Concussion Flashcards
initial rest
24-48 hours followed by activities that do not increase symptoms
concussion review
rapid onset of short lived impairment and neurological dysfunction that resolves spontaneously
resolving symptoms within
7-10 days with proper RTL and RTP protocols
what can be associated with persistent concussion symptoms
younger age
female
LOC or post traumatic amnesia at the time of injury
previous history of concussion
ADHD and mood disorders
initial H/A or dizziness at the time of injury
delayed symptoms onset
initial symptom burden
3 categories of post concussion disorder that we focuse on
physiological (BF dysregulation)
vestibulo-ocular
cervicogenic
starting rehab tips
turn the blue light off on devices
wear earplugs if sound sensitive
slant board for reading
coloured glasses
blue most effective followed by green, red and purple
for photophobia
tips for increasing concentration
- work at only 1 task at a time
- reduce distractions when you are concentrating
- give yourself more time to complete tasks
- choose a time when your energy level is at its best
- avoid or limit your contact with noisy or busy places
- maintain good eye contact to stay focused during conversations
sleep hygiene
regular sleep routine
try not to nap during the day
do something relaxing 1 hour before bed
dark quiet cool room
ear plugs, white noise
keep electronics out bedroom
what to do if you cant fall asleep within 30 min
do something relaxing until feel sleepy
post-traumatic psychiatric outcomes typically resolve within
3-6 months
can persist to 1 year
what is associated with the development of PCS
old age
Female
premorbid psychiatric illness
anxiety
cognitive biases
migraines H/A
cognitive behavioural therapy
psychosocial intervention approach in which pt confronts and modify the irrational thoughts and beliefs that are most likely at the root of their maladaptive thoughts
what is the gold standard for psych disorders
CBT
cervicogenic persistent symptoms - S/S
HA
neck pain
dizziness
referred pain
compression of n. roots
dec in BF
cervicogenic persistent symptoms - C0-C2 problems
C0-C1: HA, vertigo, fatigue, poor concentration, irritability
C0-C2: often fascial connection issues
whiplash MOI causes what
C/S implications
strains/spasm
facet joint contusions, sprain
Cervicogenic PCS
subtype of PCD that is mediated by isolated dysfunction of the neurological cervical spine system
nociceptive fibers transmmit important sensory info from C/S to spinal cord, brainstem and cerebellum
cervicogenic post concussion disorder
trauma or persistent muscle spasm affecting the deep and superficial cervical and sub-occipital muscles can also lead to irritation and impingement of the sensory nerves that innervate the neck and posterior scalp leading to cervicogenic headaches and occasionally occipital neuralgia
cervicogenic PCD common S/S
neck pain and stiffness
fatigue
fogginess
dizziness
where are the HA located with cervicogenic
occipital area, can radiate to the temples and eyes
cervicogenic- what makes HA worse
poor posture and neck related activities such as weight training and running
Rehab for cervicogenic
guiding local inflammation
dec. muscle spasm
ROM
restoring communication btw C/S, vestibular and oculomotor systems
manual therapy
optimal rehab for cervicogenic
manual therapy
PROM, AROM
low velocity mobs
proprio
strengthening of deep and superficial neck m.
physiological approach of rehab for PCS
recommended tailored submax exercise program
can early controlled aerobic exercise be safe post concussion
yes
may not always decrease S/S and duration
can help improve physiological state
what does research suggest with neurological recovery in physiological PCD
may be mediated by improvement of CO2 sensitivity, resting CBF, and cerebrovascular reactivity
submax aerobic activity recommendation
80-90% of HR during graded aerobic testing on treadmill 1x/day 20 min 5-6x/week
goal of aerobic exercise
adequate stimulation to facilitate positive physiological response
HR max for trained vs untrained individuals
60-70%
40-50%
HRmax= 208 - 0.7 x age
buffalo concussion treadmill test
3..6mph 5’5’’ or taller, otherwise 3.2 mph
increase incline 1% every 1min
max incline 15deg
then increase 0.4mph every min
pt rate RPE and symptom severity
terminated buffalo
max exertion reached or 3 point increase on likert scale or rapid progression of symptoms or pt report unable to continue
vesitublo-ocular PCD
dysfunction of vestibular and oculomotor systems
oculomotor and vestibular systems control
balance
posture
gaze stability
what can help with stress and fear
improving peripheral vision
clinical predictors of vestibulo-ocular dysfunction
female
pre-injury depression
post-traumatic amnesia
dizziness
blurred vision
difficulty focusing at the time of the injury
patients with vestibulo-ocular PCD can present with deficits in
impairments in convergence
accomodation
smooth pursuits
saccades
VOR
BPPV
S/S of vestibulo-ocular
dizziness
intermittent blurred vision or diplopia
difficulty focusing or concentrating
fogginess
motion sensitivity
postural imbalance
HA
Key visual skills for sport
gaze stabilization
ability to maintain visual acuity while the body/head is in motion
postural stability
ability to maintain upright posture, balance and equilibrium in response to body movements
motion sensitivity
information about the position and movement of the head in space
progression of visual and vestibular exercises
brock string
vision therapy tool
learn to use eyes together more effectively
vestibulo-ocular motor screen as rehab
smooth pursuits
saccades
near point of convergence
VOR
visual motion sensitivity
1min 2-3x/day
what are you assessing when doing rehab
HA
dizziness
fogginess
nausea
see ppt for exercises
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