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711 Adult Neurological Rehab > Concussion > Flashcards

Concussion Flashcards

1
Q

How is the Biodex used?

A

Given to athletes before an injury to give a baseline. Then given after injury to assess all 3 sensory feedback systems and make a return to play decision.

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2
Q

What are some low cost and technology concussion assessment tools used in the clinic? (

A

BESS (Balance Error Scoring System), Modified CTSIB , HiMAT (High Level Mobility Assessment Tool). Dynamic Gait Index, Functional Gait Assessment, Visual Acuity/Dynamic Visual Acuity using Snellen Eye Chart

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3
Q

What are the 4 positions of the modified CTSIB? How long is each position held?

A
  1. Eyes open, solid surface. 2. Eyes closed, solid surface, 3. Eyes open compliant surface, 4. Eyes closed, compliant surface. Hold for 30 seconds
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4
Q

What do higher scores on the HiMat indicate?

A

Better mobility performance

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5
Q

Physical S&S of Concussion

A

HA, balance problems, light/noise sensitivity, blurred vision, dizziness, fatigue, nausea, neck pain

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6
Q

Cognitive S&S of Concussion

A

foggy, difficulty concentrating, confusion, delayed processing

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7
Q

Emotional S&S of Concussion

A

Irritability, sadness, nervousness, anxiety, lability

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8
Q

Sleep S&S of Concussion

A 
Drowsy, altered sleep patterns
May exacerbate of symptoms:
Irritability/anxiety
Depression
Poor concentration/attention
Delayed reaction time
Fatigue
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9
Q

APTA recognizes us for concussion management which includes…

A

Education

Examination/eval

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10
Q

H.R. 353(2) Protecting Student Athletes From Concussions Act of 2013 does what?

A 
Mandates school district concussion management plans: 
Prevention
ID
Treatment
Management
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11
Q

Coup-Contrecoup injury leads to

A

Axonal shearing/ Diffuse Axonal injury

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12
Q

Concussion symptoms worsen after initial axonal injury due to…

A

Metabolic crisis and release of large amount of neurotransmitters

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13
Q

Labyrinthine Concussion S&S

A

Ataxia, imbalance, potential BPPV

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14
Q

Blast Related TBI important S&S

A

Has the same S&S, especially noticeable are Dizziness, Balance problems, Vision Changes

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15
Q

In the Motion Sensitivity Quotient (MSQ) what score indicates mild impairment?

A

0-10

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16
Q

In the Motion Sensitivity Quotient (MSQ) what score indicates moderate impairment?

A

11-30

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17
Q

In the Motion Sensitivity Quotient (MSQ) what score indicates severe impairment?

A

31-100

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18
Q

Compensation is a response to a _____________ vestibular lesion.

A

permanent

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19
Q

What is compensation?

A

An increase in response of the remaining vestibular system in which the CNS changes to optimize function.

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20
Q

What are the functional goals of concussion rehab?

A

Decrease symptomatic complaints, Improved balance/increase gait speed/ decrease risk for falling, Improve vision during head movement, Improve quality of life

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21
Q

What is substitution?

A

Other strategies are used to replace lost or impaired function.

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22
Q

What are the protocols for utilizing substitution in rehab?

A

Progress from easy/static EO/EC to difficult/dynamic EO/EC.

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23
Q

What is the habituation method? How many provoking maneuvers should you chose to base your treatment on?

A

systematically provoke symptoms to produce reduction in those symptoms. Pick 2 or 3.

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24
Q

What are some convergence exercises?

A

Pencil Push Ups
Brock String
Arrow Chart/Dot Card

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25
Q

What are some cervical proprioceptive exercises?

A

Head Laser with Targets
Combine with Saccades
Eyes Closed awareness

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26
Q

What are the 6 stages to return to play?

A

Stage 1- Complete physical and cognitive rest
Stage 2- Light aerobic exercise (Monitored vital signs,
Stage 3-Sport Specific exercise
Stage 4-Non contact Training Drills
Stage 5-Full Contact after medical clearance
Stage 6-Normal Game Play

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27
Q

What is the purpose of vestibular ocular/motor screening?

A

Identify impairment and recognize the need for referral.

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28
Q

Bony section of the Labyrinth

A

3 semicircular canals, the cochlea and the vestibule

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29
Q

Membranous section of the Labyrinth

A

membranous portions of the canals and utricle and saccule.

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30
Q

Ampulla

A

contain the cupula (hair cells) which convert displacement into neuro firing thru bending of hair cells to detect linear/angular motion

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31
Q

Otolith Organ (Utricle/Saccule)

A

contain calcium carbonate crystals called otoconia. Shift in these crystals set off neuro firing detecting gravity and acceleration

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32
Q

ratio of eye to head movement

A

1:1

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33
Q

Vestibular input sends information to:

A

cerebellum

vestibular nuclear complex

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34
Q

Why are cerebellar strokes commonly missed?

A

mimics an episode of vertigo

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35
Q

Vestibular Ocular Reflex (VOR)

A

generates eye movements to produce clear vision during head motion

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36
Q

Vestibular Spinal Reflex (VSR)

A

compensatory body movement in order to maintain head and postural stability–prevents falls

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37
Q

Vestibular Collic Reflex (VCR)

A

stabilizes head in space

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38
Q

3 Vestibular Ocular Reflexes

A

Angular
Linear/Translational
Ocular Tilt Reflex

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39
Q

cervicoocular reflex (COR)

A

proprioception/somatosensory

innervation C1-C2 dorsal nerve roots

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40
Q

cervicocollic reflex (CCR)

A

head stability

contracts to align head

41
Q

Cervicospinal Reflex (CSR)

A

postural stability through limb activation

42
Q

Balance

A

The ability to control the Center of Gravity over the base of support in a given sensory environment

43
Q

Postural Stabilization System

A

body in balance while an individual stands and actively moves in daily life

44
Q

Gaze Stabilization System

A

maintains gaze direction of the eyes and visual acuity during activities involving active head and body movements

45
Q

Benign Paroxysmal Positional Vertigo (BPPV)

A

brief episodes of vertigo when head is moved in certain positions

46
Q

Concussion Symptoms

A 
Dizziness
Vertigo
Tinnitus
Lightheadedness
Blurred vision/Double vision
Photophobia
Disruption in gaze stabilization
47
Q

Cranial Nerves Controlling the Eye Movements

A 
III Superior Rectus
III Medial Retus
III Inferior Oblique
IV Superior Oblique
VI Lateral Rectus
48
Q

oculomotor n. responsibilities

A

saccades
pursuit
fixation (fast and slow objects)

49
Q

Vergence System Function

A

moves eyes in opposite directions

50
Q

Convergence

A

Both eyes fixing on one near object

51
Q

Vergence triad

A

convergence causes accomodation which causes pupil constriction (blinking)

52
Q

convergence insufficiency

A

reduced vergence > 6cm from nose

53
Q

Vergence Spasm

A

increased vergence response

54
Q

Vergence Symptoms

A

Asthenopia
Frontal Headaches
squinting/closure single eye
floating letters on page

55
Q

convergence insufficiency

A

double vision
frontal headaches
“pulling sensation” on eyes

56
Q

4 kinds of strabismus

A

exotropia - beats out
esotropia - beats in
hypertropia - beats up
hypotropia - beats down

57
Q

Tropia

A

Overt deviation of the eye (exo, eso, hyper, hypo)

58
Q

Phoria

A

ocular deviation occurs when dissociation occurs

59
Q

Cranial Nerve Screen

A

o I: smell coffee
o II: read eye chart
o III: PEARL, tracking penlight
o IV: look inferiorly
o V: light touch to face, jaw MMT, jaw jerk reflex
o VI: look laterally
o VII: make facial expressions, taste food
o VIII: feel and hear tuning fork, balance with eyes closed
o IX/X: check gag reflex/swallowing, practice speech
o XI: Traps and SCM MMT
o XII: stick out tongue

60
Q

Joint Position Error (JPE)

A

o Patient begins seated with crown of head 90cm from target with laser pointer on forehead
o (Right rotation x3 reps, left rotation x3 reps, extension x3 reps) – done with eyes open and closed
o Error >4.5 degrees are likely significant for head and neck proprioception deficit

61
Q

Vertebral Artery Test

A

Supine, Extension, Rotation

Red Flag if diaphoresis, dysphagia, dysarthria, drop attacks, or diploplia

62
Q

Saccadic Gaze System

A

for rapid eye movement to bring object into view of foveo

63
Q

Vestibulo Gaze System

A

keeps image steady on fovea during movements

64
Q

Vergence Gaze System

A

keeps image on fovea when moved closer

65
Q

Spontaneous Nystagmus

A

nystagmus while holding head still and pt then looks straight ahead

66
Q

Fixed Gaze Nystagmus

A

nystagmus while holding head still at 30 degrees left, right, up, and down from center

67
Q

Convergence

A

ability to focus on finger from 2 feet away to 5-8cm from brow

68
Q

Smooth Pursuits

A

Finger moving slowly at 2-3 feet from patient and taken to 60 degree total arc to avoid end range nystagmus

69
Q

Saccades Test

A

o Rapid conjugate movements of the eyes to pace the object of interest on the fovea
o Have patient look between 2 targets approximately 15 degrees apart
o Normal is

70
Q

Cover Uncover Test

A

test for tropia - perform cover test first on each eye; if no movement of uncovered eye tropia is not present

71
Q

Alternate Cover Test

A

test for phoria - measures magnitude of phoria and tropia by covering one eye at a time and observing for phoria in contralateral eye

72
Q

Maddox Rod Test

A

o Cylindrical slot testing looking at horizontal and vertical alignment
o Room is dimmed and Maddox rod is placed over one eye. Pt is asked to note pen lights position in relation to red line on rod. If the light is not right on the line, a multilevel prism is used as a treatment and the change in diopter is noted as the prescription to fix the malalignment of the eye

73
Q

Head Thrust Test

A

tilt patient’s head down 30 degrees and start moving the head side to side while they focus on your nose, gradually increasing speed, repeat in vertical plane

74
Q

Visual Acuity

A

snellen eye chart done both statically and dynamically

75
Q

Tragal Pressure

A

pressure that is applied to the cartilage at the front of the ear, closing the canal and increasing pressure on the tympanic membrane
Positive if nystagmus or increased dizziness

76
Q

Modified Balke Protocol

A

test used to assess threshold for aerobic activities

77
Q

Neurocom

A

high tech tool used to assess balance

78
Q

Skull Fx TBI S&S

A

UVL/BVL (partial/complete)
Conductive hearing loss
Mixed peripheral and central lesions

79
Q

Hemorrhage into labyrinth TBI S&S

A

Post traumatic hydrops
Acute vertigo
Unilateral hearing loss

80
Q

Hemorrhage into brainstem TBI S&S

damage to vestibular and occulomotor nuclei

A

CN III signs
poor smooth pursuit
vertigo
perception of tilt

81
Q

Increased ICP

TBI S&S

A

Fluctuating hearing loss
Ataxia
Imbalance

82
Q

Oscillopsia

A

“bouncing” or blurred vision

83
Q

Primary Injury of Blast

caused by Barotrauma

A

Affects hollow organs:
Lungs, abdomen and middle ear
Potential to affect great vessels in neck and inner ear and brain

84
Q

Post concussion dizziness:

Peripheral related

A 
BPPV
Labyinthine Concussion
Perilymphatic Fistula (SCD)
85
Q

Post concussion dizziness:

Central related

A

Post traumatic migraine

Brainstem concussion

86
Q

Post concussion dizziness:

Non Vestibular causes

A

Ocular Motor Problems
Autonomic/orthostatic
Cervicogenic Dizziness

87
Q

Dix Hallpike Test

A 
Pt in long sitting
Head rotated 45* to side of testing
Neck ext to 20-30* in supine
Hold for 30-60 sec
Observe for nystagmus
88
Q

Results for Dix Hallpike

A

Post. canal BPPV: upbeating nystagmus
Ant. canal BPPV: downbeating nystagmus
60 sec = Cupulolithiasis

89
Q

Roll Test for Horizontal Canal BBPV

A

Pt supine
Turn head 90* and hold to observe nystagmus on both sides
Determine which side the nystagmus is worse and the direction of it

90
Q

Roll Tests for Horizontal Canal Results

A

Canalithiasis: Geotrophic (with gravity) involved side stronger nystagmus
Cupulolithiasis: Ageotrophic (against gravity) involved side weaker nystagmus

91
Q

Modified Epley/ Canal Repositioning Technique

A 
Pt long seated head 45* rotation to affected side
Supine neck extended 30*
Head rotates 45* opposite direction
Roll to Sidelying same as head
Short sitting EOB
92
Q

Initial ____ are better severity predictors after Sport-related concussions than _____ .

A
  1. Symptoms (dizziness, HA, etc.)

2. Age, sex, LOC, amnesia etc.

93
Q

Differential Dx of Concussions

A 
More serious TBI
Peripheral vestibular involvement
Migraine
Anxiety
Other mood disorders
Behavior, malingering, physiologic responses
Cervical pathology
94
Q

Post Concussion Syndrome

A

Essentially the same S&S but last longer than a month

Persistent HA, Fogginess and Dizziness when standing may warrant Vestibular Therapy

95
Q

Second Impact Syndrome

A

Occurs when an initial head injury doesn’t resolve before another head injury is acquired
Often fatal or involves serious impairments

96
Q

Imaging for mTBI

A

CT (SPECT) for blood flow
PET scan for brain metabolism
fMRI for real time blood flow and metabolic changes

97
Q

SCAT 3 AND Child SCAT 3

A

Acute testing with 7 Subsets
Child = 5-12 y.o.
Use for on-field assessment

98
Q

King Device Test

A

Assess eye movement is used as baseline and compares on field exam against it, quick, affordable, easy with online data management

99
Q

ImPACT Testing

A

Neurocognitive computerized exam used for baseline and return to play protocols

711 Adult Neurological Rehab (12 decks)

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