Concussion Flashcards
What % of concussions are non sport related?
83.5%
Definition of Concussion
Brain injury that is a complex pathophysiological process affecting the brain, induced by biomechanical fores
What is the mechanism of injury fora cuncussion?
Acceleration/deceleration forces
What happens to axons during an acceleration/deceleration injury?
Axonal stretching and deformation of the cell membrane
What % of concussions involve LOC?
4-10%
What is the onset and resolution of concussion symptoms?
Rapid onset of short-lived impairment of neurological function that resolves spontaneously
What are concussion impairments due to?
Due to functional disturbance, not structural
What is the PSI of a hurricane? Blast?
Hurricane-.25 psi (200 km/hr)
Blast-100psi (2,414 km/hr)
What types of injuries do you usually see with blast injuries
Secondary and tertiary
What is a secondary blast injury?
Ballistic wounds produced by primary fragments
What are tertiary blast injuries?
Blast wave propels individuals onto surfaces/objects onto individuals causing whole body translocation
Crush injuries
What affects the severity of the blast injury?
Initial strength of the blast
Environment
How does the environment affect the severity of blast injury?
Open space less trauma than closed space
Less damage in air than water
Distance from blast (3 meters 9x more pressure than someone 6 meters away)
Can you see concussion impairments on imaging?
No
Are neurons destroyed with a concussion?
They are dysfunctional not destroyed so they can repair
What happens to the energy demands after concussion?
You have a decreased blood supply but the energy and metabolic demands are increased which leads to a metabolic crisis and inflammation
What are some concussion symptoms?
MANY
headache, nausea, vomiting, balance problems, fatigue, dizziness, sleep problems, light/noise sensitivity, sadness many more
What system do some people think is damaged with a concussion?
The reticular activating system
What is a function of the reticular activating system?
Primitive brainstem complex where all systems travel through
involved in sleep/wake, posture, equilibrium
eye movements/gaze
How does age affect healing from concussions?
Over age 12, the older you are, the faster you heal
Which concussion symptom clusters do PT’s mostly deal with?
Vestibular, occular, and cervical
What are some computer-based neurocognitive tests?
Cogsport
headminders
ANAM
ImPactq
What is retrograde amnesia?
Loss of memory of events that happen before injury
What is post-traumatic amnesia?
Amnesia of events that happen after trauma
What is VOMS?
Vestibular/Ocular motor screening for concussion
What does VOMS test for?
Tests for saccades, VOR, S.P. and the symptom provocation to each one
What visual ability might be impaired in concussion patients?
Convergence
What is normal near point of convergence?
6-10 cm with corrected vision
What is the BESS test?
3 postures (feet tog, single limb, tandem) on firm/foam eyes closed for 20 sec
What condition on the CTSIB is often impaired in patients with concussions?
Conditions with dome over head
What is an ocular misalignment?
When you take away the focal point, the eye drifts out to where it wants to go
Why do you perform a cervical spine assessment with concussion patients?
Many are whiplash injuries
may have cervicogenic dizziness
What are you testing with a VOR head thrust test?
Labrtinthine concussion
Why might whiplash be a missed diagnosis with a concussion and vice versa?
Similar symptoms
How many G’s are sufficient to generate a whiplash injury?
14 G’s
What type of hits usually result in concussion?
Usually have a rotary component
What is the recovery by 3 weeks with a concussion?
Thought that by 3 weeks, 80% are recovered, but if you actually exert the patieients, they may still present with symptoms (so not fully healed)
What are symptoms that predict a poorer outcome?
3-7 days post concussion foggy feeling difficulty concentrating vomiting dizziness
Which on field symptom predicts protracted recovery from concussion?
Dizziness
What are ways used to describe dizziness?
off balance
lightheadedness
spinning nausea
sensation of motion
What is the PT intervention for postural control retraining?
- Sensory integration by reducing visual over-reliance and increase use of vestibular inputs
- Include cervical position sense training
- exertional training
How should activities be modified with concussion?
Need to educate patient to help find out what are causing symptoms. Journaling may help.
What are the gudelines for PT treatment?
Begin slowly
monitor symptom response
progress slowly
monitor activity
What are some vestibular rehab exercises?
Gaze stability exercises
oculomotor training exercises
Sensory integration exercises
Visual motion sensitivity exercises (graded exposure)
How many times/day should you perform gaze stability exercises?
10 reps–> 30 reps
2–>3 x a day
How do you progress gaze stability exercises
Large-->small target size Near-->far target Simple-->complex background Supported siting-->standing Firm-->compliant support surface wide-->narrow BOS
What do you use Brock’s string for?
Oculomotor training for
Voluntary eye movements
Vergence eye movements
What is considered error with cervical position sense training?
> 2 3/4 inches from target
When do you start exertional training?
Only when the individual is symptom free at rest (no headache/dizziness)
5 stages of exertional training?
30-40% max heart rate 40-50% max heart rate 60-80% max heart rate 80-90% max heart rate Full exertion
What happens if symptoms persist with exertional training?
Revert to previous level of exertion
When can you return to sport?
go through all 5 stages of exertional training and symptom free on neurocog testing
What is second impact syndrome?
Catastrophic cerebral edema after an apparent mTBI/concussion
usually 2 hits in close succession
often FATAL and usually in young adults (, ~26 yo)
What is CTE?
Neurodegenerative disease occuring years or decades after recovery from acute affects of head trauma, insidious onset in mid-life with a gradual course
What protein is found in CTE?
Tau protein
