Concussion Flashcards
What are definitions of concussion?
Biomechanically induced neurological injury resulting in an alteration of mental status…which may or may not result in a loss of consciousness
A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces
What is pathophysiology of brain injury?
Necrosis: tissue death
Axonal injury: death of the electrical wires of the brain
Apoptosis: programmed cell death
Demyelination: loss or destruction of the nerves myelin coating in the CNS
Microgliosis: presence of microglia (immunological cells) in nervous tissue secondary to injury
Neuro-regeneration: regrowth of repair of nervous tissues, cells, or cell products
How are PTs involved in concussion management?
Acute on field evaluation: sports, military
Sub-acute assessment: balance/vestibular/neurologic screen
Rehab/return to play/activity: balance/vestibular therapy, management of co-existing cervicogenic issues related to HA/dizziness, return to exertion
What are symptoms of concussion?
Headache Feeling slowed down Difficulty concentrating Dizziness Fogginess Fatigue Visual blurring/double vision Light sensitivity Memory dysfunction Balance problems
What 3 symptoms of concussion come from vestibular system?
Dizziness, visual blurring/double vision, balance problems
What are cognitive/fatigue complaints in concussions?
Headache of 0/10 in morning, worsens progressively
Increasing fatigue at day goes on
Distractibility, poor attention
Symptoms with physical activity
May have sleep deficits
*If we see these it’s a sign of cognitive issue and they either needs to rest or do things to get brain going
What are cervical subjective complaints?
Neck pain/soreness
Limited cervical ROM
Symptoms worse with prolonged sitting/reading postures
Headaches (occipital)
C/O dizziness and visual symptoms related to cervical ROM
May have generalized balance complaints
What are ocular subjective complaints?
Frontal headache or pressure behind eyes brought on by visual activities
Problems in high visual and cognitive demand classes (math/science)
Blurry vision, double vision, difficulty maintaining visual focus
Fatigue, distractibility
What are anxiety/mood subjective complaints?
Hypervigilance, rumination
Overwhelmed (poor tolerance of busy environments)
Difficulty initiating sleep (unable to turn thoughts off)
Difficulty maintaining sleep
Excessive focus on/inventory of symptoms
Limited socialization
What are subjective complaints for post traumatic migraines?
Variable headache and intermittently severe
Often wakes with headache
Nausea, photo, and/or phonophobia
Stress, anxiety, lack of exercise
Sleep dysregulation
May also present with vestibular migraine symptoms
What are common vestibular findings?
Dizziness, nausea, one step behind, overwhelmed/anxious in busy environments, off balance
What are details of injury you should ask about in the subjective?
LOC (duration) Amnesia Prepared for impact vs blindsided Removed from play/activity vs continue to participate On field symptoms include dizziness
What should you ask about in prior history during the subjective?
Migraines: personal and family history
Prior concussion: length of recovery, complete recovery
Mood disorders
Learning disabilities
Ocular motor problems: strabismus, lazy eye, amblyopia
During subjective what should you ask about current symptoms?
headache, dizziness, visual complaints/difficulty reading, imbalance, neck pain, auditory system complaints, fatigue, sleep dysfunction
What are the key factors related to recovery ?
Age: younger takes longer to recover
Exertion: athletes who engaged in high levels of activity in weeks following concussion had increased symptoms
Migraine: athletes with post traumatic migraines had significantly lower cognitive performance
Amnesia: presence was most predictive of post injury difficulties
Dizziness: when reported as on field symptom it led to 6.4x increased risk of protracted recovery
Repetitive injury: multiple concussions may be risk factor for future
