Ch 2 - TBI: Mild TBI and Postconcussion syndrome Flashcards
What is the definition of a mild TBI?
Traumatically induced physiological disruption of the brain with at least 1 of the 4 manifestations:
- Any LOC
- Loss of memory of event before or after events
- Any alteration in mental status at time of accident
- Focal neuro deficits that may or may not be transient
Mild TBI does not exceed the following criteria:
– LOC > 30 minutes
– PTA >24 hours
– Initial GCS < 12
What in found on CT/MRI head in mild TBI?
Negative radiologic findings
What is the MC symptoms of mild TBI?
Headache
When do symptoms recover in mild TBI?
First few weeks or months post-injury (usually within 1–3 months).
What is second impact syndrome?
Second brain injury before symptoms of prior concussion cleared
What is the DSM-IV criteria for Post-concussion syndrome?
A. Hx TBI causing “significant cerebral concussion”
B. Cognitive deficit in attention and/or memory
C. Presence of at least 3 of 8 sx for 3 months
What are the symptoms of post-concussion syndrome?
Fatigue Sleep disturbance HA Dizziness Irritability Affective disturbance Personality change Apathy
What is persistent post-concussion syndrome?
Concussion symptoms lasting over 3 to 6 months
What are different grading scales for concussion?
– Colorado Medical Society Guidelines
– American Academy of Neurology (AAN) Guidelines
– Cantu Guidelines
What is a Grade 1-mild TBI based on the Cantu system?
- No LOC
* PTA/PCSS < 30 min
What is a Grade 2-moderate TBI based on the Cantu system?
- LOC < 1 min
- PTA 30 min–24 hr
- PCSS 30 min–7 days
What is a Grade 3-severe TBI based on the Cantu system?
- LOC > 1 min
- PTA > 24 hr
- PCSS > 7 days
What is a Grade 1-mild TBI based on the Colorado system?
- No LOC
* Confusion < 15 min
What is a Grade 2-moderate TBI based on the Colorado system?
- No LOC
* Confusion > 15 min
What is a Grade 3-severe TBI based on the Colorado system?
- Grade 3a—Brief LOC (sec)
* Grade 3b—Prolonged LOC (min)
What are the rules on return to play day of concussion?
No return to play regardless of concussion severity
What is the first step in concussion management?
Physical and cognitive rest until the acute symptoms resolve (usually 24 to 48 hours)
What follows rest in concussion management?
Stepwise graded program of exertion prior to medical clearance and rereturn to play (RTP)
How can an athlete proceed to the next step of the Graduate RTP Protocol?
Asymptomatic at the current level and each step takes ~24 hours
What happens if an athlete experiences any post-concussive symptoms during graduated RTP protocol?
Drop back to the previous asymptomatic level and try to progress again after another 24-hour period of rest has passed
What is the first Rehabilitation stage on graduate RTP protocol?
No activity
What is the functional exercise during the first Rehabilitation stage on graduate RTP protocol?
Symptom limited physical and cognitive rest
What is the objective of the first Rehabilitation stage on graduate RTP protocol?
Recovery
What is the second Rehabilitation stage on graduate RTP protocol?
Light aerobic exercise
What is the functional exercise during the second Rehabilitation stage on graduate RTP protocol?
Walking, swimming or stationary cycling keeping intensity <70% maximum permitted heart rate No resistance training
What is the objective of the second Rehabilitation stage on graduate RTP protocol?
Increase HR
What is the third Rehabilitation stage on graduate RTP protocol?
Sport-specific exercise
What is the functional exercise during the third Rehabilitation stage on graduate RTP protocol?
Skating drills in ice hockey, running drills in soccer. No head impact activities
What is the objective of the third Rehabilitation stage on graduate RTP protocol?
Add movement
What is the fourth Rehabilitation stage on graduate RTP protocol?
Non-contact training drills
What is the functional exercise during the fourth Rehabilitation stage on graduate RTP protocol?
Progression to more complex training drills, e.g., passing drills in football and ice hockey May start progressive resistance training
What is the objective of the fourth Rehabilitation stage on graduate RTP protocol?
Exercise, coordination and cognitive load
What is the fifth Rehabilitation stage on graduate RTP protocol?
Full-contact practice
What is the functional exercise during the fifth Rehabilitation stage on graduate RTP protocol?
Following medical clearance participate in normal training activities
What is the objective of the fifth Rehabilitation stage on graduate RTP protocol?
normal training activities
Restore confidence and assess functional skills by coaching staff
What is the sixth Rehabilitation stage on graduate RTP protocol?
Return to play
What is the functional exercise during the sixth Rehabilitation stage on graduate RTP protocol?
Normal game play
