Concussion Clinical Profiles - Return to Learn and Sport Flashcards
CDC definition of concussion
type of traumatic brain injury-or TBI caused by a bump, blow, or jolt to the head or by a hit to the body
what is the CISG definition of sport related concussion (SRC)
initiation of neurotransmitter and metabolic cascade
possible axonal injury, blood flow change, and inflammation
signs and symptoms can present immediately or evolve over time
no abnormality on standard structural neuroimgaing
what are the metabolic changes associated with concussions
calcium influx (in)
potassium efflux (out)
glutamate release (always bad)
what does metabolic change affect?
neurotransmission
explain blood flow dynamics with a concussion
demand for blood is increased but blood flow rate reduces
what is relevant for healthcare providers that treat individuals with SRC
consensus statement on concussion in sport
what is the composition of the consensus statement on concussion in sport
12 R’s
in the first 24-48 hrs post concussion, what occurs
assessment done by ATC or MD on sideline
what does the ATC or MD assess for after concussion
Glascow Coma Scale
C-spine
symptoms
cognition
memory
static balance
what will red flags warrant post concussion
further imaging
what are the red flags related to concussion
neurological changes
increasing headache
loss of consciousness
deteriorating level of consciousness
repeated vomiting
combative state
seizures
convulsions
what is educated to patient’s support system post-concussion
how to assess for red flags and what to do if present
fear of subdural / epidural hematoma
when is imaging recommended following SRC
LOC or red flags
what does the IMPACT symptom checklist do that most others don’t
assesses psychological symptoms, sleep and balance
recommendations during acute phase SRC recovery
relative rest from ADL’s (48hrs)
reduced screen time (48hrs)
light intensity as long as symptoms are only mildly exacerbated
what is symptom exacerbated threshold defined as
activity that does not bring on or worsen symptoms from baseline measurements
what does recovery have to include
resolution of symptoms
return to learn
return to play
what do a majority of individuals with SRC experience prognostically
recovery within 7-10/14 days
what do some patients experience post SRC prognostically
recovery within 2-4 weeks
– with follow-up treatment and/or assessment
what do a small subset of patients with SRC experience prognostically
persistent symptoms beyond 4 weeks
- will require interdisciplinary care
what is the strongest predictor of recovery
severity of initial symptoms
risk factors for prolonged recovery include
younger age
female sex
previous concussion(s)
history of learning disorders
history of mental health conditions
history of migranes
what are some pre-injury conditions to consider when assessing patient post-SRC
visual, oculomotor, cervical or vestibular problems
sleep disturbances
dysautonomia (ie POTS disease)
pain
what are the concussion clinical profiles
vestibular
ocular
cognitive/fatigue
migraine
anxiety/mood
s/s of cognitive profile SRC
difficulty:
thinking
remembering
concentrating
mental speed
fatigue / decreased energy
nonspecific headache
sleep disturbances
change in academic/occupational performance
explain headache symptoms in those with cognitive concussion
worsens with cognitive activity
what is the assessment for those with cognitive profile SRC
neurocognitive testing
risk factors for those with cognitive SRC
continued play after hit
attention/learning disorders
poor quality of sleep prior to SRC
what is neurocognitive testing?
something like IMPACT testing
cognitive profile SRC management
academic/work accommodations
behavioral regulation
stimulant medications
vestibular profile SRC s/s
dizziness
imbalance
nausea
lightheadedness
fogginess
motion sickness
when do symptoms of vestibular SRC worsen
head movement
risk factor for vestibular SRC profile
prior motion sickness
assessment for those with vestibular SRC profile
oculomotor exam (VOMS)
postural control (tandem walk f/b with a dual task)
likelihood for patient with SRC to be in vestibular profile
50%
ocular SRC profile S/S
blurred/double vision
trouble focusing
frontal HA/pressure
fatigue w/reading or computer work
assessment of ocular profile SRC
oculomotor exam
VOMS
explain prognosis of those with ocular profile SRC
risk of prolonged recovery
BUT
no known risk factors
explain management of ocular profile SRC
vestibular rehab
habituation
s/s of migraine profile SRC
moderate-to-severe pulsating HA with nausea
and/or
photosensitivity/phonosensitivity
what is the most common symptom post concussion
headache
what may be associated with migraine profile SRC
sleep dysregulation and anxiety/mood disturbance
symptom worsening under stress or exercise
decline memory / mental speed on neurocognitive testing
risk of longer recovery
explain management of migraine / post traumatic headache
aerobics
maybe meds
– if migraine, refer to headache specialists
symptoms related to anxiety/mood profile SRC
depression
anxiety
emotional fluctuations
moodiness / irritability
sleep dysregulation
exaggerated/inconsistent symptoms
what to be mindful of when treating those with SRC
influence of mental health on physical symptoms
patient may not recognize the interconnectedness of psychology and physiology
indications of underlying emotional disturbance
inconsistencies in symptoms/performance on neurocognitive testing
worsening of symptoms overtime
risk factors for anxiety/mood profile SRC
prior mental health condition
– can indicate prolonged recovery
anxiety/mood SRC profile management
counseling / psychotherapy
cognitive-behavioral therapy
exposure therapy
modifiers of SRC
cervical / sleep
what are cervical modifiers of SRC? what to do with this information?
loss of ROM
pain / paresthesias
weakness
—- need to follow neck pain CPG
sleep modifiers of SRC
excessive daytime sleepiness
multifactorial and can be detrimental to other profiles/symptoms related to them
what is the timeline associated with return to sport strategy
progression of steps typically takes a minimum of 24 hrs
– may begin step 1 within 24 hrs of injury
steps in return to sport strategy
1 - symptom limited activity
2 - aerobic exercise
3 - individual sport-specific exercise
4 - non-contact drills
5 - full contact practice
6 - return to sport
explain activity at step 1 of return to sport strategy
daily activities that do not exacerbate symptoms
explain the division of stage 2 return to sport
2a - light aerobics (55% of maxHR)
2b - moderate (70% of maxHR)
activity related to step 2 return to sport
stationary cycling/walking
slow to medium pace
start light resistance training if below symptom exacerbated threshold
when can steps 4-6 of return to sport protocol begin
resolution of:
any symptoms
abnormalities in cognitive function
in TN who can make return-to-play decisions
MD DO or neuropsychologist w/concussion training
explain the steps in return to learn protocol
1 - daily activities below symptom exacerbation threshold
2 - school activities
3 - return to school part time
4 - return to school full time
activity related to returning to school part time
gradual introduction of school work
may need partial school day or access to rest breaks
activity related to return to school full time
gradual progression in activities if a full day can be tolerated without more than mild symptom exacerbation
what is mild exacerbation of symptoms quanitified as
no more than 2 pts on a 0-10 scale for less than 30 min when compared to baseline
