Concussion Pathology And Exam Flashcards
What are the three components of the Glasgow coma scale
Eyes response, verbal, motor
What are 4 additional red flags that may indicate cerebral edema from meningeal tear (slow bleed)
Worsening dizziness/vertigo
Double vision
Worsening HA
Loss coordination
What time range does mTBI usually improve
7-14 days
What are the 4 main categories of TBI symps
Behavioral, environment, cognitive, motor
What does each tract control:
-lateral vestibular tract
-medial vestibular tract
-vestibulocerebellar tract
-controls LE motor units for balance (flex and ext mus)
-C/S and t/s mus
-coordination
What 3 CN are found in ocular motor systems
CN III: oculomotor
CN IV: trochlear
CN VI: abducens
What does the vestibule-ocular reflex do
Info from vestibular nucleus generates movements that stabilize gaze during head movements
What does the vestibular and ocular-motor systems undergo in TBI? What does it cause?
Chemical distruption
Disrupts timing —> dizziness, vertigo, walking difficulties
What is post-concussion syndrome
Concussion s/s for over 6 weeks
Central issue —> continued neuroinflam
What brain changes occur in post-concussion syndrome (4)
-decreased hippocampal vol (memory)
-increased cell death risk
-smaller thalamus (unable to process sensory info)
-risk limbic atrophy
Symptoms of post-concussion syndrome
HA, dizziness, fatigue, poor coordination, anxiety
Inability to habituate
What is the difference between dizziness and vertigo
-light headed, woozy, off balance (caused by alcohol, OH, not sleeping)
-work spinning; inner ear
Which pathway controls orientation
Medial vestibular pathway
Difference between dizziness and disequilibrium
Dizziness: light headed, woozy, off balance, external causes
Disequilibrium: inner ear imbalance
Specific vestibular s/s of mTBI
N/v, nystagmus (w/ rapid head movements)
What 4 things combined contribute to decreased postural control
Visual, vestibular central and peripheral, and poor integration
What is one big ANS change in mTBI?
BP - loss of auto regulation
Vasorestriction and exercise intolerance
What energy sources decrease in mTBI? What can it lead to?
Glucose and mitochondria
Brain fog/fatigue
2 main common behavioral symps
HA with noise and light sensitivity
Dizziness
3 main symptoms specificity regarding metabolism
Attention, HA, fatigue
What is the King Devick test
-pre and post injury
-rapid # naming
-athletes
3 cards
Assesses eye movement, attention, language, suboptimal brain fxn
When not to perform a graded exertional tolerance exam
If pt has symps at rest
What to keep track of during graded aerobic ex
-time, mode, symp onset
-BP and HR
-RPE
If vestibular involved what form of aerobic exercise to test
Bike
Describe the process of the buffalo concussion treadmill test
-start at 3.3 mph w/ no incline
-1 min increase incline to 2%
-each min increase 1%
-monitor BP, HR, and RPE each min increase incline
-stop if fatigued, can’t communicate
What is the Rivermead test
-assesses physical, cognitive, behavioral
- > 3 symptoms after 3 m’s = post concussion syndrome
S/S for whiplash associated injury
HA, neck pain, memory and concentration, tinnitus
What is accommodation in oculomotor
Eye ability to adjust lens to focus on different distance objects
What is vergence
Synch eye movement and symmetry track objects
What is convergence
Eyes move medial, crossed eye
What is the gold standard vestibular system assessment (?) what does it consist of?
VOMS
Horizon/vert VOR, convergence, VOR cancellation, saccades, smooth pursuit
What 3 main categories can PT assess
Ocular motor, vestibular, symps
What components can rule out c/s injury with manual spine exam
-ext rot exam
-palp for tender c/s facets
-cervical facet dysfxn
+ if pain > 3/10, resist to motion is mod in rot or manual spine exam
-jt proprioception test (laser pointed headlamp)
