Concussion and mTBI

Question 1

A concussion is a ____ induced by biomechanical forces resulting in an alteration in _____ that may or may not involve _____.

Answer 1

Mild TBI
Mental Status
Loss of consciousness

Question 2

True or False: A concussion only occurs with impact to the skull.

Answer 2

FALSE

Can occur as a result of impact to any part of the body

Question 3

What injury occurs as a result of a concussion?

Answer 3

Coup or contre coup injury

Question 4

What 2 things increase and what 2 things decrease relative to the neurometabolic cascade that follows a concussion?

Answer 4

1. Increase in ion channel activity
2. Increase in glucose immediately after the injury followed by a rapid decline in glucose
3. Decreased ATP production secondary to mitochondrial damage
4. Decrease in cerebral blood flow

Question 5

Describe the physical, cognitive, emotional, and sleep symptoms that may occur following a concussion.

Answer 5

1. Physical: Headache, nausea, dizziness, postural instability
2. Cognitive: foggy, difficulty with concentration and memory, confusion, forgetfulness
3. Emotional: Irritability, sadness, more emotional, anxiety
4. Sleep: Drowsiness, sleep more than usual, sleep less than usual

Question 6

Concussion does not require _____. This only occurs in ___% of the cases and lasts less than ____ minutes.

Answer 6

Loss of consciousness
10% of cases
<30 minutes

Question 7

What is a good indicator of the severity of a concussion?

Answer 7

Posttraumatic Amnesia

Question 8

____ is an imaging technique used to assess white matter integrity.

Answer 8

DTI

Question 9

What is the typical prognosis from a concussion?

Answer 9

Most people recover well, typically within a few weeks

Question 10

_____can occur if at least ___ symptoms of concussion persist within a month following injury and remain impaired for at least ___ months.

Answer 10

Post concussion syndrome
3 symptoms
3 months

Question 11

What are 3 types of post concussion disorders (PCD)?

Answer 11

1. Physiologic: impaired cerebral metabolism
2. Vestibulo-ocular: impaired oculomotor and vestibular function
3. Cervicogenic: dysfunction in the cervicospinal system

Question 12

Describe the pathophysiology, symptoms and physical exam characteristic of physiologic PCD.

Answer 12

1. Pathophysiology – alterations in cellular function and cerebral blood flow
2. Symptoms – headache – exacerbated during physical exercise, nausea, dizziness, vomiting, fatigue, difficulties with concentration
3. Physical Exam – No focal neurologic changes; elevated resting heart rate; symptoms exacerbated during exercise

Question 13

List 3 interventions used to manage physiologic PCD.

Answer 13

1. Physical and cognitive rest
2. School accommodations
3. Sub-symptom threshold aerobic exercise

Question 14

Describe the pathophysiology, symptoms and physical exam characteristic of vestibulo-ocular PCD.

Answer 14

1. Pathophysiology – dysfunction with the vestibular and oculomotor system
2. Symptoms – dizziness, vertigo, light-headed, nausea, gait instability, blurred/double vision, difficulty tracking objects, motion sensitivity
3. Physical Exam – impairments on standardized balance testing, impaired VOR, problems with horizontal and vertical saccades, convergence

Question 15

Patients with ___ PCD do not show symptoms on exercise programs.

Answer 15

Vestibulo-ocular PCD

Question 16

List 3 interventions used to manage vestibulo-ocular PCD.

Answer 16

1. Vestibular rehabilitation
2. Vision therapy
3. School accommodations

Question 17

Describe the pathophysiology, symptoms and physical exam characteristic of Cervicogenic PCD.

Answer 17

1. Pathophysiology – muscle trauma and inflammation, dysfunction of cervical spine proprioception
2. Symptoms – neck pain, stiffness, decreased range of motion (ROM), occipital headaches (exacerbated during head movements), postural imbalance, lightheadedness
3. Physical Exam – decreased lordosis and ROM, paraspinal and sub-occipital muscle tenderness, impaired head neck position sense

Question 18

Patients with ___ PCD will reach exertion on exercise without symptoms.

Answer 18

Cervicogenic PCD

Question 19

List 3 interventions used to manage Cervicogenic PCD.

Answer 19

1. Cervical spine manual therapy
2. Head-neck proprioception re-training
3. Balance and gaze stabilization exercises

Question 20

_____ can occur as a result of repetitive brain trauma due ___ and ____ impacts. This is commonly seen in ____.

Answer 20

Chronic traumatic encephalopathy

Sub-concussive and concussive impacts

Boxers

Question 21

Chronic traumatic encephalopathy is characterized by deposition of _____ . _____ are only seen in a subject of cases.

Answer 21

Neurofibrillary tangles

Amyloid plaques sometimes seen

Question 22

List 4 gross changes that occur as a result of chronic traumatic encephalopathy.

Answer 22

1. Decrease in brain weight
2. Larger lateral and third ventricles
3. Thinning of corpus callosum
4. Fenestrated cavum septum pellucidum

Question 23

_____ is no longer recommended for treatment post concussion. What strategy is used to treat concussion?

Answer 23

Cocoon therapy is NO longer recommended

ACTIVE rehabilitation is encouraged