Concussion Management: intervention and return to play Flashcards
1
Q
What is post concussion syndrome
A
- symptoms persist after concussion
- time frame varies amoung guidelines from post-acute to several weeks
- symptoms may continue for weeks or months
- interventions can help symptoms resolve: PT, cognitive, retraining, vision therapy, OT
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2
Q
PT interventions for concussion management
A
- education: symptom, impairments, activity limitations
- stress most people recover quickly
- movement related impairments, including reaction time
- cervical and thoracic spine dysfunction
- vestibular impairments: BPPV, vestibular and oculomotor rehab, visual-motion
stress symptom based approach
3
Q
Aerobic exercise
A
- should implement a symptom-guided, progressive aerobic exercise training program
- for patients who are planning to return to vigorous physical activities levels
- may implement progressive aerobic training for all patients
- to reduce risk for deconditioning
- promote functional brain healing
4
Q
Typical protocol for treating concussion
A
- start with light exercise
- 30-40% fof age-adjusted heart rate using karvonen formula
- balance activities, stretching, PREs
- progress through to stage 5
- sports performance training
- full exertion
5
Q
Concussion training
cognitive retraining
A
- attention
- memory
- visual tracking & recognition
- social pragmatics
- activities to promote neuroplasticity
- OT may be more involved with this
6
Q
When can a student return to learn post concussion
A
- cognitive rest
- electronics/computers/phones,
- classroom participation
- accomodation plans (504)
- decreased ability to pay attention to
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7
Q
When can a service member return to active duty
A
- can not return to active duty for at least seven days after a concussion
- blast injury may increase recovery time
- PTSD may increase recovery time
- military protocol: 6 stages:
- stage 1: realtive rest and stage 6: return to full duty: must stay at each stage for at least 24 hours
8
Q
Primary interventions for concussion
A
- train caregivers in symptom recognition
- fall prevention
- bike/helmet safety
- pedstrian/driving safety
- recreational safety
9
Q
What is second impact syndrome
A
- second concussion before first concussion reolves
- can result in a long term functional and cognitive deficit
- activity modification is important for prevention
10
Q
What is the Canadian CT head rule
A
CT head scan is only required for patients with minor head injuries with any one of the following:
high risk:
- GCS score < 15 at 2 hours after injury
- suspected open or decompressed skull fx
- any sign of basal skull fracture
- vomiting ≥ 2 episodes
- age ≥ 65 years
medium risk
- amnesia before impact > 30 minutes
- dangerous mechanism
11
Q
What is a minor head injury definted as
A
- witnessed loss of Consciousness, defined amnesia or witnessed disoreintation in patients with GCS score of 13-15
- not applicable if warfarin use ot bleeding disorder or patient suffered a seizure before arrival to ED
12
Q
What is the RECARN guidelines for children
A
high risk
- GCS < 15 at 2 hours after injury
- suspected open or decompressed skull fx
- history of worsening headache
- irritabilty on exam
Medium risk
- any sign of basal skull fx
- large, boggy hematoma of the scalp
- dangerous mechanism of injury
13
Q
Signs of skull fx
A
- battle’s sign: mastoid ecchymosis
- raccon eyes
14
Q
Acute concussion management
A
- remove from play
- medical assessment to rule out C/S injury
- no return to play on day of concussion
- supervise player for next several hours
15
Q
Concussion training
Vestibular profile pt complaints
A
- feel dizzy
- blurred vision
- reports motion sickness/wooziness
- off balance/falls
- symptoms worse in busy environments
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16
Q
Concussion training
Vestibular profile impairments
A
- VOR impairments
- BPPV
- Visual motion sensitivity
- balance impairment
- falls
- cervicogenic dizzines
17
Q
concussion
Ocular profile pt complaints
A
- frontal headache with computer use, school, work
- pressure behind eyes
- blurry/double vision
- difficulty focusing
18
Q
Concussion
ocular profile impairments
A
- smooth pursuit impairment
- saccade impairment
- convergence deficits
- accomodation deficits
19
Q
Concussion
migraine profile
A
- photophobia+phonophobia/nausea
- limits activity/exercise/rehab potential
20
Q
Concussion
EBP treatments for migraine profile
A
- medication
- exercise
- relaxation techniques
- patients education about triggers
- cognitive behavioral therapy
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21
Q
Concussion
mood/anxiety profile
A
- hypervigilance
- depression/anxeity
- poor tolerance of busy environments
22
Q
Concussion
EBP treatments: mood/anxiety profile
A
- medication
- exercise
- CBT/self-helps groups
23
Q
Concussion
Cognitive profile
A
- feels better in AM
- headache increases with cognitive or physical demands
- worsens with sleep dysfunction
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24
Q
Concussion
EBP treatments: cognitive profile
A
- activity modification
- exercise
- medication
25
Adaptation tasks
- VOR x1 w/ stroop cards vertical and horizontal, circles
- VORx2 w/ stroop cards vertical and horizontal, circles
- progress from seated to standing
- targets: shapes card
- virtual reality: optokinetic training, crowd VR, ski VR
- add busy environments
26
Substitutation task
- shoes off
- start with double limb stance: eyes open/eyes closed on foam, add cognitive task
- progress to: tandem, single-limb stance, eyes open/eyes closed on firm and foam, add cognitive task
27
Habituation tasks
- gait with head turns
- add cognitive task
28
Aerobic activity
- begin subthreshold aerobic training as cervical/vestibular symptoms allow
- spoort/school/work specific
