Concussion Flashcards
T/F: the majority of concussions are sports related.
False. 83.5% non.
What is the typical mechanism of injury for concussion?
Acceleration / deceleration
- blast
- blow to body
- blow to head
T/F: With concussion, imaging is abnormal.
False, it’s normal.
What is a typical blast wave pressure?
100 psi
What environmental aspects make blast injury more damaging?
- closed versus open space
- in water versus air
- distance from blast
With mechanical trauma, there is deformation of the cell membrane and neurometabolic changes. Why doesn’t this show up on imaging?
Neurons are dysfunctional, not destroyed.
What factors lead to the metabolic crisis and inflammation seen in concussion?
Increased energy demand with decreased blood supply.
What does the reticular formation control? Categorize by ascending and descending tracks.
ASCENDING
- Arousal
- Attention
- Sleep/wake
DESCENDING
- Posture
- Equilibrium
- Autonomic function
Name 4 risk factors for concussion.
- Female
- Age (younger is greater)
- Previous concussion
- Level of play (pro is better)
What are the 3 symptoms that PTs treat in concussion?
- Vestibular
- Cervical
- Ocular
Of the 4 computer-based neurocognitive tests (Cogsport, Headminders, ANAM, ImPact), which is most accessible and widely used?
ImPact.
T/F: An unanticipated blow results in greater severity of concussion?
True.
When administering a Vestibular/Ocular Motor Screening for concussion, what do you typically see with saccades and smooth pursuit?
Saccadic overshooting and smooth pursuit breakdown.
What is normal convergence (point at which target becomes double)?
6-10cm
What do PTs want to examine wrt ocular function after concussion?
Convergence
VOR cancellation
CTSIB
Why is the CTSIB used for people with concussion?
Sensory integration problems
What types of abnormal ocular findings are present with concussion?
Gaze-evoked nystagmus
Ocular misalignment
Why do we see gaze evoked nystagmus?
central, problem with neural integrator
Physical therapy examination should include what tests to rule in / out other possible pathology?
- Dix-Hallpike for BPPV
- Cervical Spine Assessment for whiplash, cervicogenic dizziness
- VOR with headthrust for labyrinthine concussion
What cluster of symptoms does whiplash present with? These are also common findings for concussion.
Headache Balance problems Dizziness Fatigue >sleep Numbness and tingling
Do people who have had >1 previous concussion recover faster or slower than those experiencing their first?
Slower.
What concussion symptoms predict a poor outcome?
Foggy feeling
Difficulty concentrating
Vomiting
Dizziness
What onfield symptom predicts protracted recovery time?
Dizziness
Does migraine usually occur in central vestibular or peripheral disorders?
Central
What is the most valuable PT intervention with concussion?
Activity modification and patient education.
T/F: It is important to begin and progress slowly with concussion management to minimize symptom provocation?
True.
What exercises would you use in vestibular rehab?
Gaze stability (X1) Oculomotor (Brock's string) Sensory integration (manip inputs while changing balance)
How is treating concussion different than vestibular hypofunction?
Less reps, less often
Training for improved processing, not motor learning
As the patient progresses, what movement is important to incorporate?
Head movements, especially if they provoked dizziness in the past.
When rehabing concussion, the cervical spine is important. Manual therapy, ROM, balance retraining and what other category are important?
Cervical proprioception and oculormotor
When can exertional training resume?
When symptom free at rest.
- no dizziness
- no headache
When is return to play safe?
Symptom free -at rest -with exertion No meds Back to neurocog baseline
What is second impact syndrome?
Catasprophic cerebral edema after 2nd mild TBI is close succession
- Coma and severe neuro deficits
- Age <26
How long does chronic traumatic encephalopathy occur after intital injury?
years or decades later
-repeated axonal perturbations
