Concussion Flashcards
Concussion definition
functional disturbance rather than structural injury
“mild” TBI b/c not life threatening
alters neurometabolism
- increased metabolic demand
- cellular energy crisis
not visualized with imaging
Prior concussions history makes 3x more likely to sustain a second, 6x greater w/ +LOC
Poor prognostic indicators
Increased severity of acute and subacute symptoms is the most consistent predictor of slowed recovery
Dizziness (6.4x greater likelihood of prolonged recovery)
Post-concussive syndrome (PCS)
Persistence of at least 3 symptoms for > 4 weeks
SCAT-5
Sport concussion assessment tool
Gold standard
SAC
Standardized assessment of concussion
Orientation
immediate memory
neurologic function
concentration
delayed recall
Red flags
Immediate referral to ER
Cervical instability/fx
Spasticity
Reflex changes
Ataxia
Weakness
Sensory changes
CN abnormalities
Seizures
Prolonged LOC
Progressing headache
Altered mental status
HTN
Autonomic dysregulation
Additional warning signs
One pupil larger than the other
Drowsy or cannot be awakened
Worsening headache
Weakness, numbness, decreased coordination
Repeated vomiting/nausea
Slurred speech
Convulsions or seizures
Cannot recognize people or places
Increasing confusion/agitation
Unusual behavior
LOC
Exam
C-spine
Vestibular-oculomotor
Balance
BPPV
Symptoms w/ exertion
Cervicogenic dizziness PT exam
Head-neck rotation testing
Smooth pursuit neck torsion test
Neck proprioception
Endurance of deep neck musculature
Pain, ROM, muscle imbalance, c-spine strength
Return to sport guidelines
Free of concussion symptoms >24 hours
Attending full days of school
Tolerating full academic workload
Off any medications started for concussion
No same day RTP
More red flags!!
Neck pain or tenderness
Double vision
Weakness or tingling/burning in arms or legs
Severe or increasing headache
Seizure
LOC
deteriorating conscious state
vomiting
Increasingly restless, agitated, combative
