Concussions

Question 1

Definition of concussion

Answer 1

Trauma resulting in a change in brain function. Can be direct (a hit) or indirect (MVA)

Question 2

5 symptoms of concussions

Answer 2

headaches, confusion, loss of consciousness, light + noise sensitivity, nausea, abnormal vision, dizziness

Question 3

name some delayed signs and symptoms

Answer 3

difficulty sleeping, difficulty concentrating, personality changes, fatigue, depression

Question 4

Name some facts about etiology

Answer 4

1 million per year 90% go unnoticed or reported

head injuries - recreational athletes (football>hockey>soccer)

Question 5

Common methods of injury (MOI)

Answer 5

MVA
Sports injuries
getting hit in the head
Coup/contrecoup

Question 6

1 thing to remember about pathophysiology of concussion

Answer 6

neurometabolic cascade leads to altered homeostasis of the brain

Question 7

risk factors of concussions

Answer 7

athlete, age, sport, gender, hx of concussions, apoliprotein E4 (genetic risk factor) and post traumatic LOC

Question 8

Limitations of diagnosis?

Answer 8

Based on accurate reportings from the client/patient

Question 9

symptom prompting medical attention

Answer 9

nausea

Question 10

sumptom prompting ER

Answer 10

LOC

Question 11

Is dx imaging needed

Answer 11

No. it will be negative and is only done to rule out something more serious such as cx # or brain bleeding

Question 12

t/f pt and at can dx concussions

Answer 12

no, we can give clinical impressions but a dx must come from a physician.

Question 13

what is dx primarily based on (3)

Answer 13

MOI, accurate reporting of sx, baseline+neuro testing

Question 14

1 - what are the types of baseline testing

2 - why are they done

Answer 14

1 - King devick + SCAT 5
2 - done to have a baseline of current cognitive functions and baseline of symptoms

Question 15

what is the better baseline test and why

Answer 15

SCAT 5
looks at many different variables while the king devick only shows one aspect. it takes longer but is more accurate.

Question 16

what is a limitation of the SCAT 5

Answer 16

difficult to have normative values d/t variances in individuals

Question 17

What can scores of the SCAt 5 be influenced by

Answer 17

age, gender, previous injuries, adhd, dyslexia etc..

Question 18

Red flags of concussions

Answer 18

different size pupils
seizures
nausea/vomitting
unusual behaviours
loc
slurred speech
weaknes, numbness and decreased coodination

Question 19

name 2 ways of testing the following:

vestibular
neurological
balance

Answer 19

1 - nystagmus or pupil dilation

2 - rapid alternating movements or finger to nose

3 - BESS

Question 20

what does sideline assessment look like

Answer 20

-choose baseline test and perform.
-rule out any red flags
-test ROM + strength or cx spine
-neuro assessment (dematomes, myotomes, reflexes) -> if 2 or more present, could be a red flag
-coordination,
-balance

if there is a concussion but no red flags, educate ++ on protocol

make notes for school/work absences.

Question 21

Return to learn steps (5)

Answer 21

1 - no activity
2 - daily activities with no symptoms
3 - school activities OUTSIDE of classroom
4 - return to school part time with accomodations
5 - return to school full-time without accommodations

Question 21

What does rehab in the initial phase

Answer 21

education
active rest, avoiding cognitive stress, no resistance training, wear sunglasses, use earplugs, avoid alcohol

Question 22

steps to return to play (5)

Answer 22

1. minimal/no activity
2. light aerobic exercise
3. sport specific training
4. non contact training drills
5. full contact practice
6. games

Question 23

What are things to keep in. mind regarding return to play and return to sport

Answer 23

pt must have no exacerbation of sx for more than 24hrs in order to move onto the next step. if there is an exacerbation of sx, pt must move to previous step until there are no exacerbations

time spent at each step may vary. the majority will recover within 7-10 days

Question 24

What is PCS

Answer 24

concussion symptoms that last greater than 6 weeks and that plateau in the RTL and RTP protocols

Question 25

what is SIS

Answer 25

cerebral edema and brain herniation due to concussion (neurometabolic cascade) and the brains inability to regulate intracranial and cerebral perfusion.

Question 26

what are the longterm effects of concussions

Answer 26

recurring - longer recovery time after each one, increased risk of pcs, increased risk of a next concussion

later on in life - increase risk of MCI, depression and chronic traumatic encephalopathy (CTE)

Question 27

ways to prevent

Answer 27

mouthguard use, EDCUATION, head and neck strengthening, baseline testing