Concussion

Question 1

T/F: the majority of concussions are sports related.

Answer 1

False. 83.5% non.

Question 2

What is the typical mechanism of injury for concussion?

Answer 2

Acceleration / deceleration

• blast
• blow to body
• blow to head

Question 3

T/F: With concussion, imaging is abnormal.

Answer 3

False, it’s normal.

Question 4

What is a typical blast wave pressure?

Answer 4

100 psi

Question 5

What environmental aspects make blast injury more damaging?

Answer 5

• closed versus open space
• in water versus air
• distance from blast

Question 6

With mechanical trauma, there is deformation of the cell membrane and neurometabolic changes. Why doesn’t this show up on imaging?

Answer 6

Neurons are dysfunctional, not destroyed.

Question 7

What factors lead to the metabolic crisis and inflammation seen in concussion?

Answer 7

Increased energy demand with decreased blood supply.

Question 8

What does the reticular formation control? Categorize by ascending and descending tracks.

Answer 8

ASCENDING

• Arousal
• Attention
• Sleep/wake

DESCENDING

• Posture
• Equilibrium
• Autonomic function

Question 9

Name 4 risk factors for concussion.

Answer 9

1. Female
2. Age (younger is greater)
3. Previous concussion
4. Level of play (pro is better)

Question 10

What are the 3 symptoms that PTs treat in concussion?

Answer 10

1. Vestibular
2. Cervical
3. Ocular

Question 11

Of the 4 computer-based neurocognitive tests (Cogsport, Headminders, ANAM, ImPact), which is most accessible and widely used?

Answer 11

ImPact.

Question 12

T/F: An unanticipated blow results in greater severity of concussion?

Answer 12

True.

Question 13

When administering a Vestibular/Ocular Motor Screening for concussion, what do you typically see with saccades and smooth pursuit?

Answer 13

Saccadic overshooting and smooth pursuit breakdown.

Question 14

What is normal convergence (point at which target becomes double)?

Answer 14

6-10cm

Question 15

What do PTs want to examine wrt ocular function after concussion?

Answer 15

Convergence
VOR cancellation
CTSIB

Question 16

Why is the CTSIB used for people with concussion?

Answer 16

Sensory integration problems

Question 17

What types of abnormal ocular findings are present with concussion?

Answer 17

Gaze-evoked nystagmus

Ocular misalignment

Question 18

Why do we see gaze evoked nystagmus?

Answer 18

central, problem with neural integrator

Question 19

Physical therapy examination should include what tests to rule in / out other possible pathology?

Answer 19

1. Dix-Hallpike for BPPV
2. Cervical Spine Assessment for whiplash, cervicogenic dizziness
3. VOR with headthrust for labyrinthine concussion

Question 20

What cluster of symptoms does whiplash present with? These are also common findings for concussion.

Answer 20

Headache
Balance problems
Dizziness
Fatigue
>sleep
Numbness and tingling

Question 21

Do people who have had >1 previous concussion recover faster or slower than those experiencing their first?

Answer 21

Slower.

Question 22

What concussion symptoms predict a poor outcome?

Answer 22

Foggy feeling
Difficulty concentrating
Vomiting
Dizziness

Question 23

What onfield symptom predicts protracted recovery time?

Answer 23

Dizziness

Question 24

Does migraine usually occur in central vestibular or peripheral disorders?

Answer 24

Central

Question 25

What is the most valuable PT intervention with concussion?

Answer 25

Activity modification and patient education.

Question 26

T/F: It is important to begin and progress slowly with concussion management to minimize symptom provocation?

Answer 26

True.

Question 27

What exercises would you use in vestibular rehab?

Answer 27

``` Gaze stability (X1) Oculomotor (Brock's string) Sensory integration (manip inputs while changing balance) ```

Question 28

How is treating concussion different than vestibular hypofunction?

Answer 28

Less reps, less often | Training for improved processing, not motor learning

Question 29

As the patient progresses, what movement is important to incorporate?

Answer 29

Head movements, especially if they provoked dizziness in the past.

Question 30

When rehabing concussion, the cervical spine is important. Manual therapy, ROM, balance retraining and what other category are important?

Answer 30

Cervical proprioception and oculormotor

Question 31

When can exertional training resume?

Answer 31

When symptom free at rest. - no dizziness - no headache

Question 32

When is return to play safe?

Answer 32

``` Symptom free -at rest -with exertion No meds Back to neurocog baseline ```

Question 33

What is second impact syndrome?

Answer 33

Catasprophic cerebral edema after 2nd mild TBI is close succession - Coma and severe neuro deficits - Age <26

Question 34

How long does chronic traumatic encephalopathy occur after intital injury?

Answer 34

years or decades later | -repeated axonal perturbations