Concussion Flashcards
Dizziness with moving environments is called what?
Treated with what?
visual vertigo
Habituation through optokinetic training
Change in position or head movement is called what?’
Treated with what?
motion sensitivity
Habituation per MSQ or other movements that provoke
When someone with Post concussion syndrome gets on a treadmill and has symtpoms what are we thinking is going on?
Autonomic dysfunction: exaggerated smpathetic NS activity
Cerebral autoregulation distrubance: perfusion to the brain not regulated causeing symptoms on exertion
Can there be physiologic or non physiologic causes?
Yes?
Autonomic vs. anything else
Explain the Balke protocol for submax treadmill testing
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
Exercise prescription based on submax testing
80% of max HR obtained in test
20-30 minutes
5-6 days a week
Reset the threshold at 2-3 weeks
BDNF importance
promotes neural connectivity
decreasing cognitive symptoms
uptake of BDNF how many days post concussion w/ exercise?
14-21
two exercises for convergence insufficiency
brock string
pencil push ups
Average adult VOR hz?
ADLS?
2-4 Hz
ADLS: .5-2 Hz
Military/athlete: 4-6 Hz
RTS: Stage one
daily activities asymptomatic
RTS: Stage two
light aerobic exercise: increased HR
walking or stationary cycling
RTS: Stage three
sport specific exercise: running or skating drills
no head impact activities
RTS: stage four:
non contact training drills: passing, can start resistive training
RTS: stage five
full contact practice following medical clearing
RTS: stage six
game day
What is the main thing you want to avoid when treating concussion?
do NOT exacerbate symptoms
If symptoms occur during return to play what do you do?
Stop immediately and for 24 hrs. Then returning at previous asymptomatic level
Explain the steps of injury to the brain during concussion
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
Sub max exercise increases what?
What does this chemical do
BDF: brain derived neurofactor
It creates neuronal connections
Big picture concept behind concussions
energy crisis leading to post concussive irritability/symptoms
energy crisis =
supply not meeting demand
Mitochondrial damage + ________ = _________ leading to ______
Mitochondrial damage + cell death = hypometabolic state leading to impaired neuronal connectivity
Four things Angela always does first day bc she doesn’t have time to do it all?
Hx, symtpoms, Cog assessment including delayed recall, neuro screen (balance, coordination), occulomotor exam
What is highly correlated with prolonged recovery?
dizziness and amnesia
Impact testing assesses what?
What is it not a measure of?
cognition!
Not a measure of baseline balance or oculomotor status
What are the 5 pieces of SCAT cognitive assessment
1) orientation
2) immediate memory (5 o 10x3)
3) concentration: backwards numbers and months backwards
4) neuro screen including BESS
5) delayed recall
Neurological screen of the SCAT what do they need to get their finger to their nose?
5 finger to nose <4 seconds
Explain the BESS
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
If the pt cannot hold BESS position for >5 seconds what score do they get for that position
max of 10
FGA (what we did in class)
out of how many total
Out of 30 total:
DGI
out of how many total
cut off for falls risk
DGI: out of 24 (higher is better)
< or = 19 falls risk in geriatric population
if someone is complaining they are having a hard time reading post concussion what do you want to test in them?
convergence
