Concussion

Question 1

MOI for TBI

Answer 1

• direct/indirect trauma
• acceleration/deceleration forces
• sport related trauma
• falls
• abuse
• mvc

Question 2

glasgow scale- mild mod severe scores

Answer 2

mild- 13-15
mod-9-12
severe- 3-8

Question 3

2 motor responses in TBI

Answer 3

1. decorticate (abnormal flexion)- upper brainstem lesion

2. Decerebrate ( abnormal extention)- one/both corticospinal tracts

Question 4

factors that effect severity of TBI

Answer 4

• mechanism + trauma
• loss of consciousness
• hemotoma
• increased intra cranial pressie
• region of brain effected

Question 5

Canadian CT head rule: Ct required if

Answer 5

• age 65+
• vommiting >2x
• skull fracture
• GCS <15
• reterograde amnesia

Question 6

Difuse axonal injury

Answer 6

• white marks throughout the cortex
• widespread axonal sheering
• more severe than hematonas/hemorages

Question 7

Epidural hemotoma

Answer 7

• accumulation of blood b/w dura + skull
• Patient may have LOC followed by lucid interval which exam is normal
• slow accumulation of blood (sudden herniation)

Question 8

Subdural hematoma

Answer 8

Acute (48-72hrs)

• bleeding in subdural space
• severity based on accumulation of blood

Question 9

What does increase intracrainal pressure lead to and how to relieve it

Answer 9

• increased risk of herniation

- head down position to relieve

Question 10

sequale of moderate and sever TBI (5)

Answer 10

1. Neuromuscular- abnormal muscle tone, sensory inpairment, motor function impairment
2. Visual- double vision
3. Cognitive- altered LOC/ alertness, mem loss, altered orientation
4. Behavioural- imoulsiveness, agressiveness
5. Communication- impaired reading, writting, expression

Question 11

Neurometabolic cascade (4 steps)

Answer 11

1. Acute ionic flux (surge of energy use than difuse depression like state
2. Attempt to restore homeostasis- metabolic overdrive + reduced cerebral blood flow
3. Depletion of energy stores= metabolic uncoupling
4. Impaired metabolic state can last up to 7-10 days

Question 12

When should an athlete be removed from play

Answer 12

• if indv. reports any of the cardinal s+s (preasure felt in head, dizziness, nausea, balance
• if indv. demonstrates reduced level or alertness

Question 13

concussion care model (3 step)

Answer 13

1. physician led + monitored care (1-2w)
2. Appropriate + timely referals for rehab
3. Reassesment approx. every 1-2 w untill discharge

Question 14

RTP protocol (6 step)

Answer 14

1. symptom limited activity
2. light aerobic exercise
3. sport-specific exercise
4. non contact training drills
5. full contact prac
6. Normal game