Concussion Flashcards
a concussion is what type of injury?
metabolic
with a concussion you get increased energy demand + decreased blood supply which results in what?
metabolic crisis
what is there an increased energy demand in the neuron following a concussion?
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
what are the subtypes of concussion
vestibular ocular cognitive/fatigue post-traumatic migraine cervical anxiety/mood
which subtype is seen more early on following a concussion?
cognitive/fatigue
symptoms of cognitive/fatigue subtype
- intense fatigue
- HA w/ cognitive & physical ac`tivity
- “end of day” symptoms
- sleep disturbances
cognitive/fatigue subtype exam findings for a vestibular/ocular screening
should be normal
cognitive/fatigue subtype exam findings for a neurocog test
- mild global/widespread deficits across all composites
- deficits with retrieval, encoding intact
what kind of treatment would you do for cognitive/fatigue subtype
- physical/cognitive breaks (NOT naps)
- pharmacological options (neurostimulants, sleep aide)
- cognitive therapy
- monitored, structured exercise progression
ocular/visual subtype risk factors
personal/family hx of ocular dysfunction
ocular/visual subtype symptoms
frontal HA driven by visual work difficulties with visually-based classes, assignments or activites pressure behind eyes visual "focus" issues blurry vision double vision
ocular/visual subtype exam findings for vision/oculomotor exam
- potentially may see + smooth pursuit & saccades
- convergence difficulties
- accomodative insufficiency
- strabismus
ocular/visual subtype exam findings for neurocog test results
- deficits in reaction time
- deficits with visual memory
convergence
ability of eyes to turn inward to focus on a near target
divergence
ability of eyes to move outwards to focus on a further target
general symptoms of vergence dysfunction
- intermittent/constant double vision
- asthenopia when reading (eye strain)
- frontal HA
- letters appear to float/move on page
what are common vergence problems
- convergence insufficiency
- convergence excess
- convergence spasm
accomodation
adjustment of the optics of the eye to keep an object in focus on the retina as its distance from the eye varies
accommodative dysfunction will look like
- reduction in ability to focus at near
- accomodative spasm
- struggle to coordinate accommodation and vergence, leading in spatial awareness
ocular/visual subtype treatment
ocular motor training
physical exertion is ok
vestibular subtype risk factors
PMHx of car sickness/motion sensitivity
migraine
anxiety
vestibular subtype symptoms
vertigo dizziness nausea overwhelmed in visually-stimulating environments balance impairments
what symptoms is the biggest complaint post concussion
dizziness - 55-80%
S/S of vestibular dysfunction
dizziness blurry vision nystagmus tinnitus vertigo hearing loss loss of balance/falls broad based stance sweating, N/V
vestibular subtype exam findings for a vestibular/ocular screen
VOR dysfunction
VOR suppression
+ smooth pursuit, saccades
vestibular subtype exam findings for a neurocog test result
difficulty with visual motor speed, rxn time
coexists with migraine and/or anxiety subtypes
vestibular subtype treatment
vestibular rehab
pharmacological
anxiety/mood subtype risk factors
personal/family hx of anxiety, migraine, vestibular disorders
anxiety/mood subtype symptoms
ruminative thoughts hyper-vigilant fastidious easily overwhelmed difficulties initiating/maintaining sleep
anxiety/mood subtype exam findings?
vestibular - normal
neurocog - normal
anxiety/mood subtype treatment
psychotherapy treat other subtypes if present structured training cog behavior training regulated schedule meds
post traumatic migraine subtype risk factors
personal or family hx of migraine, “ice cream HA,” motion sensitivity, vestibular disorder, anxiety
post traumatic migraine subtype symptoms
variable HA
nausea, photo and/or phonophobia
stress, anxiety, lack of exercises
sleep dysregulation
when do you see photosensitivity
post traumatic migraine
what is a migraine
neurovascular event
failure of central modulation of trigeminovascular system
how many pt will experience a preceding aura with a post traumatic migraine
1/3
post traumatic migraine exam findings for vestibular/ocular screens
normal
post traumatic migraine exam findings for neurocog test results
verbal and visual memory deficits
post traumatic migraine treatment
meds
diet
stress management
avoid triggers
cervical subtype risk factors
prior c-spine injury
high velocity injury
strong rotational component to injury
cervical subtype symptoms
neck pain, stiffness, soreness
HA radiating forward from upper cervical spine
cervical subtype exam findings
all normal except + cervical screen
cervical subtype treatment
imaging cervical stabilization exercises meds injection/nerve block massage, acupuncture
what are the top 10 most reported symptoms in post concussive athletes in order from most to least
HA feeling slowed down difficulty concentrating dizzy fogginess fatigue visual blurring/double vision light sensitivity memory dysfunction balance probs
when do you start seeing recovery
80-90% within first 10-14 days
how long would full recovery take
21-28 days
recovery from sports related injury in adolescents takes how long
4 weeks
what aids in return to sport without prolonged sequelae
early identification of impairments
what are 6 predictors of prolonged recovery
initial symptoms sex - female age loss of consciousness post traumatic amnesia premorbid comorbidities
