Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NeuroPT2 > Concussion and Post-Concussion Syndrome > Flashcards

Concussion and Post-Concussion Syndrome Flashcards

1
Q

Concussion:

International Consensus:

A

Complex pathophys. process affecting brain, induced by biomech forces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Concussion:

American Academy of Neurology:

A

Clinical syndrome of biomech. induced alteration of brain function, typ affecting memory and orientation, which MAY INVOLVE loss of consciousness (does not have to)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Concussion in terms of Severity

A

see pics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Concussion may/may not result in…

A

loss of consiousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Resolution of clinical and cognitive sxs of concussion follows _____

A

sequential course

*small %→ post-concussive sxs may be prolonged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Simply put… concussion is _____

A

A form of TBI and should NOT be taken lightly!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Post-concussion syndrome

WHO:

A

Head injury usually suff. to result in loss of consiousness after which at least 3 of 8 common sx’s arise w/in 4wks

  • Sx’s include:
    • HA
    • dizzy
    • fatigue
    • irritbility
    • sleep probs
    • concentration probs
    • memory probs
    • probs tolerating stress/emotional/alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why should PTs care about concussion?

Lots of Overlap!!!

A

see pics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Concussion in sports

usually…

A

High contact sports

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Concussion + military

A

common injury exp’d in US military

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Concussion and helmets

what should you remember?

A

Helmets do NOT protect from accel/decel forces→ only FOCAL injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Concussion Risk Factors:

A
  • Previous concussion
    • Hx concussion assocd w/ 2.5-8.5x higher risk of another
  • #, Severity, Duration
    • higher→ predictor of prolonged recovery
    • *Dizziness→ GREATEST PREDICTOR for recovery taking >21d
    • Cognitive or migraine sxs req more recovery time
  • Migraines
    • hx of pre-exist migraine HA= risk factor
    • MAY BE assocd w/ prolonged recovery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Concussion risk factors

Sex

A

Females sustain more concussions

GREATER # and severity of sx’s and longer duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Concussion risk factors

Age

A

Youth have more prolonged recovery + more susceptible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Concussion risk factors

sport, pos, style of play

A

Most common mech= player contact

full contact= highest risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Signs and Sxs Concussion

4 Categories

A

see pics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

S/S Concussion if concomitant C/S injury:

A
  • Neck pain/stiff→ includes upper back
  • HA
  • dizzy
  • tinnitus
  • blurred vision
  • sleep disturbs
  • guarding+lmtd AROM C/S
  • compensatory motions
  • *sympathetic sx’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What should be done if concussion suspected?

McCrory et al, 2017

The CPG

A

see pics and note highlighted areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

during-sport assess. for Concussion

A

SCAT5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why is removal from activity so important if concussion suspected?

A

Second Impact Syndrome (SIS) ***

  • When person who has NOT fully recovered from an initial concussion sustains a 2nd impact
  • 2nd impact may be of a substantially smaller magnitude and may not even be directly to the head
  • may occur in mins, days or weeks after initial concussion
  • 2nd injury may result in catastrophic brain swelling and can lead to marked disability or death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Regulations in NJ for concussion:

in a nutshell…

A
  • Any player exhibiting s/s concussion: LOC, HA, dizzy, confused, balance probs)→ immed. removed and not return until cleared to play
  • “approp. healthcare pro” authorizes return-to-play is trained physician
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Med. Exam for concussion

A
  • Neuropsych. testing useful esp if baseline testing avail
  • img’ing not sensitive enough to visualize damage→ can rule out more severe BI
  • exam by phys.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Categorization of Severity: Am. Acad of Neuro Concussion Grading

A

see pics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Relevant Outcome Measures for Concussions:

see slides 24-29

A

NOTE: SCAT5

→ immediate and follow-up versions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Other exam methods assocd w/ Concussion

3:

A
  1. C/S
    • given comorbidity of a whiplash injury→ screening and/or full exam of c/s warranted
      1. pt may not notice sx’s right away

2 and 3. Vestibular and Oculomotor Systems

  • Probs here by many who sustain concussion
26
Q

PT Exam for persons w/ Concussion:

Taking the Hx pt. 1

A

Be thorough!

  • Mech. of injury
    • prepared? blindsided?
    • linear vs. rotation forces
  • Sx’s
    • Immed, delayed, still present
  • Immediate removal from act? or return right away?
  • Hx of prev concussions
    • More than 3 predicts slower recovery
27
Q

PT Exam for persons w/ concussion:

Taking the Hx part 2:

A
  • Mood disorders
    • anxiety/depression
  • Learning disorders
    • ADHD
  • Migraine hx
    • pre-injury dx in 14% concussed athletes**
    • Report of more migraine-type sx’s→ correlates w/ more protracted (takes longer) recovery
  • Hx of visual impairs
28
Q

Problem Inventory w/ Concussion

3 to particularly focus on:

A
  1. Dizziness
    1. If on-field dizziness→ 6.34x > likelihood protracted recovery AND post-concussion syndrome
  2. Amnesia
    1. If on-field amnesia→ 10x > likelihood poorer outcome 3 days post concussion*
    2. If on-field anterograde amnesia→ 4x > likelihood poorer outcome 3 days post concussion*
      1. anterograde= cannot form new memories after trauma
  3. Loss of Consciousness
    1. SOME evidence that brief LOC (<30s) NOT predictive of poorer outcome
29
Q

Top 11 Sx’s of protracted recovery w/ Concussion:

A
  1. Fogginess
  2. Diff concentrating
  3. Vom
  4. Dizzy
  5. Nausea
  6. HA
  7. Slowness
  8. Imbalance
  9. Lt. Sensitivity
  10. Noise Sensitivity
  11. Numbness*
30
Q

Clinical Trajectories: 6

A

6 Clinical trajectories ID’d that describe common clusters and s/s exp’d by people who sustain concussion

  1. Cognitive/Fatigue
  2. Vestibular
  3. Ocular
  4. Post-Traumatic Migraine
  5. Cervical
  6. Anxiety/Mood
31
Q

Clinical Trajectory:

Cognitive/Fatigue

A
32
Q

Clinical Trajectory:

Vestibular

A

see pics

33
Q

Clinical Trajectory:

Ocular

A

see pics

34
Q

Clinical Trajectory:

Post-Traumatic Migraine HA

A

see pics

35
Q

Clinical Trajectory:

Cervical

A

see pics

36
Q

Clinical Trajectory:

Anxiety/Mood

A

see pics

37
Q

Clinical Trajectory:

NOT PART OF ORIG. 6:

Autonomic Sx’s

A
  • Typical Sx’s
    • Ex. intolerance
    • Cog. intolerance
  • Questions to Ask
    • Does ex provoke sx’s?
    • Does concentrating or focusing provoke sx’s?
38
Q

During Observation and the Exam:

We are looking @ 3 things in particular:

A
  1. Eye appearance
    1. strained/squints
    2. glassy/bloodshot
  2. Eye position
    1. @ rest
    2. cover/uncover test
  3. Head/neck pos.
    1. head tilt
    2. FHP
39
Q

Oculomotor Exam:

What CN’s are “eye stuff”

A

3, 4, 6!!!

3: Oculomotor
4: Trochlear
6: Abducens

40
Q

Oculomotor Exam:

Components?

A
  • CN III, IV, VI
  • smooth pursuit
  • convergence
  • accommodation
  • King-Devick Test

*NOTE: Dysfunction on oculomotor exam, particularly saccades and smooth pursuit, are HIGHLY PREDICTIVE of poor recovery and dev. of post-concussion syndrome

41
Q

Tests and Measures:

UPMC Vestibular/Ocular Motor Screening (VOMS)

A
  • Includes exam (0-10) of HA, Dizzy, Nausea and Fogginess during several conditions:
    • @ Rest
    • Smooth pursuit (vert/horiz)
      • following finger smoothy
    • Saccades (vert/horiz)
      • following something then “snap” eyes back to place
    • Convergence (dist. also)
      • follow to nose like crossing eyes
    • VOR
      • move head but eyes stay focused on one thing
        • NAJEEEEB Hockey Game!!!
    • Visual motion sensitivity
      • like “car sickness”
  • These will differentiate those w/ and w/out concussion
  • HIGHER SCORES= poorer recovery/dev. of post-concussion syndrome***
42
Q

Tests and Measures:

Vestibular Assess.

A
  • Differentiate CAUSES of dizziness
    • some occur. BPPV in concussion (~5%)
    • Include tests of cervicogenic dizziness
      • C/S!!!
43
Q

Tests and Measures:

Balance and Gait

We do what we can to induce the problem**

A
  • Probs w/ postural control may persist longer than week after injury even when there are no signs of unsteadiness
  • Assess balance w/ visual motion conflict → may be more sensitive measure
  • EXAMPLES:
    • Dynamic posturography
    • BESS/MBESS
    • DGI or FGA
44
Q

Tests and Measures:

MSK

Examine like a whiplash injury

A
  • UQS
  • C/S and T/S ROM + Jt. mobility
  • C/S mm strength and flex.
    • Deep Neck Flexors
45
Q

Tests and Measures:

CV Status

A
  • RHR may be elevated post-concussion
  • Autonomic dysf. may result in sympathetic dysreg.
  • EXAMPLES:
    • TM tests
    • Tilt table tests
    • observe during Valsalva maneuver
46
Q

Tests and Measures:

Buffalo Concussion TM Test

see canvas!!

A
  • Mod. version of Balke Protocol
  • Safe + reliable
    • Very high Sn for ID’ing sx exacerbation
  • Measures ex. tol.
  • Assists in diff. dx
    • lack of sx exacerbation indicates presence of some other cond.
      • cervicogenic HA/dizzy
      • migraine
      • PTSD
  • Objective measure of recovery
47
Q

Med. Mgmt Concussion:

Common S/S to look for:

A
  • Migraine HA
  • Sleep disturb
  • Mood disorders
  • Cognitive deficits
48
Q

Med. Mgmt:

Meds*

A
  • often prescribed for HA pain, but result in rebound HAs
  • NSAIDs and aspirin should be Avoided during acute stages→ due to risk of hematoma
49
Q

Commonly prescribed meds

Focus on the “what for”

A
  • Amantadine
    • cog. fatigue and HA
  • Amitriptyline (Elavil)
    • depression + irritability
  • Meclizine
    • Vestib suppressant/anti-emetic
50
Q

Interdisciplinary Team Mgmt:

2 things to consider:

A
  1. Return to Sport or Play
  2. Return to School or Work
51
Q

Return to Sport or Play

Progressions

A

see pics

52
Q

Return to School/Work

Progressions

A

see pics

53
Q

PT Mgmt

Modified Return to Play/Work Protocols:

A
  • Vestib rehab + Oculomotor exercise
    • addresses dizziness, balance, HA
      • *HA may be vision-induced
  • Manual Tx
    • HA, neck pain, strength impairs
  • Progressive Aerobic Act→ INCs cerebral bloodflow
    • addresses decond. and DECd cerebral blood flow
54
Q

Vestibular Rehab

Main Goals to Improve:

Consists of:

A
  • Main Goals:
    • dizziness, balance, oculomotor function, overall act. lvl
  • May Consist Of:
    • gaze stab.→ focus eyes
    • oculomotor ex→ ROM/accuracy eye mvmts
    • Balance retraining
    • Canalith repos. or other techs
      • addresses vestib system itself***
55
Q

Manual Therapy

Main Goals:

May Consist of:

A
  • Main Goals:
    • ROM/Jt mobility
    • DEC cervical and HA pain
    • improve neck strength
    • improve somatosensory input from c/s
  • May Consist Of:
    • Jt mobs/soft tissue work
      • focus on c/s & t/s
      • examine + address issues w/ C1
    • strengthen deep neck flexors and cervical ext’s
    • strengthen scapular mm’s
56
Q

Why are PTs Key Providers?

A

see pics

Experiment:

  • Control Group: traditional concussion rehab*
    • postural-ed
    • ROM ex
    • phys/cognitive rest until asymptomatic
    • graded exertion
  • Intervention Group:
    • control intervention + c/s and vestib tx
57
Q

Aerobic Activity

Main Goals:

May Consist Of:

A
  • Goals:
    • endurance and aerobic capacity
    • restore homeostasis by balancing autonomic functions
  • Consists Of:
    • Progression of lt aerobic activity based on symptom response
      • consider modality
      • monitor HR
      • start w/ short act. (~15mins work) and work to longer durations
    • Progress to more moderate act.
      • walk/jog → all jog
      • trampoline/agility
      • add head/body mvmt
    • ***Early on, oculomotor training should precede aerobics, but should be moved to AFTER when able to perform mod. activities sx free
58
Q

Aerobic Activity:

When to progress??

A

*MONITOR CAREFULLY!!!

Not Enough Rest

vs.

Too Much Rest

59
Q

Recovery from Concussion

A

see pics

  • Not yet clear
  • Even after substantial amt of time, with sx inventory and fMRI resolutions
    • pts were still only 80% and 90% recovered, respectively→ shows that there are still lingering sx’s OR post-concussion syndrome
60
Q

Recovery from Concussion

Factors that affect Recovery:

3

A
  1. Prev. concussion
    1. Hx of 3 or more prev. concussions→ prolonged recovery
  2. Sex
    1. Bio. girls/women have longer recovery pd.
      1. smaller head, lower cervical strength, hormones
  3. Age
    1. Younger athletes have longer recoveries
    2. Need to consider whether return to play is approp. for children under 10yo?????
    3. Conservative approach is warranted in younger pts
61
Q

Chronic Traumatic Encephalopathy

A

*Form of neurodegen. that is believed to result from rep’d head injuries

62
Q

Chronic Traumatic Encephalopathy:

Clinical Presentation

A
  • Stage 1→ HA + loss of attn
  • Stage 2→ Depression, anger outbursts, STM loss
  • Stage 3→ Exec. dysf. and cog. impairs
  • Stage 4→ Dementia, aggression, word-finding diffs

NeuroPT2 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions