Concussion Flashcards

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1
Q

What is LYSTEDT LAW?

A

Any youth athlete showing signs of concussion must be evaluated by licensed HCP before return to play *coaches, parents and athletes require some education

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2
Q

What is the definition of a CONCUSSION?

A

TBI induces by biomechanical forces

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3
Q

Who has a higher incidence of concussion (younger vs older, men vs women)? Which of these groups are more likely to have slower recovery?

A

In comparative sports females have higher incidence, are more severe and have slower recovery Younger athletes have higher incidence, and slower recovery (brain is more vulnerable)

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4
Q

Does CT or MRI show structural abnormalities after concussion?

A

No, unless it is more than a mild injury. *may show ultrastructural changes (fine structures, especially within a cell)

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5
Q

What is the proposed pathophysiology of concussion?

A

-Angular and rotational forces = neuronal shearing -Linear acceleration-deceleration = macroscopic damage

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6
Q

What is the primary neurochemical cause of concussion?

A

Increased permeability of neuronal membranes (from stretching, damage of axons) = increase glutamate production (interferes with cell communication), K+ release, NA+ influx = causes axon dysfunction or death

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7
Q

What is SECOND IMPACT SYNDROME?

A

Occurs with a 2nd head injury after previously having one without symptoms returning to baseline Results in impaired consciousness and death from cerebral edema (occurs within a few days)

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8
Q

What are some PHYSICAL symptoms of concussion?

A

Headache, nausea, vomiting, balance, dizziness, visual impairment, light/sound sensitivity

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9
Q

What are some SLEEP related symptoms of concussion?

A

Drowsy, difficulty falling/staying asleep, less/more sleep than usual

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10
Q

List some EMOTIONAL symptoms related to concussion.

A

Increased emotion, irritability, sadness, nervous, anxious

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11
Q

List COGNITIVE symptoms related to concussion.

A

“Foggy”, difficulty concentrating or remembering, confusion, recall challenges

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12
Q

What is the STRONGEST predictor of slow recovery post concussion?

A

The severity of initial symptoms after injury

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13
Q

What is a way to help with tracking recovery post concussion?

A

Baseline testing: neuropsychologic, balance, PMH pertinent to concussion(includes those that may overlap with post concussive symptoms - depression, fatigue, HAs, learning disability etc)

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14
Q

What are some different TESTS that can be used to assess for CONCUSSION?

A

Balance Error Scoring System (tests static balance - part of SCAT) King -Derick test (eye movement - speed - rapid number naming) Vestibule-ocular tests (smooth pursuits, VOR, convergence)

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15
Q

What are some things you can EDUCATE the athlete on regarding CONCUSSION ?

A
  • Significance of injury - Recognition and management - Equipment (helmets, mouth guards) don’t decrease incidence - State regulations regarding RTP process * there is no single tool for guaranteed diagnosis or RTP clearance
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16
Q

Can co-morbidities play a role in CONCUSSION MANAGEMENT?

A

Yes - example, hx of ADHD = 3 days longer to return to baseline

17
Q

What test is utilized to assess the athlete for concussion on the sideline?

A

SCAT5 - Sport Concussion Assessment Tool Guides testing -> red flag assessment, S+S to give info about injury, memory assessment, Glasgow coma scale, C/S assessment

18
Q

What are some immediate tests that can be performed to determine if an athlete is concussed?

A
  • get background, S+S - cognitive screening (orientation, immediate memory and concentration) - brief neuro screen and delayed recall assessment *periodic testing should be perform to ensure athlete stabilizes
19
Q

What are your recommendations for an athlete and their family post concussive event?

A

-Educate on S+S to monitor -Give copy of SCAT5 for reference -review importance of sleep, hydration and rest from stressful activities -recommend follow up with physician

20
Q

What are some important factors with regards to early management of concussion?

A

-rest is IMPORTANT (avoid too little and too much - can result in persistence or exacerbation of symptoms) - recommend against early med use (except previous prescriptions) - SLOW and GRADUAL activity progression (return to full school before full activity) - must be SYMPTOM FREE along each step

21
Q

What is typical RETURN TO PLAY for young individuals with concussion?

A

Approximately 14-28 days

22
Q

What are some predictors of POOR or DELAYED prognosis for athletes with concussion?

A

Dizziness (6x more likely for protracted recovery), post trauma migraines, depression, ADHD, cognitive deficits, difficulties with oculomotor function

23
Q

What impairment DOMAINS should the SCS inquire about when assessing sport related concussion?

A

Cervical, Headaches, Vestibular, Oculomotor, Sleep, Affective, Cognitive, Cardiovascular

24
Q

What are CERVICAL IMPAIRMENTS related to concussion?

A

Neck pain, impaired proprioception, cervicogenic dizziness *these aren’t directly involved with changes in brain

25
Q

What are some common findings with CERVICOGENIC HEADACHES?

A

-unilateral pain, headache -HA increased with sustained positions and neck movement -decreased ROM, strength, endurance, coordination

26
Q

What are some basic treatments to be performed with both the ACUTE and SUBACUTE cervicogenic headache patient?

A

Acute = gentle C1-C2 SNAGS Subacute = manual therapy -> cervical manip, mob

27
Q

List some tests that can be performed to assess CERVICOGENIC HEADACHES and DIZZINESS.

A

-Cervical Joint Reposition Error Test -Smooth Pursuit neck torsion test -Cervical flexion-rotation test -Craniocervical flexion test -Deep neck flexor endurance test

28
Q

What is Post-Concussive Syndrome? What increases the likelihood that an athlete will experience this?

A
  • persistent symptoms beyond normal course of recovery (majority resolve quick; 1/3 have symptoms >10 days) - if VESTIBULO-OCULAR DYSFUNCTION post concussion = increased likelihood
29
Q

What is VOR? What is VSR?

A
  • Vestibulo-ocular reflex = images stabilized during head movement (eye movement opposes head movement) - Vestibulo-spinal reflex = vestibular input stabilizes body/maintains posture *if these are affected = increased likelihood of LE injury
30
Q

What are the possible CAUSES of dizziness?

A
  • cervicogenic (possible with neck pain; not likely without) - vestibular disorder (includes otolith issue - BPPV) *assessment should drive intervention! (may find - impaired balance, VOR, fixation, and convergence; +ve saccades)
31
Q

What are some TREATMENT options for vestibular dysfunction post concussion?

A

-BPPV habituation -Balance Training -Dynamic head-neck stabilization and proprioception -Gaze stabilization exercises (VOR) -Manual Therapy (C-spine dysfunction) *A combination = is more effective when treating RTP athletes

32
Q

What is a common TREATMENT for OCULOMOTOR impairments post concussion?

A

-eye-head coordination exercises (e.g., VOR x1, convergence)

33
Q

What effect can OCULOMOTOR impairments POST CONCUSSION have on the student athlete and their ability to return to school?

A

-visual issues can interfere with: reading, ability to see the board, walking stairs etc.

34
Q

What are some of the possible effects of concussion on: EXECUTIVE FUNCTION?

A

-decreased attention, impaired memory, impaired concentration, slow recall *should assess these weekly to look for changes (SCAT5 diagnostic utility decreases after 5 days) *symptoms > 2 weeks = refer (neuropsychologist, SLP, CBT)