concussion Flashcards
what is a sports related concussion
- traumatic brain injury induced by biomechanical forces
what high school sports have highest rates of concussion
- wrestling
- ice hockey
- girls soccer
- football
- boys basketball
- lacrosse
primary injury in concussion
- accel/decel injury: coup contrecoup
- unrestricted head movement -> shear, tensile and compressive forces on brain
- closed head injry
secondary injury in concussion
- injury that happens immediately but clinical si/sx takes minutes or hours to manifest
- neurochemical cascade
metabolic changes with concussion
- hyperacute influx of K and Ca
- release of excitatory neurotransmittors
- acute hyperglycolysis
- inflammation
- decreased cerebral BF for days - weeks
sx associated with frontal injury
- irritability
- inappropriate tearfulness
sx associated with parietal injury
- HA
- nausea
sx associated with occipital injury
- dizziness
- disequilibrium
- visual sx
sx assoc with injury to the top of the head
- LOC
double hit
- checked in head then hits the ice
second hit
- previous unreported or undetected blow to head in same day/ game, or days-weeks prior
- lowers threshold for more severe concussion
high risk mechanisms for concussion
- double hit
- second hit
- trauma with rotational forces
lowered threshold for concussion
- dehydration
- fatigue or sleep deprivation
- malnutrition
- concurrent illness
- illicit drug use
what are the hallmarks of concussion
- confusion
- amnesia
- most often dont have LOC
when do si/sx of concussion occur
- may be immediate
- may evolve over minutes/ hours
physical si/sx of concussoin
- HA
- N/V
- balance problems
- incoordination
- dizziness
- visual problems
- phono/photophobia
- numbness, tingling
- neck pain
cognitive si/sx of concussion
- confusion
- disorientation
- blank stare
- difficulty concentrating
- slurred, slowed speech
- amnesia
emotional si/sx of concussion
- irritability
- sadness
- emotional lability
- nervousness
sleep related si/sx of concussion
- drowsiness
- sleeping too much
- insomnia
assessment tools for concussion
- helmet sensors- really just in research
- SCAT-5
- non-healthcare concussion recognition tool 5 (CRT5)
- concussion assessment and response (CARE)
- sideline assessment of concussion (SAC)
- graded sx checklist
what is assessed on field with the SCAT5
- red flags
- observable signs
- memory assessment, maddock’s questions
- glasgow coma scale
- c spine assessment
what is assessed off field with the SCAT5
- athlete background
- sx eval
- cognitive screening
- neuro exam
- delayed recall of list of words
- decsions
components of the typical neuro exam
- read and follow instructions
- full ROM of neck pain free
- finger to nose
- tandem gait
- modified balance error scoring system (mBESS)
- CN testing
- strength and sensation
diagnosis of concussion
- clinical dx
- hx of trauma
- si/sx soon after injury
- std assessment of sx, balance and neurocognitive function
- exclusion of structural intracranial injuries