Concussion

Question 1

Dizziness with moving environments is called what?

Treated with what?

Answer 1

visual vertigo

Habituation through optokinetic training

Question 2

Change in position or head movement is called what?’

Treated with what?

Answer 2

motion sensitivity

Habituation per MSQ or other movements that provoke

Question 3

When someone with Post concussion syndrome gets on a treadmill and has symtpoms what are we thinking is going on?

Answer 3

Autonomic dysfunction: exaggerated smpathetic NS activity

Cerebral autoregulation distrubance: perfusion to the brain not regulated causeing symptoms on exertion

Question 4

Can there be physiologic or non physiologic causes?

Answer 4

Yes?

Autonomic vs. anything else

Question 5

Explain the Balke protocol for submax treadmill testing

Answer 5

Take baseline HR, symptom rating, perceived exertion

3.3 mph t/o test
start at 0% incline

Increase the grade 2% after the 1st minute

then increase 1% grade every minute after

MONITOR HR AFTER EVERY INCREASE

Terminate test if pt goes up 2 points on baseline symptoms, is exhausted or 15 minutes

Question 6

Exercise prescription based on submax testing

Answer 6

80% of max HR obtained in test

20-30 minutes

5-6 days a week

Reset the threshold at 2-3 weeks

Question 7

BDNF importance

Answer 7

promotes neural connectivity

decreasing cognitive symptoms

Question 8

uptake of BDNF how many days post concussion w/ exercise?

Answer 8

14-21

Question 9

two exercises for convergence insufficiency

Answer 9

brock string

pencil push ups

Question 10

Average adult VOR hz?

ADLS?

Answer 10

2-4 Hz

ADLS: .5-2 Hz

Military/athlete: 4-6 Hz

Question 11

RTS: Stage one

Answer 11

daily activities asymptomatic

Question 12

RTS: Stage two

Answer 12

light aerobic exercise: increased HR

walking or stationary cycling

Question 13

RTS: Stage three

Answer 13

sport specific exercise: running or skating drills

no head impact activities

Question 14

RTS: stage four:

Answer 14

non contact training drills: passing, can start resistive training

Question 15

RTS: stage five

Answer 15

full contact practice following medical clearing

Question 16

RTS: stage six

Answer 16

game day

Question 17

What is the main thing you want to avoid when treating concussion?

Answer 17

do NOT exacerbate symptoms

Question 18

If symptoms occur during return to play what do you do?

Answer 18

Stop immediately and for 24 hrs. Then returning at previous asymptomatic level

Question 19

Explain the steps of injury to the brain during concussion

Answer 19

axonal injury causing membrane to rupture

Rupture –> release of excitatory NT (glutamate) –> depolarization of the cell

Influx of Ca, K and Mg leave.

Sodium, potassium pump wants equilibrium so it kicks into overdrive

Pump needs ATP therefore –> increase glucose metabolism to power the pump

Reduced cerebral blood flow = run out of glucose = energy crisis

Calcium continues to influx into the cell creating mitochondrial damage –> worsens the metabolic crisis

Question 20

Sub max exercise increases what?

What does this chemical do

Answer 20

BDF: brain derived neurofactor

It creates neuronal connections

Question 21

Big picture concept behind concussions

Answer 21

energy crisis leading to post concussive irritability/symptoms

Question 22

energy crisis =

Answer 22

supply not meeting demand

Question 23

Mitochondrial damage + ________ = _________ leading to ______

Answer 23

Mitochondrial damage + cell death = hypometabolic state leading to impaired neuronal connectivity

Question 24

Four things Angela always does first day bc she doesn’t have time to do it all?

Answer 24

Hx, symtpoms, Cog assessment including delayed recall, neuro screen (balance, coordination), occulomotor exam

Question 25

What is highly correlated with prolonged recovery?

Answer 25

dizziness and amnesia

Question 26

Impact testing assesses what?

What is it not a measure of?

Answer 26

cognition!

Not a measure of baseline balance or oculomotor status

Question 27

What are the 5 pieces of SCAT cognitive assessment

Answer 27

1) orientation
2) immediate memory (5 o 10x3)
3) concentration: backwards numbers and months backwards
4) neuro screen including BESS
5) delayed recall

Question 28

Neurological screen of the SCAT what do they need to get their finger to their nose?

Answer 28

5 finger to nose <4 seconds

Question 29

Explain the BESS

Answer 29

eyes closed the entire time, 20 seconds, 3 positions….

Rhomberg, tandem, SLS

Get a point for each of these things

1) ABD 30 degrees
2) hands off iliac crests
3) eyes open
4) stumble/fall
5) lifting heel or forefoot
6) remaining out of test position for >5 sec

If they can’t hold the positon for 5 seconds they get max score of 10

Question 30

If the pt cannot hold BESS position for >5 seconds what score do they get for that position

Answer 30

max of 10

Question 31

FGA (what we did in class)

out of how many total

Answer 31

Out of 30 total:

Question 32

DGI
out of how many total
cut off for falls risk

Answer 32

DGI: out of 24 (higher is better)

< or = 19 falls risk in geriatric population

Question 33

if someone is complaining they are having a hard time reading post concussion what do you want to test in them?

Answer 33

convergence