6: Mild TBI and Concussions Flashcards
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?
75%
50%
Concussion is a complex ____________________ process affecting the brain, induced by __________ forces
pathophysiological
biomechanical
What are 5 causes of concussions?
1) high impact sports (football, hockey, etc)
2) work related injuries (military, construction, etc)
3) recreational activities
4) motor vehicle accidents
5) violence
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.
cellular damage
shearing
vascular and neuronal
Concussion may result in neuropathologic changes, but the acute clinical symptoms more often reflect a __________ disturbance rather than a ___________ injury detected via __________________
functional
structural
neuroimaging
With concussions, in some cases symptoms can evolve over:
But they typically result in the ____ onset of ____-_______ impairment of neurologic function that resolves ___________
a number of minutes to hours
rapid
short-lived
spontaneously
MRIs and CT scans are often not sensitive enough to detect what? So what do we have to do?
subtle neurocognitive and neurophysiological changes associated with concussion
rely on other diagnostic measures
Neuro changes and symptoms experienced post-concussion can vary in _______ and _______ based on the ___________ and __________ of the impact
degree and extent
severity and location
The suspected diagnosis of concussion can be made based on what?
- symptoms outwardly observed by support staff
- symptoms directly experienced by the individual
(symptoms can be physical, cognitive, neurobehavioral, or sleep-related)
What are 18 possible post-concussion symptoms?
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
What are 7 neurocognitive post-concussion symptoms?
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
What are reasons athletes may not report post-concussion symptoms?
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
What are 3 consequences of returning to a high-impact activity before post-concussion symptoms have resolved?
1) more severe symptoms
2) longer recovery period
3) second impact syndrome (SIS)
What is second impact syndrome?
occurs when an individual suffers repeated concussions without adequate time to heal between concussions
When SIS occurs, the brain is in a vulnerable state and when injured again, what 2 things can occur due to impaired ____________ _______________
1) cerebral edema
2) cerebral herniation
cerebral autoregulation
(uncommon but can lead to death)
What are 7 common post-concussive syndrome/symptoms?
1) persistent headache
2) light-headedness
3) lethargy
4) sleep disturbance
5) light/noise sensitivity
6) memory dysfunction
7) decreased attention/concetration
What are 3 secondary symptoms/factors of post-concussive syndrome?
1) anxiety
2) irritability
3) depression
What is the typical resolution of concussion symptoms?
80-90% resolve in 7-14 day period if managed appropriately, but can be prolonged
There is research emerging about the additional influences of routine, repetitive, and acutely asymptomatic subconcussive blows to the head that says:
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
Preliminary research shows varsity football offensive and defensive lineman can incur in excess of ________ subconcussive hits over the course of 1 season.
1,000
What is the long term consequences of repeated concussions/sub-concussive hits?
Chronic Traumatic Encephalopathy (CTE)
What is CTE?
A neurodegenerative disease that occurs years or even decades following recovery from head trauma
How is CTE diagnosed?
can only be made through autopsy
reduced brain volume in frontal, temporal, and parietal lobes
What are 4 symptoms of CTE?
1) increased anger
2) suicidal tendencies
3) poor episodic memory
4) weakened executive function skills
What are 7 factors that can negatively impact recovery?
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
What are 3 acute post-concussion recommendations from academic instructors?
1) delay assignments/exams
2) extended time for assignments/exams
3) environmental changes (preferential seating, noise and light reduction, distraction free exam environment)
What are 7 acute post-concussion recommendations from the athletic perspective?
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
When should a person be seen for a more comprehensive eval by an SLP and possible a neuropsychologist?
if symptoms persist for greater than 3 montsh
Based on assessment results, MU clinic develops an individualized therapy program for the treatment of persistent ____________ and ______________ problems via the use of:
memory and attention
hierarchical strategies
