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Neuromuscular Phys > Concussion management > Flashcards

Concussion management Flashcards

1
Q

ABI vs TBI

A

TBI is a type of ABI.

ABI is anything not hereditary, congenital, degenerative, or induced by birth trauma

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2
Q

Mild brain injury classification

A

Normal imaging

Loss of consciousness 0-30 mins

Alteration of consciousness up to 24 hours

PTA 0-1 day

Glassgow coma score 13-15

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3
Q

Do you need to have loss of consciousness for it to be a Mild TBI?

A

no

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4
Q

Moderate TBI

A

GCS 9-12

PTA: 24hours to 7 days

Loss of consciousness 30 mins to 24 hours

some imaging findings

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5
Q

What is the most common symptom of a concussion

A

headache

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6
Q

Pathophysiology of concussion

A

acceleration/deceleration causing microscopic deformations. metabolism changes lead to an energy crisis

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7
Q

What age group is at highest risk of concussion?

A

5-14 year olds

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8
Q

Why are concussions less likely to be treated in older adults

A

social isolation because they dont want to admit theyre having problems or that they fell

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9
Q

What is the leading cause of concussions in military personnel in active war zones

A

improvised explosive devices

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10
Q

Who is more likely to have multiple concussions, military personnel or civilians

A

Military personnel in warzones

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11
Q

T or F: the rate of concussions in sports is underreported

A

T, estimated to be 6-10x greater

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12
Q

What risk factors are associated with a sports related concussion

A

Younger age

female gender

past history of concussion

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13
Q

T or F: People with multiple concussions or history of pre-existing health concerns are more likely to have multiple concussion symptoms

A

T

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14
Q

T or F: Men are more likely to have worse signs and symptoms of concussion

A

F, women are

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15
Q

What physical attributes are associated with the gender difference in concussions

A

Strength, neck dimensions, hormones, brain connectivity

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16
Q

What gender takes longer to recover from concussions

A

females

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17
Q

12 Rs of sports related concussion

A

Recognize

Reduce

Remove

Re-eval

Rest

Refer

Rehab

Recover

Return to learn/sport

Reconsider

Retire

Refine

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18
Q

implementing _______ prevention across all levels of sport is a priority that can reduce concussions

A

Primary prevention:

Rule changes

protective equipment

training

concussion management

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19
Q

Should we still remove a player even if their concussion is not confirmed

A

Yes

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20
Q

Which of the 3 Rs do first-responders handle

A

Recognize

Remove

Refer

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21
Q

What is the slogan for working on the sidelines of sports

A

If in doubt, sit them out

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22
Q

What assessment tool is made for medical professionals to use

A

SCAT6

Sport concussion assessment tool 6th edition

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23
Q

What assessment tool is made for non-medical professionals to use

A

Concussion recognition tool 6

CRT6

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24
Q

T or F: The CRT6 is used to diagnose concussions

A

F

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25
Q

What age range is the SCOAT6 for

A

13+

Child SCOAT for 8-12

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26
Q

T or F: The SCAT6 is diagnostic for concussions

A

F, not diagnostic on its own

does not replace a comprehensive medical assessment

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27
Q

When does the SCAT6 tool have the most utility

A

for acute concussion

first 72 hours and up to 5-7 days after

28
Q

What are the steps to the SCAT6 immediate assessment

A

Observable signs
GCS
Cervical Spine Assessment
Coordination and ocular/motor screen
Memory assessment

29
Q

Steps to SCAT6 off the field assessment

A

Athlete background

Symptom Evaluation

Cognitive Screening

Coordination/Balance assessment

Memory Assessment

Decision (to return or not)

30
Q

Observable signs of concussion

A

Lying still more than 5 seconds

No protective action w/ fall

Motor incoordination- balance difficulties, stumbling

Disoriented/limited responsiveness

Blank look

Facial injury

Impact seizure

High risk mechanism of injury

31
Q

If patient has any of these red flags what do we need to do:

Neck pain/tenderness

Double vision

Weakness/tingling/burning in more than 1 arm/leg

Severe headache/increasing HA

Seizure or convulsion

LOC

Deteriorating consciousness

Vomiting

Increased restlessness, agitation, aggressiveness

GCS under 15

Visible deformity of the skull

A

Remove from play WITH spinal precautions

Go to ED immediately

32
Q

Treat all unconscious players as if ______ unless proven otherwise

the ______ takes precedence

A

neck injury

airway

33
Q

SCAT6: cervical spine assessment questions

A

Neck pain at rest

Tenderness to palpation

IF no pain/tenderness, do they have full active pain free ROM

Are limb strength and sensation normal

34
Q

SCAT6: how to test coordination and oculomotor

A

is finger to nose normal for both hands with eyes open and closed

without moving their neck or head, can the patient look side to side and up and down

are extraocular eye movements normal

35
Q

SCAT6 memory assessment

A

“First im going to ask you a few questions, please listen carefully and give it your best effort. First tell me what happened”

What venue are we at today
What quarter is it
Who scored last………..

can pick your own specific questions for the setting

36
Q

Initial advice for concussion management

A

Avoid another concussion

Avoid increasing physical or cognitive demand

Monitored for first 24 hours

no driving allowed

not to be home alone

be monitored during sleep that night

no alcohol, drugs

37
Q

Most concussions resolve ________________

A

10-14 days

38
Q

How long should a person w/ a concussion have relative rest

what is recommended after

A

24-48 hours

light to moderate physical activity (walking/cycling) for first 5 days as long as symptoms are not exacerbated

39
Q

What should a player do if their concussion symptoms suddenly worsen at home

A

Go to ED

40
Q

T or F: early return to activities should be encouraged as long as symptoms don’t increase more than 2 points on a 0-10 scale

A

T

41
Q

Concussion return progression

A

Symptom limited activity -> Aerobic exercise -> individual sport specific exercise -> noncontact training -> full contact practice -> RTS

42
Q

When should children return to sport post concussion

A

Not until 14 days after resolution of symptoms

43
Q

After how many days is the typical re-eval for sports related concussion

A

3+ days

44
Q

What are the recommendations for a player for the first 2 days post-concussion

A

reduce screen time, relative rest but full ADLs

45
Q

How fast do we progress aerobic exercise in patients post-concussion if theyre symptom free during exercise

A

5bpm every 3 days

exception: if they pass the test without symptoms but then get the symptoms later that night do not progress

46
Q

Persistent post-concussion symptoms show after ….

A

10-14 days in adults and 4+ weeks in children

47
Q

Risk factors for developing post concussion syndrome

A

Female gender

Adolescent

Hx of personal or family anxiety or depression

DD or learning disorders

pre-existing visual dysfunction

Continuing to play post concussion

severity of symptoms in first few days

vestibular symptoms

resting too long

48
Q

If you see a patient for post concussion syndrome 14 days after their concussion what should you do

A

Refer to a concussion trained physical therapist

49
Q

whiplash requires 4.5G or force, concussion require 60-160G, so what can we assume

A

That if someone has a concussion, then highly likely patients will also have a whiplash injury

50
Q

In what order is PPCS typically treated

A

VIsual -> C Spine -> Vestib

but we usually start with the system causing the most symptoms

51
Q

If pt still has concussion symptoms but the c-spine, vestib system, and visual system are clear.. what is likely involved

A

ANS

52
Q

What preventative measures are shown to decrease concussion

A

Neck strength. for every 1lb of strength odds of concussion dc by 5%

Dynamic cervical stab

Training of athletes self awareness of surroundings and collisions

53
Q

What is CTE

A

Chronic traumatic encephalopathy

way more common in pro athletes than general population

54
Q

T or F: there are specific criteria that can lead someone to deciding to retire due to concussion

A

F

55
Q

Does second impact syndrome have neuro imaging changes?

A

Yes

56
Q

What is second impact syndrome

A

When someone sustains a second concussion before the first one has resolved…

Can result in seizure and death

57
Q

Steps of the full SCAT6

A

Immediate assessment:

  1. Observable Signs
  2. GCS
  3. Cognitive Screen
  4. Coordination and Oculomotor screen
  5. Memory Assessment and Maddocks questions

Off field assessment

  1. Athlete background
  2. Symptom Evaluation
  3. Cognitive Screen
  4. Coordination and balance
  5. Delayed recall
  6. Decision
58
Q

Maddox score must be ________ or we remove from play

A

5

59
Q

T or F: Athlete can have normal score on scat6 and still have a concussion

A

T

60
Q

What are the 3 parts of the SCAT6 coordination measure

A

mBESS (modified balance error scoring system)

Timed Tandem Gait

Dual task gait

61
Q

Where should the off-field SCAT6 assessment be done

A

In a distraction free environment with the athlete in the resting state

62
Q

T or F: we should prescribe absolute rest to concussion patients for the first 48 hours

A

no, just relative rest

63
Q

What are the 3 parts to the SCAT6 verbal cognitive test

A

Count backwards from7 or 3
Months backwards
Immediate memory test

64
Q

Persistent concussion symptoms are those that last over _________ in adults

and

over _________ in children

A

10-14 days

4 weeks

65
Q

What is the difference between the SCAT and the SCOAT

A

The scoat is the “office assessment” done typically with followup

66
Q

What outcome measure is used for re-eval of concussion in a dr office

A

SCOAT6

or Child SCOAT6 for 8-12

67
Q

What age range is the child SCAT6 for?

A

5-12

Neuromuscular Phys (26 decks)

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