Concussion And Testing Flashcards
What kind of brain injury is a concussion considered
Mild traumatic brain injury
What kind of deficits will a person w a concussion have (50-60%) of the time
Vestibular and oculomotor deficits
What is our AP at rest
-70
Na+ is high outside
Cell is less postivie on the inside
What is the sodium threshold and what moves in ? What is the potassium threshold and what moves out
-55 , calcium
30 , potassium
What matter typically gets affected w a concussion
White matter
Waht matter is mostly heavily myelinated axons and connects brain regions to help with learning , attention , and motor control and peaks in middle age
White
What matter is mostly neuronal cell bodies and processes and transmits information and controls movements , memory and emotion amd fully develops in ur 20s
Gray
On impact of a concussion what releases
Massive glutamate release and depolarization of brain cel;s
What kind of axons are more prone to injury
Unmyelinated
What is white matter damages more associated with
Cognitive impairments
How much linear force is require for a concussion
70-120 g’s
How much force is required for a subdural hematoma
316g
What is the common force in hockey for a concussion (g and rad)
18.4 g
1465 rad
How much force is seen w soccer headers for U 14 girls and colle girls
- U14 girls
- 20.4 g;
- College girls
- 19.8g
How much force is seen from a Olympic boxer for a jab (g) and a cross hook (rad)
58
6343
What is the criteria for a patient to have a concussion
- MOI
- 1 symptom present
What is the most common symptom of a concussion
Headache
What are the common cognitive SYMTOMS?? And somatic ??
- feeling slowed down
-difficult concentrating
-fogginess
-memory dysfucntion - headache
-dizziness
-fatigue
-visual blurring/ double vision
-photophobia a
-balance problem
What are other somatic symptoms someone with a concussion can feel
- nausea
- vomiting
-phonophobia
Are children or older adults more vulnerable to concussion
Children
What are children more vulnerable to concussion
- on going brain development
- increased metabolic demand
- more vulnerable brain structure
- longer SYMTOMS duration
- axons not fully myelinated
What should u immediately do on field for a concussion
Rule out life threatening concerns
What is the sideline assessment for concussion
- know pt
- SCAT 6
- cervical spine assessments
- perform CN testing in under 1 min
- when in doubt sit out
What does the SCAT 6 ask
- postive observable signs
- GCS < 15
- neck pain , tenderness or loss of ROM
- coordination or ocular motor screen abnormal
- memory question score < 5
If any of these are yes then remove from play
What are the SCAT 6 red flags (10)
- neck pain or tender
- seizure or convulsion
- double vision
- LOC
- weakness or tingling in more then 1 arm or leg
- deteriorating conscious state
- vomiting
- severe or increasing headache
- restless , agitated or combative
-GCS < 15 - visible deformity og the skull
What 4 things does the vestibular screening tool have
- vergence
- VOR
- cervical
- balance
when determining the outcome and severity of concussion what matters
Number of symptoms
Duration of symptoms
What is the persistent concussion symptoms
More than 3 persistent symotms at rest
30 or more days following a concussion
What is the 3 causes of PCS
Autonomic dysregualtion
Inflammation
Visual , vesetobualr and cervical systems
What does autonomic dysregulation affect for PCS (6)
- Blood flow
- Digestion
- Anxiety/stress
- Sleep problems
- Hormone imbalances
- Cognitive problems
What is the gut brain axis
Leads to increased permeability of gut
Who reports more sleep problems with PCS
Females which leads to more HA
What is associated with greater reduction of PCS
Active rehab - early physical activity
What is second impact syndrome
When 2nd conciussion occurs before the 1st concussion has properly healed
Who is the second impact syndrome most common in
Athletes under 21
What can happen w catastrophic increase in intracranial pressure w second impact syndrome
- vasomotor paralysis
-edema
-massive selling
-hernimation
-death
What are signs are second impact syndrome
- dilated pupils (w light)
- loss of eye movement
- unconsciousness
- respiratory failure
-death
What should u do day 1 w a concussion
- baseline testing
- assessment
-treatment
-education ** big
What are the 5 common forms of baseline testing for concussion
- computerized nueorgocitive testing
- imPACT testing
- SCAT 6
- BESS test
- symptoms checklist
What does teh imPACT testing assess
Reaction time
Attention
Short term memory
What 4 things does it take for success after concussion
- Find a good trained professional
- Eating healthy
- Moderate rest for 24-48 hours
- Early rehabilitation
What is included in early rehab for concussion
- Sub-symptom threshold exercise!
- Too much can be detrimental (use the BCTT)
- Cervical spine manual therapy
- Vestibular therapy
- Ocular motor system
What acids should u increase intake of post concussion
Omega 3 fatty acids
How much should the pt eat post concussion
Half the number of calories the athlete would consume
Do not restrict protein or calories during the time
What is the most important thing to recommend for deitrary changed post concussion
Water!!!
Half ur body weight in OZ
What things should u avoid after a concussion (4)
- caffeine and alcohol
-processed sugar/foods - artificial sweeteners
- fad diets
What test should u do day 2 of concussion
Buffalo concussion treadmill test
What does teh BCTT assess
Degress of exercise tolerance in pt post concussions
What does teh BCTT identifity and help with
Identify the HR at which concussion specific SYMTOMS occurs
Help establish a safe level of exercise from treatment and differentiate between concussion and other possible diagnoses for symtoms
• Acute myocardial infarction
• High-risk unstable angina
• Uncontrolled cardiac arrhythmias causing symptoms or hemodynamic compromise
• Symptomatic severe aortic stenosis
• Uncontrolled symptomatic heart failure
• Acute pulmonary embolus or infarction
• Acute myocarditis or pericarditis
• Acute aortic dissection
These are all what kind of contras fro BCTT
Absolute
• Left main coronary stenosis
• Moderate stenotic valvular heart
disease
• Electrolyte imbalance
• Severe arterial hypertension (>200 mmHg systolic or >110 mmHg diastolic)
• Tachyarrhythmia or bradyarrhythmia
• Hypertrophic cardiomyopathy and other
forms of outflow tract obstruction
• Mental or physical impairment leading to inability to exercise adequately
• High-degree atrioventricular block
These are all what kind of contras for BCTT
Realtive
What are teh 3 seps of the BCTT protocol
Step 1: pre test readiness assessment (RPE) (if over 7 dont do it
Step 2: warm up ( 2.5 mph w 0 incline for 2 mins)
Step 3: the test
What is the test for BCTT protocol
Increased speed to 3.3 mph w 0 incline and after each minute increased incline by 1% , continue for up to 15 minutes to 15% incline
Perform w HR monitor
What is the fail criteria for the BCTT
Patient experiences an increase (worsening) of their overall wellbeing score by 3 or more
How would a patient pass teh BCTT
Pt does not experience worse overall condtions by 3 or by reaching their age adjusted max HR or reaching max exertion on borg scale
What do u do day 3 of concussion
Cervical and VOMS testing
What is assessed in the cervical screen (5)
• Assess the cervical spine for ROM
• Assess VBI
• Assess transverse ligament
• Assess alar ligament
• Assess semicircular canals if needed
What is include in the VOMS (vestibular) screen
- smooth pursuit
- convergence
- saccades horizontal and vertical
- VOR horizontal and vertical
- VOR cancellation
