Concussion

Question 1

what are some focal traumatic injuries

Answer 1

-subdural hematoma
-epidural hematoma

Question 2

what are some diffuse traumatic injuries

Answer 2

-concussion
-diffuse axonal injury
-hypoxia anoxia

Question 3

what are the clinical subtypes of concussion

Answer 3

1. cervical
2. vestibular
3. ocular
4. cog/fatigue
5. post traumatic migraine
6. anxiety/mood

Question 4

what is a concussion

Answer 4

TBI induced by biomechanical forces
-caused by direct blow to head, face or neck or indirect blow that transmits forces to head

-clinical signs reflect a functional disturbance rather than a structural injury
-may or may not result in loss of consciousness

Question 5

what type of TBI is a concussion

Answer 5

mild

Question 6

what are the causes of TBI

Answer 6

1. falls
2. MVA
3. other

Question 7

is concussion mechanism physiological or structural

Answer 7

physio

Question 8

what happens to the brain wtih concussion

Answer 8

-alters neuronal membrane
-increase cell demand for ATP
-increase glucose demand
-deregulation of blood flow in brain
-metabolic demand may be greater than supply
-results in altered cog functino, sensory interpretation etc

Question 9

what is the prognosis

Answer 9

-typical recovery 24 hours, up to 7-10 days
-prolonged recovery is 10-30 days
-persistent sytoms resulting in post consusion syndrome >30 days

Question 10

what are poor prognostic factors of a concussion

Answer 10

1. severity of acute and subacute symptoms
2. prior history of concussion
3. posttraumatic migraine
4. history of anxiety, depression or ADHD
5. dizziness
6. cog deficits in first few days
7. females
8. impact/collision sports

Question 11

talka bout dizziness and vestibualr dysfunction

Answer 11

-common after concussion and can result in a 6.4x greater likelihood of prolonged recovery
-can be a result of visual, peripheral and central vestibular disturbances, neck tightness
-imbalance and gaze stability defiicits common in athletes

Question 12

what is the risk of repeat concussion

Answer 12

increases 3x after first event

Question 13

what is Post-concussive syndrome

Answer 13

-persistence of at least 3 symptoms for >4 weeks
-can be related to neuroinflammation and altered cerebral blood flow
-may be more likely in person with previous TBI

Question 14

what is chronic traumatic encephalopathy

Answer 14

-diagnosed after death w autopsy
-degenerative brain tissue found in athletes, vetereans nad others with repeated brain trauma
-families may report mood, behavioral, or cog changes that progressively develop

Question 15

what are some somatic symptoms

Answer 15

-headache
-nausea
-vomit
-balance problems/dizzy
-sensitity to light and noise
-N/T
-blurred vision

Question 16

what are some neurobehavioral symtpmos

Answer 16

-drowsy
-fatigue
-sad
-nervous
-sleeping more than usual
-trouble falling asleep

Question 17

what are some cognitivie symptoms

Answer 17

-feelin slow
-feelin in a fog
-difficulty concentraintg
-hard to rememember

Question 18

what does SCAT-5 do

Answer 18

gold standard for concussion eval
-performed on athletes 13-65
-looks at….:
1. GCS
2. maddocks score
3. symptom eval
4., cog and physical eval
5. neck exam
6. balance
7. coordination
8. delayed recall

supposed to be performed within 24 hours of injury

Question 19

what does SAC measure

Answer 19

1. orientation
2. immediate memory
3. neurologic function
4. concentration
5. delayed recall

Question 20

what is rivermead post consussion symptoms scale

Answer 20

self administered
degree of sypmtoms within last 24 hours
high score is more problems

measures physical, cog, behaviors

Question 21

what is ImPACT

Answer 21

computerized test that examines verbal/visual memory, brain processing speed, reaction time

Question 22

what is the BESS

Answer 22

assesses static postural stability
all EC

Question 23

what is the HiMAT

Answer 23

assesses pt with high level balance and mobility problems
13 items asssessing:
-walking and running
-jumping
-stairs
-hopping
-skipping

Question 24

what is buffalo concussion TM test

Answer 24

-obtain resting HR, BP, VAS, RPE then repeat all of that every minute

seeing if symptoms worsen with CV exercise

Question 25

what is the VOMS assessment

Answer 25

asses baseline headache, dizzy, nausea, fogginess

Question 26

what are some red flags

Answer 26

-cervical instabilty
-neurologic signs
-proloonged LOC
-HA that is progressing
-altered mental status
-HTN
-autonomic dysregulation
-one pupil larger
-drowsy/cant be waken
-weak,numb, loss of coordination
-repeated vomiting/nausea
-slurred speech
-convulsions or seizures
-cannot recognize people or places
-becomes confused
-unusual behvaior
-unconsoiusness

Question 27

how can you test cervicogenic dizziness

Answer 27

1. smooth persuit neck torsion test
2. joint position error test
3. head-neck rottion test

Question 28

what does rehab look like

Answer 28

-acute concussion: symptom limited rest is best
-after 2 weeks, rest is detrimental
-exercise can be done at subsymptmo threshold

Question 29

what is the biggest goal of the sideline assessment

Answer 29

-recognize risk and remove from play
-screen for red flags

Question 30

what is return to learn

Answer 30

-24-48 hour period of rest followed by gradual return to activity
-encourage sub-symptomatci daily activity
-reduce screen time, reading, homework
-quality nutrition and hydratino
-avoid pain medications because they can mask symptoms
-contact with sfchool counselor

Question 31

what is the criteria for exercise progression

Answer 31

-decline in symptoms
-able to remain symptom free during aerobic training
-tolerating increaseing resistance with lifting
-incoroprate dual task and reaction time based training
-return to running, sprint etc without sypmtom exacertation