concussion Flashcards
what is the huge thing that changed from one consensus to another
ACTIVITIES THAT DO NOT PROVOKE AN INCREASE in symptoms
Used to say rest until symptoms are gone
Research is now supporting initial relative physical and cognitive rest for 24-48 hour rest followed by activities that do not increase symptoms
If they have a 3/10 headache before activity, activity must not increase this headache
definition of concussion
Typically results in a rapid onset of short lived impairment and neurological dysfunction that resolves spontaneously
Commonly see resolving symptoms within_ days with proper RTL and RTP protocols
7-10 days
Clinical variables associated with prolonged recovery and the development of PCS vary across studies but may include
Younger age
Female sex
Loss of consciousness or post-traumatic amnesia at the time of injury
A previous history of concussion
ADHD and mood dis-orders
Initial headache or dizziness at the time of injury
Delayed symptom onset
Initial symptom burden
what are the 3 subtypes of post concussion disorders
physiological (blood flow dysregulation)
vestibulo-ocular
cervicogenic
TIP to help concussion symptom
- Turn the blue light off on your devices (night shift mode iphone) linked to better sleep
- wear earplug
- slant board for reading -> 22º degree angle
what are the color of glasses that are most effective
blue -> green -> red -> purple
which color is the only one that did not provide relief of symptom
yellow
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
-Repeat what you heard the person say
what can you do to improve sleep hygiene
Regular sleep routine (fixed bedtime and wake time)
If you do not fall asleep within 30 minutes, get out of bed and do something relaxing. Return when you feel sleepy
After first few days after your concussion, try not to nap during the day (if nap needed 20-30 min x1)
At least 1 hour before bed do something relaxing (warm bath, reading a book, soothing music, deep breathing exercises)
Dark, quiet, cool room
Ear plugs or white noise machine/fan
Keep electronics out to the bedroom
Emotional symptoms such as sadness or depressed mood, nervousness or anxiety, irritability, fatigue, and difficulty sleeping are commonly reported among athletes and will spontaneously resolve typically within _
3-6 months
can persist for a year, 7-15% of patient with TBI
what are considered associated with development of PCS Psychiatrist outcome
Old age, female sex, premorbid psychiatric illness, anxiety sensitivity, cognitive biases and migraine headaches are considered associated with the development of PCS
what is the gold standard for psychological disorder
cognitive behavioral therapy
what is cognitive behavioral therapy
psychosocial intervention approach in which patients confront and modify the irrational thoughts and beliefs that are most likely at the root of their maladaptive behaviours.
Gold standard for psychological disorders
what is included in cognitive behavioral therapy
Self instructions (distraction, imagery, motivational self-talk)
Relaxation strategies
Biofeedback
Development of coping strategies (e.g. minimizing negative or self-defeating thoughts)
Changing maladaptive beliefs about pain
Goal setting
can CBT improve severity of symptom
It’s effect on PCS is still unclear for improving severity of symptoms
However it might be an effective treatment option for improving depression, anxiety and social integration in individuals with TBI
Cervicogenic Persistent Symptoms
Common S/S- HA, neck pain, dizziness
C0-C1 problems HA, vertigo, fatigue, poor concentration, irritability
C0-C2- often fascial connection issues
what is a cervicogenic PCS
Subtype of PCD that is mediated by isolated dysfunction of the neurological cervical spine system
Nociceptive fibers transmit important sensory information from cervical spine to the spinal cord, brainstem, and cerebellum
These interconnections form specialized reflexes including the cervicocollic, vestibulocollic, and cervico-ocular reflexes that help;
mediate head, gaze, and neck position sense, and stabilization during rapid head movements
what can cause 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
headache with cervicogenic PCD is located where
The headaches are often located in occipital area, and can radiate to the temples and eyes, and are frequently exacerbated by poor posture and neck-related activities such as weight training and running
can someone with cervicogenic PCD continue aerobic activity
yes
Rehabilitation of Cervicogenic PCD
Guiding local inflammation
Decreasing muscle spasm (suboccipitals, paraspinals)
Restoring ROM
Restoring communication between cervical spine, vestibular and oculomotor systems
Manual therapy, passive and active range of motion exercises, low velocity mobilizations, proprioceptive retraining, and exercises to strengthen the deep and superficial cervical musculature
which muscle would you want to release with cervicogenic PCD
suboccipital, paraspinal
Physiological persistent concussion patients typically present with
persistent headaches, dizziness, fatigue, and sensitivity to light that are exacerbated by PHYSICAL ACTIVITY
what can be the cause of physiological persistent concussion
Studies suggest alterations in cerebral metabolism, resting blood flow, cerebrovascular reactivity and neurovascular coupling
Autonomic Nervous System dysfunction/exercise intolerance
what happened with physiological persistent concussion patient that cesse exercise
is associated with reduced blood volume and cardiac stroke volume
Body compensates by INCREASING SNS activity to maintain oxygen delivery