Concussion

Question 1

a concussion is what type of injury?

Answer 1

metabolic

Question 2

with a concussion you get increased energy demand + decreased blood supply which results in what?

Answer 2

metabolic crisis

Question 3

what is there an increased energy demand in the neuron following a concussion?

Answer 3

the Na/K ATP-dependent pump increases membrane pumping to re-establish balance which depletes the energy stores, leading to an increased demand of energy

Question 4

what are the subtypes of concussion

Answer 4

vestibular
ocular
cognitive/fatigue
post-traumatic migraine
cervical
anxiety/mood

Question 5

which subtype is seen more early on following a concussion?

Answer 5

cognitive/fatigue

Question 6

symptoms of cognitive/fatigue subtype

Answer 6

• intense fatigue
• HA w/ cognitive & physical ac`tivity
• “end of day” symptoms
• sleep disturbances

Question 7

cognitive/fatigue subtype exam findings for a vestibular/ocular screening

Answer 7

should be normal

Question 8

cognitive/fatigue subtype exam findings for a neurocog test

Answer 8

• mild global/widespread deficits across all composites

- deficits with retrieval, encoding intact

Question 9

what kind of treatment would you do for cognitive/fatigue subtype

Answer 9

• physical/cognitive breaks (NOT naps)
• pharmacological options (neurostimulants, sleep aide)
• cognitive therapy
• monitored, structured exercise progression

Question 10

ocular/visual subtype risk factors

Answer 10

personal/family hx of ocular dysfunction

Question 11

ocular/visual subtype symptoms

Answer 11

frontal HA driven by visual work 
difficulties with visually-based classes, assignments or activites 
pressure behind eyes
visual "focus" issues 
blurry vision
double vision

Question 12

ocular/visual subtype exam findings for vision/oculomotor exam

Answer 12

• potentially may see + smooth pursuit & saccades
• convergence difficulties
• accomodative insufficiency
• strabismus

Question 13

ocular/visual subtype exam findings for neurocog test results

Answer 13

• deficits in reaction time

- deficits with visual memory

Question 14

convergence

Answer 14

ability of eyes to turn inward to focus on a near target

Question 15

divergence

Answer 15

ability of eyes to move outwards to focus on a further target

Question 16

general symptoms of vergence dysfunction

Answer 16

• intermittent/constant double vision
• asthenopia when reading (eye strain)
• frontal HA
• letters appear to float/move on page

Question 17

what are common vergence problems

Answer 17

• convergence insufficiency
• convergence excess
• convergence spasm

Question 18

accomodation

Answer 18

adjustment of the optics of the eye to keep an object in focus on the retina as its distance from the eye varies

Question 19

accommodative dysfunction will look like

Answer 19

• reduction in ability to focus at near
• accomodative spasm
• struggle to coordinate accommodation and vergence, leading in spatial awareness

Question 20

ocular/visual subtype treatment

Answer 20

ocular motor training

physical exertion is ok

Question 21

vestibular subtype risk factors

Answer 21

PMHx of car sickness/motion sensitivity
migraine
anxiety

Question 22

vestibular subtype symptoms

Answer 22

vertigo
dizziness
nausea
overwhelmed in visually-stimulating environments 
balance impairments

Question 23

what symptoms is the biggest complaint post concussion

Answer 23

dizziness - 55-80%

Question 24

S/S of vestibular dysfunction

Answer 24

dizziness
blurry vision
nystagmus
tinnitus
vertigo
hearing loss
loss of balance/falls
broad based stance 
sweating, N/V

Question 25

vestibular subtype exam findings for a vestibular/ocular screen

Answer 25

VOR dysfunction VOR suppression + smooth pursuit, saccades

Question 26

vestibular subtype exam findings for a neurocog test result

Answer 26

difficulty with visual motor speed, rxn time | coexists with migraine and/or anxiety subtypes

Question 27

vestibular subtype treatment

Answer 27

vestibular rehab | pharmacological

Question 28

anxiety/mood subtype risk factors

Answer 28

personal/family hx of anxiety, migraine, vestibular disorders

Question 29

anxiety/mood subtype symptoms

Answer 29

``` ruminative thoughts hyper-vigilant fastidious easily overwhelmed difficulties initiating/maintaining sleep ```

Question 30

anxiety/mood subtype exam findings?

Answer 30

vestibular - normal | neurocog - normal

Question 31

anxiety/mood subtype treatment

Answer 31

``` psychotherapy treat other subtypes if present structured training cog behavior training regulated schedule meds ```

Question 32

post traumatic migraine subtype risk factors

Answer 32

personal or family hx of migraine, "ice cream HA," motion sensitivity, vestibular disorder, anxiety

Question 33

post traumatic migraine subtype symptoms

Answer 33

variable HA nausea, photo and/or phonophobia stress, anxiety, lack of exercises sleep dysregulation

Question 34

when do you see photosensitivity

Answer 34

post traumatic migraine

Question 35

what is a migraine

Answer 35

neurovascular event | failure of central modulation of trigeminovascular system

Question 36

how many pt will experience a preceding aura with a post traumatic migraine

Answer 36

1/3

Question 37

post traumatic migraine exam findings for vestibular/ocular screens

Answer 37

normal

Question 38

post traumatic migraine exam findings for neurocog test results

Answer 38

verbal and visual memory deficits

Question 39

post traumatic migraine treatment

Answer 39

meds diet stress management avoid triggers

Question 40

cervical subtype risk factors

Answer 40

prior c-spine injury high velocity injury strong rotational component to injury

Question 41

cervical subtype symptoms

Answer 41

neck pain, stiffness, soreness | HA radiating forward from upper cervical spine

Question 42

cervical subtype exam findings

Answer 42

all normal except + cervical screen

Question 43

cervical subtype treatment

Answer 43

``` imaging cervical stabilization exercises meds injection/nerve block massage, acupuncture ```

Question 44

what are the top 10 most reported symptoms in post concussive athletes in order from most to least

Answer 44

``` HA feeling slowed down difficulty concentrating dizzy fogginess fatigue visual blurring/double vision light sensitivity memory dysfunction balance probs ```

Question 45

when do you start seeing recovery

Answer 45

80-90% within first 10-14 days

Question 46

how long would full recovery take

Answer 46

21-28 days

Question 47

recovery from sports related injury in adolescents takes how long

Answer 47

4 weeks

Question 48

what aids in return to sport without prolonged sequelae

Answer 48

early identification of impairments

Question 49

what are 6 predictors of prolonged recovery

Answer 49

``` initial symptoms sex - female age loss of consciousness post traumatic amnesia premorbid comorbidities ```