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Neuro 4 (sam > Concussion > Flashcards

Concussion Flashcards

1
Q

What % of concussions are non sport related?

A

83.5%

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2
Q

Definition of Concussion

A

Brain injury that is a complex pathophysiological process affecting the brain, induced by biomechanical fores

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3
Q

What is the mechanism of injury fora cuncussion?

A

Acceleration/deceleration forces

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4
Q

What happens to axons during an acceleration/deceleration injury?

A

Axonal stretching and deformation of the cell membrane

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5
Q

What % of concussions involve LOC?

A

4-10%

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6
Q

What is the onset and resolution of concussion symptoms?

A

Rapid onset of short-lived impairment of neurological function that resolves spontaneously

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7
Q

What are concussion impairments due to?

A

Due to functional disturbance, not structural

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8
Q

What is the PSI of a hurricane? Blast?

A

Hurricane-.25 psi (200 km/hr)

Blast-100psi (2,414 km/hr)

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9
Q

What types of injuries do you usually see with blast injuries

A

Secondary and tertiary

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10
Q

What is a secondary blast injury?

A

Ballistic wounds produced by primary fragments

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11
Q

What are tertiary blast injuries?

A

Blast wave propels individuals onto surfaces/objects onto individuals causing whole body translocation
Crush injuries

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12
Q

What affects the severity of the blast injury?

A

Initial strength of the blast

Environment

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13
Q

How does the environment affect the severity of blast injury?

A

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)

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14
Q

Can you see concussion impairments on imaging?

A

No

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15
Q

Are neurons destroyed with a concussion?

A

They are dysfunctional not destroyed so they can repair

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16
Q

What happens to the energy demands after concussion?

A

You have a decreased blood supply but the energy and metabolic demands are increased which leads to a metabolic crisis and inflammation

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17
Q

What are some concussion symptoms?

A

MANY
headache, nausea, vomiting, balance problems, fatigue, dizziness, sleep problems, light/noise sensitivity, sadness many more

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18
Q

What system do some people think is damaged with a concussion?

A

The reticular activating system

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19
Q

What is a function of the reticular activating system?

A

Primitive brainstem complex where all systems travel through
involved in sleep/wake, posture, equilibrium
eye movements/gaze

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20
Q

How does age affect healing from concussions?

A

Over age 12, the older you are, the faster you heal

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21
Q

Which concussion symptom clusters do PT’s mostly deal with?

A

Vestibular, occular, and cervical

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22
Q

What are some computer-based neurocognitive tests?

A

Cogsport
headminders
ANAM
ImPactq

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23
Q

What is retrograde amnesia?

A

Loss of memory of events that happen before injury

24
Q

What is post-traumatic amnesia?

A

Amnesia of events that happen after trauma

25
Q

What is VOMS?

A

Vestibular/Ocular motor screening for concussion

26
Q

What does VOMS test for?

A

Tests for saccades, VOR, S.P. and the symptom provocation to each one

27
Q

What visual ability might be impaired in concussion patients?

A

Convergence

28
Q

What is normal near point of convergence?

A

6-10 cm with corrected vision

29
Q

What is the BESS test?

A

3 postures (feet tog, single limb, tandem) on firm/foam eyes closed for 20 sec

30
Q

What condition on the CTSIB is often impaired in patients with concussions?

A

Conditions with dome over head

31
Q

What is an ocular misalignment?

A

When you take away the focal point, the eye drifts out to where it wants to go

32
Q

Why do you perform a cervical spine assessment with concussion patients?

A

Many are whiplash injuries

may have cervicogenic dizziness

33
Q

What are you testing with a VOR head thrust test?

A

Labrtinthine concussion

34
Q

Why might whiplash be a missed diagnosis with a concussion and vice versa?

A

Similar symptoms

35
Q

How many G’s are sufficient to generate a whiplash injury?

A

14 G’s

36
Q

What type of hits usually result in concussion?

A

Usually have a rotary component

37
Q

What is the recovery by 3 weeks with a concussion?

A

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)

38
Q

What are symptoms that predict a poorer outcome?

A 
3-7 days post concussion
foggy feeling
difficulty concentrating
vomiting 
dizziness
39
Q

Which on field symptom predicts protracted recovery from concussion?

A

Dizziness

40
Q

What are ways used to describe dizziness?

A

off balance
lightheadedness
spinning nausea
sensation of motion

41
Q

What is the PT intervention for postural control retraining?

A
  • Sensory integration by reducing visual over-reliance and increase use of vestibular inputs
  • Include cervical position sense training
  • exertional training
42
Q

How should activities be modified with concussion?

A

Need to educate patient to help find out what are causing symptoms. Journaling may help.

43
Q

What are the gudelines for PT treatment?

A

Begin slowly
monitor symptom response
progress slowly
monitor activity

44
Q

What are some vestibular rehab exercises?

A

Gaze stability exercises
oculomotor training exercises
Sensory integration exercises
Visual motion sensitivity exercises (graded exposure)

45
Q

How many times/day should you perform gaze stability exercises?

A

10 reps–> 30 reps

2–>3 x a day

46
Q

How do you progress gaze stability exercises

A 
Large-->small target size
Near-->far target
Simple-->complex background
Supported siting-->standing
Firm-->compliant support surface
wide-->narrow BOS
47
Q

What do you use Brock’s string for?

A

Oculomotor training for
Voluntary eye movements
Vergence eye movements

48
Q

What is considered error with cervical position sense training?

A

> 2 3/4 inches from target

49
Q

When do you start exertional training?

A

Only when the individual is symptom free at rest (no headache/dizziness)

50
Q

5 stages of exertional training?

A 
30-40% max heart rate
40-50% max heart rate
60-80% max heart rate
80-90% max heart rate
Full exertion
51
Q

What happens if symptoms persist with exertional training?

A

Revert to previous level of exertion

52
Q

When can you return to sport?

A

go through all 5 stages of exertional training and symptom free on neurocog testing

53
Q

What is second impact syndrome?

A

Catastrophic cerebral edema after an apparent mTBI/concussion
usually 2 hits in close succession
often FATAL and usually in young adults (, ~26 yo)

54
Q

What is CTE?

A

Neurodegenerative disease occuring years or decades after recovery from acute affects of head trauma, insidious onset in mid-life with a gradual course

55
Q

What protein is found in CTE?

A

Tau protein

Neuro 4 (sam (7 decks)

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