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CATA 437 final > Concussion > Flashcards

Concussion Flashcards

1
Q

what is a concussion

A

TBI caused by a direct blow to the head, neck or body resulting in an impulsive force being transmitted to the brain that occurs during sport or exercise

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2
Q

concussion impact types

A

direct contact

inertial contact (acceleration)

shear forces caused by rotational acceleration (primary predominant mechanism of concussion)

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3
Q

primary mechanism of concussions

A

shear forces caused by rotation

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4
Q

concussion mechanism determined by

A

amount of mechanical energy from acceleration transferred to the brain and vascular tissue

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5
Q

which population sustains more concussions

A

high school athletes > college

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6
Q

physiology of concussion

A

acceleration/deceleration = injury
nerve is deformed = shearing and stretching motion

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7
Q

physiology cascade of events

A
  1. neurotransmitters are released and influx of ions
  2. binding of glutamate to excitatory amino acids receptor
  3. leads to further neuronal depolarization with efflux of potassium and calcium
  4. the Na+ K+ pump works in overtime to try and restore neuronal membrane
  5. this requires increased use of ATP
  6. increase in glucose metabolism “hyper-metabolism” + diminished cerebral blood flow = cellular energy crisis !
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8
Q

most important part of physiology

A

energy crisis

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9
Q

what impairs the mitochondria, ATP production, and neural connectivity

A

calcium

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10
Q

what does calcium accumulation do

A

can directly activate pathways leading to cell death

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11
Q

what are changes in the brain metabolism following a concussive episode called

A

metabolic vulnerability

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12
Q

second impact syndrome

A

second head injury (hit) before the complete recovery of the initial injury

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13
Q

second impact syndrome physiology

A

results from the dysfunctional cerebral blood flow autoregulation leading to increased intracranial pressure
herniations = rapid pressure develop and deterioration and leading to death within 2-5min

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14
Q

concussion prevention

A

neck strength
ability to actively engage neck muscles and resist linear/rotational acceleration (neuromuscular training)

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15
Q

helmets and mouthguards

A

may help but more research is needed

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16
Q

symptoms of concussion may develop within

A

48-72 hours

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17
Q

% of people who experience persistent symptoms

A

up to 30% of children and adults

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18
Q

how much time do persistent symptoms last on average

A

2 weeks + for adults
4 weeks+ for children

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19
Q

what are persistent concussion symptoms associated with

A

mental health problems
declines in QOL
difficulties returning to sport, school and ADLs

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20
Q

risk factors for concussion outcomes

A

history of concussions
history of migraines
diagnosis of learning disability or ADHD
sex ( more females)
age (younger)

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21
Q

does a SCOAT6 replace a clinical assessment

A

no

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22
Q

what does the scat 6 include

A

symptoms
cognitive recall
BP
cervical evaluation
neuro exam
timed tandem gait
modified VOMs

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23
Q

what is the most commonly reported symptom during clinical assessments?

A

75% of patients experience headaches.

dizziness at time of injury AND migraines in the first week post injury BOTH require special attention

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24
Q

how do you evaluate symptoms

A

combination of self reported questionnaires and clinical interview questions

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25
Q

what do you categorize symptoms into

A

trajectories

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26
Q

what are the different trajectories

A

vestibular
ocular-motor
cognitive
post-traumatic migraines
cervical
anxiety/mood

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27
Q

S/S - cognitive

A

fatigue
decreased energy levels
non-specific H/A (increase with cognitive activity)
sleep disturbances
difficulty concentrating

symptoms increase at the end of the day

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28
Q

vestibular - S/S

A

dizziness
foggines
nausea
feeling of being detached
anxiety
overstimulation

29
Q

what increases vestibular S/S

A

busy environments
rapid head and body movements

30
Q

Ocular motor -S/S

A

localize
frontally based headaches
fatigue
distractibility
difficulties with visually based classes
pressure behind the eyes
difficulty with focus

31
Q

what can intensify symptoms - ocular motor

A

full days of work or school

32
Q

common complaints

A
33
Q

anxiety mood - S/S

A

anxiety
ruminative thoughts
hypervigilance
feelings or being overwhelmed
sadness
hopelessness
sleep distrubances
headaches
dizziness
fogginess
fatigue

34
Q

what needs to be treated before anxiety

A

vestibular symptoms

35
Q

post traumatic migraine -S/S

A

unilateral headache
pulsating
photo/phono sensitivity
increased with physical activity

36
Q

what exacerbates symptoms with post traumatic migraine

A

stress
sleep dysregulation
anxiety
emotional changes
caffeine

37
Q

differentiating headaches - vestibular migraines

A

NS problem that causes repeated dizziness
may have H/A

38
Q

differentiating headaches - cervicogenic

A

secondary H/A
referred pain caused by cervical spine dysfunction
reduced ROM of neck
increased S/S with movement of the C/S

39
Q

differentiating headaches - concussion

A

H/A that develops within 7 days post injury or after regaining consciousness
resembles a migraine
C1-3 and trigeminal nerve lead to referred hemi cranial pain

40
Q

cervical - S/S

A

headache and neck pain

41
Q

can have a concussion without C/S affected

A

yes but very rare

42
Q

tests to help differentiate C/S injury from concussion

A

cervical joint reposition error test
smooth pursuits neck torsion
flexion-rotation test
head-neck differentiation test
motor control

43
Q

purpose of smooth pursuits neck torsion test

A

test cervical spine
stimulates cervical proprioceptors NOT vestibular

44
Q

+ve smooth pursuits neck torsion

A

symptoms increase with head rotation in comparison to neutral position
(rotation side is side of the problem)

45
Q

purpose of cervical joint position error test

A

looks a proprioceptive abilities

46
Q

purpose of flexion rotation test

A

dysfunction in the C0-C2 to help determine C/S dysfunction and cervicogenic headaches

47
Q

+ve flexion rotation test

A

firm resistance
pain
limited ROM

48
Q

common impairment following concussion

A

vestibular and ocular motor

49
Q

symptoms of vestibular impairement

A

unstable vision
difficulty focusing
motion discomfort
difficulty in visual environments
imbalance and dizziness

50
Q

VOMS

A

smooth pursuits
vertical and horizontal saccades
near point of convergence
vestibulo-ocular reflex (VOR)
visual motion sensitivity (VMS)

51
Q

note changes in ___ with VOMS

A

headaches
dizziness
fogginess
nausea

52
Q

abnormal distance for near point convergence

A

> 6cm

53
Q

benign

A

not life threatening

54
Q

paroxysmal

A

comes in sudden, brief spells

55
Q

positional

A

it gets triggered by certain head positions or movement

56
Q

vertigo

A

a false sense of rotational movement

57
Q

benign paraoxymal positional vertigo

A

crystals dislodged to semicircle canals and interfere with normal fluid movement

58
Q

hallpike-dix text

A

patient long sitting with head rotated 30-45º
therapist holds head and pt is then assisted into supine position with head slightly below horizontal plane and position maintained for 30-60s

59
Q

orthostatic hypotension testing

A

helps differentiate causes of dizziness
take BP after 15 min of resting
take BP standing

60
Q

+ve test for orthostatic hypotension testing

A

2-3 min of standing a drop of 20 mmHg in systolic and/or 10 mmHg in diastolic

61
Q

Head impulse

A

assess angular vestibular ocular reflex

62
Q

buffalo concussion treadmill test

A
63
Q

conventional neuroimaging is what with concussions

A

90% normal

64
Q

brain CT of MRI

A

contribute little to concussion eval
should be used when suspicion of an intracerebral or sturctural lesion

65
Q

Functional MRI

A

demonstrates activation patterns that correlates with symptoms severity and recovery

66
Q

how much rest is too much

A

normal 24-48 hours
no optimal time yet

67
Q

neuroplasticity of the brain after concussion

A

injured brain tries to use another area for the same thing

68
Q

after 3 months of concussion symtoms still experienced, what occurs in the brain?

A

changes in neuroplasticity and becomes the body’s new norm

CATA 437 final (5 decks)

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