Concussion management Flashcards
ABI vs TBI
TBI is a type of ABI.
ABI is anything not hereditary, congenital, degenerative, or induced by birth trauma
Mild brain injury classification
Normal imaging
Loss of consciousness 0-30 mins
Alteration of consciousness up to 24 hours
PTA 0-1 day
Glassgow coma score 13-15
Do you need to have loss of consciousness for it to be a Mild TBI?
no
Moderate TBI
GCS 9-12
PTA: 24hours to 7 days
Loss of consciousness 30 mins to 24 hours
some imaging findings
What is the most common symptom of a concussion
headache
Pathophysiology of concussion
acceleration/deceleration causing microscopic deformations. metabolism changes lead to an energy crisis
What age group is at highest risk of concussion?
5-14 year olds
Why are concussions less likely to be treated in older adults
social isolation because they dont want to admit theyre having problems or that they fell
What is the leading cause of concussions in military personnel in active war zones
improvised explosive devices
Who is more likely to have multiple concussions, military personnel or civilians
Military personnel in warzones
T or F: the rate of concussions in sports is underreported
T, estimated to be 6-10x greater
What risk factors are associated with a sports related concussion
Younger age
female gender
past history of concussion
T or F: People with multiple concussions or history of pre-existing health concerns are more likely to have multiple concussion symptoms
T
T or F: Men are more likely to have worse signs and symptoms of concussion
F, women are
What physical attributes are associated with the gender difference in concussions
Strength, neck dimensions, hormones, brain connectivity
What gender takes longer to recover from concussions
females
12 Rs of sports related concussion
Recognize
Reduce
Remove
Re-eval
Rest
Refer
Rehab
Recover
Return to learn/sport
Reconsider
Retire
Refine
implementing _______ prevention across all levels of sport is a priority that can reduce concussions
Primary prevention:
Rule changes
protective equipment
training
concussion management
Should we still remove a player even if their concussion is not confirmed
Yes
Which of the 3 Rs do first-responders handle
Recognize
Remove
Refer
What is the slogan for working on the sidelines of sports
If in doubt, sit them out
What assessment tool is made for medical professionals to use
SCAT6
Sport concussion assessment tool 6th edition
What assessment tool is made for non-medical professionals to use
Concussion recognition tool 6
CRT6
T or F: The CRT6 is used to diagnose concussions
F
What age range is the SCOAT6 for
13+
Child SCOAT for 8-12
T or F: The SCAT6 is diagnostic for concussions
F, not diagnostic on its own
does not replace a comprehensive medical assessment
When does the SCAT6 tool have the most utility
for acute concussion
first 72 hours and up to 5-7 days after
What are the steps to the SCAT6 immediate assessment
Observable signs
GCS
Cervical Spine Assessment
Coordination and ocular/motor screen
Memory assessment
Steps to SCAT6 off the field assessment
Athlete background
Symptom Evaluation
Cognitive Screening
Coordination/Balance assessment
Memory Assessment
Decision (to return or not)
Observable signs of concussion
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
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
Remove from play WITH spinal precautions
Go to ED immediately
Treat all unconscious players as if ______ unless proven otherwise
the ______ takes precedence
neck injury
airway
SCAT6: cervical spine assessment questions
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
SCAT6: how to test coordination and oculomotor
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
SCAT6 memory assessment
“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
Initial advice for concussion management
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
Most concussions resolve ________________
10-14 days
How long should a person w/ a concussion have relative rest
what is recommended after
24-48 hours
light to moderate physical activity (walking/cycling) for first 5 days as long as symptoms are not exacerbated
What should a player do if their concussion symptoms suddenly worsen at home
Go to ED
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
T
Concussion return progression
Symptom limited activity -> Aerobic exercise -> individual sport specific exercise -> noncontact training -> full contact practice -> RTS
When should children return to sport post concussion
Not until 14 days after resolution of symptoms
After how many days is the typical re-eval for sports related concussion
3+ days
What are the recommendations for a player for the first 2 days post-concussion
reduce screen time, relative rest but full ADLs
How fast do we progress aerobic exercise in patients post-concussion if theyre symptom free during exercise
5bpm every 3 days
exception: if they pass the test without symptoms but then get the symptoms later that night do not progress
Persistent post-concussion symptoms show after ….
10-14 days in adults and 4+ weeks in children
Risk factors for developing post concussion syndrome
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
If you see a patient for post concussion syndrome 14 days after their concussion what should you do
Refer to a concussion trained physical therapist
whiplash requires 4.5G or force, concussion require 60-160G, so what can we assume
That if someone has a concussion, then highly likely patients will also have a whiplash injury
In what order is PPCS typically treated
VIsual -> C Spine -> Vestib
but we usually start with the system causing the most symptoms
If pt still has concussion symptoms but the c-spine, vestib system, and visual system are clear.. what is likely involved
ANS
What preventative measures are shown to decrease concussion
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
What is CTE
Chronic traumatic encephalopathy
way more common in pro athletes than general population
T or F: there are specific criteria that can lead someone to deciding to retire due to concussion
F
Does second impact syndrome have neuro imaging changes?
Yes
What is second impact syndrome
When someone sustains a second concussion before the first one has resolved…
Can result in seizure and death
Steps of the full SCAT6
Immediate assessment:
- Observable Signs
- GCS
- Cognitive Screen
- Coordination and Oculomotor screen
- Memory Assessment and Maddocks questions
Off field assessment
- Athlete background
- Symptom Evaluation
- Cognitive Screen
- Coordination and balance
- Delayed recall
- Decision
Maddox score must be ________ or we remove from play
5
T or F: Athlete can have normal score on scat6 and still have a concussion
T
What are the 3 parts of the SCAT6 coordination measure
mBESS (modified balance error scoring system)
Timed Tandem Gait
Dual task gait
Where should the off-field SCAT6 assessment be done
In a distraction free environment with the athlete in the resting state
T or F: we should prescribe absolute rest to concussion patients for the first 48 hours
no, just relative rest
What are the 3 parts to the SCAT6 verbal cognitive test
Count backwards from7 or 3
Months backwards
Immediate memory test
Persistent concussion symptoms are those that last over _________ in adults
and
over _________ in children
10-14 days
4 weeks
What is the difference between the SCAT and the SCOAT
The scoat is the “office assessment” done typically with followup
What outcome measure is used for re-eval of concussion in a dr office
SCOAT6
or Child SCOAT6 for 8-12
What age range is the child SCAT6 for?
5-12
