12 CONCUSSION MANAGEMENT

Question 1

CONCUSSION

Answer 1

Type of traumatic brain injury.
A complex pathophysiological process affecting the brain, induced by biomechanical forces.
Comes from an energy crisis.

Question 2

WHY AN ENERGY CRISIS?

Answer 2

Decreased cerebral blood flow, reducing supply of energy/glucose.
7-14 days for adults.
Up to 30 days for kids.

Question 3

WHAT TO DO AFTER CONCUSSION

Answer 3

No screen time, reading, TV.

Visual system: makes up 70% of sensory processing. Visual acuity (clearness) not affected.

Question 4

VESTIBULAR SYSTEM

Answer 4

Highly susceptible to injury following concussion.
Peripheral: injury to vestibular organ, inner ear.
Central: affecting central integration, and organization of vestibular stimuli.

Question 5

CONCUSSION RECOGNITION

Answer 5

Headache.
Dizziness.
Balance problems.

Question 6

WHAT TO DO WITH PATIENTS

Answer 6

Recognize it early.
Educate your patients.
Objective evaluation.
Provide recommendations.

Question 7

WHAT DON’T THEY DO WITH DIAGNOSING CONCUSSION

Answer 7

No longer appropriate to grade concussion.

Question 8

HIGH RISK FOR NEUROLOGICAL INTERVENTION

Answer 8

1. GCS Score less than 15 at 2 hours after injury.
2. Suspected open or depressed skull fracture.
3. Any sign of basal skull fracture.
4. Vomiting, more than 2 times.
5. Age, over 65 years.

Question 9

MEDIUM RISK FOR BRAIN INJURY ON CT

Answer 9

1. Amnesia, not remembering what happened before accident.
2. Dangerous mechanism.

Question 10

NEUROLOGICAL SCREEN

Answer 10

Cranial nerves, extremity tone, strength and reflexes, balance, gait.

Question 11

CLINICAL EVALUATION TOOLS

Answer 11

Acute Concussion Evaluation (ACE).
Sport Concussion Assessment Tool 5 (SCAT5).

Question 12

VOMS

Answer 12

Vestibular-Oculomotor Screening.

Assesses:
Smooth Pursuits.
Saccades.
Convergence.
Vestibulo-Ocular Reflex.
Visual Motion Sensitivity.

Question 13

SMOOTH PURSUITS

Answer 13

Head stationary.
Eyes track a moving object.

Question 14

SACCADES

Answer 14

Head stationary.
Eyes jump from one target to the next.

Question 15

CONVERGENCE

Answer 15

Focus on an object close to your eyes.
Keep object clear and singular.

Pencil push up.
Brock string.

Question 16

VESTIBULO-OCULAR REFLEX

Answer 16

Eyes fixed on a stationary target head moves while eyes stay fixed.

Question 17

VISUAL MOTION SENSITIVTY

Answer 17

Eyes fixed on target in hand.
Rotate whole upper body and keeps eyes fixed on target.

Question 18

CLINICAL RECOVERY VS PHYSIOLOGICAL RECOVERY

Answer 18

Uncomplicated concussion cases will resolve on there own.
Physiological recovery may take longer than clinical recovery.

Question 19

ACUTE MANAGEMENT

Answer 19

Education.
Energy management strategies.
Considerations for school, work.
Referral for concussion rehabilitation.

Question 20

REST AND CONCUSSION

Answer 20

Rest is important, but not just rest.
Early physical activity is beneficial.

Question 21

RISK OF REST

Answer 21

Depression, withdrawal, physical deconditioning.

Question 22

ACCOMIDATIONS FOR VESTIBULAR-OCULAR IMPAIRMENT

Answer 22

Limit visual demands.
Avoid busy hallways.
Quiet work areas.

Question 23

ACCOMIDATIONS FOR HEADACHES

Answer 23

Sunglasses.
Avoid busy areas.

Question 24

CONSIDERATIONS FOR RETURN TO WORK

Answer 24

Adjust dose of work.

Question 25

PCS

Answer 25

Post Concussion Syndrome.

Question 26

WHAT TO DO WITH PCS

Answer 26

Educate.
Identify triggers.
No strict rest habits.
Target rehabilitation.