Concussion Flashcards
Define concussion
- mild traumatic brain injury
- complex pathophysiologic process affecting the brain, induced by traumatic biomechanical forces
- leads to complex cascade of ionic, metabolic, and physiologic events that may affect cerebral function for several days to weeks
What are some neurometabolic changes that occur with concussions
- decreased blood flow
- increase in glucose metabolism, followed by hypometabolism
- increase in extraneuronal potassium
- increase in intraneuronal calcium
- increase in glutamate (excitoxicity)
- decrease in GABA
Incidence of concussions in miltary and sports
- military: about 12% report symptoms consisted with blast reatled mTBI
- sports: between 1.6 and 3.8 million sports related mTBIs occur annually in the US
What is required for a diagnosis of concussions
- does NOT need to include loss of consciousness (most do not)
- post traumatic amnesia
- altered mental status
- may occur several hours after concussion
- glasgow coma scale 13-15 < 13 = need imaging for bleed
not all needed
Most common signs of a concussion
- cognitive and or mood changes
- disorientation
- blank or vacant look
- postural control and balance impairemnts
based on symptoms
what are some postural control or balance impairments with concussion
- lying motionless
- slow to get up
- balance dysfunction
Most common reported symptoms of concussion
- headache or migraine
- dizziness
- nausea
- fatigue
- sleep distrubance
- blurred vision
- light sensitivity
- tinnitus
imaging for concussion
- usually not necessary
- indicated if recovery is slower than expected, decline in function or other injuries expected
CT vs MRI
CT is often used acutely (quicker)
MRI is better at detecting axonal damage/small microhemorrhages
What are some signs that imaging may be necessary
- deteriorating level of consciousness
- repeated vomiting
- diplopia
- agitation
- seizures
- severe or worsening headache
- glasgow coma scale < 13
What are some other images for. concussion
- brain scope
- EEG
- magnetoencephalography (MEG)
PT concussion screening role
- must screen for presence or absence of symptoms, impairments and activity limitations
- must screen patients for signs of medical emergency or severe pathology
PT history and intake for concussion
- PMH
- review of mental health history
- injury-related mechanism
- injury-related symptoms
- early management strategies
differential diagnosis: what type of information can aide with dx
- must evaluate for potential signs and symptoms of an undiagnosed concussion
- triangulation of information from patient/family/witness reports
- patient’s PMH
- physical observation/exam
- use of an age-appropriate symptom scale/checklist
what are some concussion assessments/outcome measures
- self-report: graded symptom checklist
- objective: performance-based: BESS, SCAT-5
- computerized neuropsycholgical assessment
BESS: balance error scoring system; SCAT-5 sports concussion assessment tool
assessment for concussion in military
- military acute concussion evaluation - 2
- neurobehavioral symptoms inventory
Additional screens for PTs
concussion
- mental health
- congitive impairment
- other potential coinciding diagnosis
- refer for additional evaluation and services as indicated
Types of concussion
- cognitive/fatigue
- vestibular
- ocular
- post-traumatic migraine
- cervical
- anxiety/mood
PT examination considerations with concussion
- C/S and T/S
- dix-hallpike
- autonomic dysfunction: orthostatic hypotension, graded exercise test
- vestibular and oculomotor function
- balance, including dual task performance
- headahces, fatigue, dizziness, vertigo
- self-efficacy/self management
