Concussion Flashcards
what are some focal traumatic injuries
-subdural hematoma
-epidural hematoma
what are some diffuse traumatic injuries
-concussion
-diffuse axonal injury
-hypoxia anoxia
what are the clinical subtypes of concussion
- cervical
- vestibular
- ocular
- cog/fatigue
- post traumatic migraine
- anxiety/mood
what is a concussion
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
what type of TBI is a concussion
mild
what are the causes of TBI
- falls
- MVA
- other
is concussion mechanism physiological or structural
physio
what happens to the brain wtih concussion
-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
what is the prognosis
-typical recovery 24 hours, up to 7-10 days
-prolonged recovery is 10-30 days
-persistent sytoms resulting in post consusion syndrome >30 days
what are poor prognostic factors of a concussion
- severity of acute and subacute symptoms
- prior history of concussion
- posttraumatic migraine
- history of anxiety, depression or ADHD
- dizziness
- cog deficits in first few days
- females
- impact/collision sports
talka bout dizziness and vestibualr dysfunction
-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
what is the risk of repeat concussion
increases 3x after first event
what is Post-concussive syndrome
-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
what is chronic traumatic encephalopathy
-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
what are some somatic symptoms
-headache
-nausea
-vomit
-balance problems/dizzy
-sensitity to light and noise
-N/T
-blurred vision
what are some neurobehavioral symtpmos
-drowsy
-fatigue
-sad
-nervous
-sleeping more than usual
-trouble falling asleep
what are some cognitivie symptoms
-feelin slow
-feelin in a fog
-difficulty concentraintg
-hard to rememember
what does SCAT-5 do
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
what does SAC measure
- orientation
- immediate memory
- neurologic function
- concentration
- delayed recall
what is rivermead post consussion symptoms scale
self administered
degree of sypmtoms within last 24 hours
high score is more problems
measures physical, cog, behaviors
what is ImPACT
computerized test that examines verbal/visual memory, brain processing speed, reaction time
what is the BESS
assesses static postural stability
all EC
what is the HiMAT
assesses pt with high level balance and mobility problems
13 items asssessing:
-walking and running
-jumping
-stairs
-hopping
-skipping
what is buffalo concussion TM test
-obtain resting HR, BP, VAS, RPE then repeat all of that every minute
seeing if symptoms worsen with CV exercise
what is the VOMS assessment
asses baseline headache, dizzy, nausea, fogginess
what are some red flags
-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
how can you test cervicogenic dizziness
- smooth persuit neck torsion test
- joint position error test
- head-neck rottion test
what does rehab look like
-acute concussion: symptom limited rest is best
-after 2 weeks, rest is detrimental
-exercise can be done at subsymptmo threshold
what is the biggest goal of the sideline assessment
-recognize risk and remove from play
-screen for red flags
what is return to learn
-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
what is the criteria for exercise progression
-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
