6: Mild TBI and Concussions

Question 1

The CDC estimates of the 1.7 million TBIs annually in the US, ____% are mild TBIs or concussions. What % of those are estimated to be unreported?

Answer 1

75%

50%

Question 2

Concussion is a complex ____________________ process affecting the brain, induced by __________ forces

Answer 2

pathophysiological

biomechanical

Question 3

What are 5 causes of concussions?

Answer 3

1) high impact sports (football, hockey, etc)
2) work related injuries (military, construction, etc)
3) recreational activities
4) motor vehicle accidents
5) violence

Question 4

The rapid acceleration and deceleration forces applied to the moving brain during concussion can cause _____________ _____________. The rotation of the head adds to the __________ forces and distortion of ___________ and ___________ elements in the brain.

Answer 4

cellular damage
shearing
vascular and neuronal

Question 5

Concussion may result in neuropathologic changes, but the acute clinical symptoms more often reflect a __________ disturbance rather than a ___________ injury detected via __________________

Answer 5

functional
structural
neuroimaging

Question 6

With concussions, in some cases symptoms can evolve over:

But they typically result in the ____ onset of ____-_______ impairment of neurologic function that resolves ___________

Answer 6

a number of minutes to hours
rapid
short-lived
spontaneously

Question 7

MRIs and CT scans are often not sensitive enough to detect what? So what do we have to do?

Answer 7

subtle neurocognitive and neurophysiological changes associated with concussion
rely on other diagnostic measures

Question 8

Neuro changes and symptoms experienced post-concussion can vary in _______ and _______ based on the ___________ and __________ of the impact

Answer 8

degree and extent

severity and location

Question 9

The suspected diagnosis of concussion can be made based on what?

Answer 9

• symptoms outwardly observed by support staff
• symptoms directly experienced by the individual
  (symptoms can be physical, cognitive, neurobehavioral, or sleep-related)

Question 10

What are 18 possible post-concussion symptoms?

Answer 10

1) headache
2) fatigue
3) reduced coordination/balance issues
4) decreased oculomotor control
5) depression
6) sadness
7) irritability
8) hypersomnia or insomnia
9) loss of consciousness
10) dizziness
11) confusion
12) nausea
13) vomiting
14) slurred/incoherent speech
15) sensitivity to light
16) sensitivity to noise
17) nervousness
18) feeling more emotional

Question 11

What are 7 neurocognitive post-concussion symptoms?

Answer 11

1) attention*
2) immediate and delayed verbal memory*
3) immediate and delayed visual memory
4) speed of processing*
5) impulse control
6) orientation
7) executive function

Question 12

What are reasons athletes may not report post-concussion symptoms?

Answer 12

1) personal drive to perform at peak levels
2) unwillingness to leave a practice or game early
3) fear of letting teammates down
4) external pressure from teammates, coaches, parents, and/or fans
5) don’t thing symptoms are significant enough to signify a concussion

Question 13

What are 3 consequences of returning to a high-impact activity before post-concussion symptoms have resolved?

Answer 13

1) more severe symptoms
2) longer recovery period
3) second impact syndrome (SIS)

Question 14

What is second impact syndrome?

Answer 14

occurs when an individual suffers repeated concussions without adequate time to heal between concussions

Question 15

When SIS occurs, the brain is in a vulnerable state and when injured again, what 2 things can occur due to impaired ____________ _______________

Answer 15

1) cerebral edema
2) cerebral herniation

cerebral autoregulation

(uncommon but can lead to death)

Question 16

What are 7 common post-concussive syndrome/symptoms?

Answer 16

1) persistent headache
2) light-headedness
3) lethargy
4) sleep disturbance
5) light/noise sensitivity
6) memory dysfunction
7) decreased attention/concetration

Question 17

What are 3 secondary symptoms/factors of post-concussive syndrome?

Answer 17

1) anxiety
2) irritability
3) depression

Question 18

What is the typical resolution of concussion symptoms?

Answer 18

80-90% resolve in 7-14 day period if managed appropriately, but can be prolonged

Question 19

There is research emerging about the additional influences of routine, repetitive, and acutely asymptomatic subconcussive blows to the head that says:

Answer 19

1) no acute symptoms reported
2) may lead to altered brain gray matter functional connectivity and white matter microstucture that cumulatively over time result in neurocognitive change

Question 20

Preliminary research shows varsity football offensive and defensive lineman can incur in excess of ________ subconcussive hits over the course of 1 season.

Answer 20

1,000

Question 21

What is the long term consequences of repeated concussions/sub-concussive hits?

Answer 21

Chronic Traumatic Encephalopathy (CTE)

Question 22

What is CTE?

Answer 22

A neurodegenerative disease that occurs years or even decades following recovery from head trauma

Question 23

How is CTE diagnosed?

Answer 23

can only be made through autopsy

reduced brain volume in frontal, temporal, and parietal lobes

Question 24

What are 4 symptoms of CTE?

Answer 24

1) increased anger
2) suicidal tendencies
3) poor episodic memory
4) weakened executive function skills

Question 25

What are 7 factors that can negatively impact recovery?

Answer 25

1) gender/neck strength
2) history of learning disability
3) number of previous concussions
4) history of migraines
5) family history of psychologic diagnosis
6) children and adolescents
7) varsity vs. club sport/recreational athletes

Question 26

What are 3 acute post-concussion recommendations from academic instructors?

Answer 26

1) delay assignments/exams
2) extended time for assignments/exams
3) environmental changes (preferential seating, noise and light reduction, distraction free exam environment)

Question 27

What are 7 acute post-concussion recommendations from the athletic perspective?

Answer 27

1) take additional rest breaks during the day
2) complete activities in quiet, distraction free environment
3) reduce cognitively strenuous activity
4) refrain from high impact physically strenuous activity
5) refrain from participating in loud, distracting environments
6) refrain from excessive electronic gaming
7) report increase in symptoms immediately

Question 28

When should a person be seen for a more comprehensive eval by an SLP and possible a neuropsychologist?

Answer 28

if symptoms persist for greater than 3 montsh

Question 29

Based on assessment results, MU clinic develops an individualized therapy program for the treatment of persistent ____________ and ______________ problems via the use of:

Answer 29

memory and attention

hierarchical strategies