
Head stationary.
Eyes track a moving object.
SACCADES
Head stationary.
Eyes jump from one target to the next.
CONVERGENCE
Focus on an object close to your eyes.
Keep object clear and singular.
Pencil push up.
Brock string.
VESTIBULO-OCULAR REFLEX
Eyes fixed on a stationary target head moves while eyes stay fixed.
VISUAL MOTION SENSITIVTY
Eyes fixed on target in hand.
Rotate whole upper body and keeps eyes fixed on target.
CLINICAL RECOVERY VS PHYSIOLOGICAL RECOVERY
Uncomplicated concussion cases will resolve on there own.
Physiological recovery may take longer than clinical recovery.
ACUTE MANAGEMENT
Education.
Energy management strategies.
Considerations for school, work.
Referral for concussion rehabilitation.
REST AND CONCUSSION
Rest is important, but not just rest.
Early physical activity is beneficial.
RISK OF REST
Depression, withdrawal, physical deconditioning.
ACCOMIDATIONS FOR VESTIBULAR-OCULAR IMPAIRMENT
Limit visual demands.
Avoid busy hallways.
Quiet work areas.
ACCOMIDATIONS FOR HEADACHES
Sunglasses.
Avoid busy areas.
CONSIDERATIONS FOR RETURN TO WORK
Adjust dose of work.
