Concussions Flashcards
Concussion is a ________ brain injury. What does this mean?
metabolic brain injury - disruption of the symbiotic environment
- neurons are stretched but not broken, leading to cascade of events
What happens to neurons during a concussion? What follows this action?
- neurons/axons are stretched
- leads to an increase in neurotransmitters, leading to cell membranes working harder to balance out which increases energy demand, and decreased blood flow due to arteries being stretched and squished
- increased energy demand + decreased blood flow leads to metabolic crisis
What will imaging look like after a concussion? Why?
normal imaging because there is no structural damage to neurons/axons (they are not broken)
- only metabolic changes which do not show up on imaging
What are the six subtypes of concussions?
- vestibular
- ocular
- cognitive/fatigue
- post-traumatic migraine
- cervical
- anxiety/mood
cognitive/fatigue is most often seen ________ following a concussion.
early on
What are the major characteristics and symptoms associated with the cognitive/fatigue subtype?
- fatigue - widespread and after the smallest amount of activity
- headache w/ cognitive and PA
- “end of day” symptoms
- sleep disturbances
What exam findings are you likely to find with the cognitive/fatigue subtype?
nothing abnormal in neuro screen
- normal vestibular/ocular screening
will show breakdown with neurocognitive testing
What are 3 helpful questions to ask a patient regarding cognitive/fatigue subtype?
- Do you have a generalized headache that increases as the day progresses?
- Do you feel more fatigued than normal at the end of the day?
- Do you feel more distractible in school/work than normal?
What does interdisciplinary treatment look like for the cognitive/fatigue subtype? Where does PT get involved?
- physical/cognitive breaks during the day - NO NAPS
- medication if needed
- cognitive therapy if symptoms linger
Typically don’t see PT unless they exercise tolerance deficits and will need a monitored, structured exercise progression
What risk factors exist for the ocular/visual subtype?
personal/family history of ocular dysfunction
- wear glasses/contacts
What symptoms are associated with the ocular/visual subtype?
- frontal headache - gets worse as day goes on
- difficulties w/ visually based classes/activities
- pressure behind eyes
- visual “focus” issues
- blurry or double vision
What exam findings are you likely to find with the ocular/visual subtype?
- smoot pursuit, saccades
- convergence difficulties
- accommodative insufficiency
- strabismus - tropias and phorias
neurocog - deficits in reaction time and visual memory
What is NOT frequently associated w/ ocular visual subtype?
photosensitivity - sensitivity to light
convergence vs divergence Which is more common?
convergence (more common) - Ability of eyes to turn inward to focus on a near target
divergence - Ability of eyes to move outwards to focus on a further target
What are the general symptoms associated with vergence impairment?
- intermittent/constant double vision (squint to compensate)
- asthenopia (eye strain) when reading
- frontal headaches
- letters appear to float/move on the page
What are the 3 most common vergence problems seen with concussion?
- convergence insufficiency
- convergence excess
- convergence spasm
How is eye accommodation achieved?
changes in the lens
- controlled by CN 2, 3 reflexive activity
What are the general symptoms of accommodation impairment?
- reduction inability to focus at near - may need reading glasses
- accommodative spasm - over-focusing at near
- struggle to coordinate accommodation and vergence
What will the struggle to coordinate accommodation and vergence lead to?
difficulty in spatial awareness
What are the treatment strategies for ocular/visual subtypes?
- ocular motor training
- exercise - make sure environment isn’t too crowded or busy
What risk factors exist for the vestibular subtype?
- PMH of car sickness/motion sensitivity
- migraine
- anxiety
What symptoms are associated with the vestibular subtype?
- vertigo
- dizziness
- nausea
- overwhelmed in visually-stimulating environments
- balance impairments
What is the relevance of dizziness post-concussion?
55-80% of concussed athletes
- negative prognostic indicator
- undiagnosed vestibular deficits may delay recovery
What are common signs and symptoms of vestibular dysfunction post-concussion? (9)
- dizziness
- blurry vision
- nystagmus
- tinnitus
- vertigo
- hearing loss
- loss of balance and possible falls
- broad-based stance (imbalance)
- sweating, N/V - due to ANS involvement