concussions Flashcards
what is an injury to the brain that is not hereditary, congenital, degenerative or induced by birth trauma
• Essentially a brain injury that occurs after birth
acquired brain injury
• Anoxia/hypoxia
• Infection/virus
• Stroke
• Tumor
• Aneurysm
• Metabolic
disorders
these are what kind of acquired brain injury
non traumatic
Penetrating
injuries:
• Assaults
• Falls
• Accidents
• Abuse
• Surgery
these are what kind of acquired brain injury
traumatic open brain injury
what kind of TBI is it if a pt has a LOC for > 24 hours
post traumatic amnesia > 7 days and <6 on the GCS
severe
what is teh GCS , PTA and LOC for a concussion/ mTBI
Concussion /mTBI
GCS: 13-15
PTA <24h
LOC: 0-30minutes
what is the most common type of TBI
concussion
what is a sported related concussion
a TBI causes by a directi blow to the head , neck or body resulting in a force going to the brain
wehn do signs and symptoms presents from a sports related concussion
may be immediately or minutes to hours after
a sports related concussion is more of a ____ disturbance rather than a ___ injury
functional
structural
does sports relate concussion have LOC
maybe or maybe not
what are the clinical symptoms for a concussion and what is the number one
o Headache*
o Dizziness
o Nausea
o Neck pain
o Confusion
o Fatigue
o Feeling of “fogginess
concussion symptoms can be ____, ____ and ____
cognitive
physcial
emotional
Disturbance of brain function related to neurometabolic dysfunction rather than structural brain injury
this is the pathophysuilogy for what
concussion
___ are the leading cause of injury in adults aged 65 and older
falls
____ are more susceptible to concussions
elderly
for a concussion there is a ___ risk for intracranial bleedinng w delayed sings for older adults
higher
why are older adults less likely to be diagnosed and treated with a concussion
bc symptoms are not always obvious and are often missed as other things for normal aging
what is the leading causes of TBI in active duty personnel in war zones
improvised explosive deceives
what are the 3 major effects that causes brain trauma from an explosion
shock waves
shrapnel
acceleration
how many SRC are reported annually
1.6-3.8 mil
strong evidence to suggest that past history of concussion is a ___ factor for future concussions*
risk
do older or younger people recover from concussionc faster
older
takes younger kids longer
is female or men more common to get concussion
female
people who have what 3 things are likely to have greater sysmtoms of a concussion
hx of concussion
pre existing developmental or health concerns (ADHD)
hx of headache
what are the main symptoms that women are gonna report w a concussion
drowsiness and sensitivity to light
women take longer to recover
what are the 12 R’s of SRC
- RECOGNIZE
- REDUCE
- REMOVE
- REFER
- RE-EVALUATE
- REST
- REHABILITATE
- RECOVER
- RETURN-TO-LEARN (RTL)/RETURN-TO-SPORT (RTS)
- RECONSIDER
- RETIRE
- REFINE
what is REDUCE for SRC
prevention of concussion
what is REMOVE for SRC
sideline evaluation
what are the 8 sings that warrant removal from play
o Actual or suspected LOC
o Seizure
o Tonic posturing
o Ataxia
o Poor balance
o Confusion
o Behavioral changes
o Amnesia
what are the 3 r’s as first responders on a sports field
recognize
remove
refer
what is the assessment tool for concussion
concussion recognition tool 6 (across spectrum)
sports concussion assessment tool (SCAT) > 13 years old
- For use by non-medical stakeholders (parents, players, officials, coaches, sports
administrators) - Used to help identify concussion in children, adolescents and adults
- Not designed to diagnose concussion
- Provides guidance to for when a player should be removed from play
- Identify red flags
- Provides basic guidance regarding management
which assessment tool dos this
CRT
is teh SCAT 6 a diagnostic on its own ?
no
t/f: Scoring on the SCAT6 should not be used as a stand-alone method to diagnose
concussion, measure recovery or make decisions about an athlete’s readiness to
return-to-sport after concussion
t
what are the 5 steps from the immediate assessment for SCAT 6
o STEP 1: Observable signs
o STEP 2: GCS
o STEP 3: Cervical spine assessment
o STEP 4: Coordination and ocular/motor screen
o STEP 5: Memory assessment
what are the 6 steps for the off field assessment for SCAT 6
o STEP 1: Athlete background
o STEP 2: Symptom evaluation
o STEP 3: Cognitive screening
o STEP 4: Coordination and balance assessment
o STEP 5: Memory assessment
o STEP 6: Decision
what are the 8 observable signs of a concussion for SCAt 6
- lying motions less >5 seconds
- no protective action
- motor incoordainton
- disorientation
- blank look
- facial injury after head trauma
- impact seizures
- high risk MOI
what are red flags from the immediate assessment for SCAT
Neck pain or tenderness
Double vision
Weakness or tingling/burning in more than one arm or in the legs
Severe or increasing headaches
Seizure or convulsion
LOC
Deteriorating consciousness
Vomiting
Increased restlessness, agitation or aggressiveness
GCS <15
Visible deformity of the skull
for the cervical spine assessment for the SCAT (step 3) what is the 4 yes or no questions
- Neck pain at rest
- Tenderness on palpation
- If NO neck pain and NO tenderness, does the athlete have full ACTIVE pain
free ROM - Are limb strength and sensation normal?
for the SCAT , step 4: coordination adn **ocular motor screen **how do u test this
- COORDINATION: Is finger-nose normal for both hands with eyes
OCULAR/MOTOR: Without moving their head or neck, can the patient look side-to-side and up-and-down without double vision open and eyes closed
most concussion resolve within how many days in adults
10-14
what is the Return to sport strategy
ymptom limited activity → aerobic exercise → individual sport-specific exercise→ non-contact
training → full contact practice → RTS
is strict rest until the complete resolution of concussion good ?
nooooo
what is persistent post concussion symptoms
Symptoms that persist > 10 – 14 days in adults and > 4 weeks in
children
what are pre existing risk factors from PPCS
• Female gender
• Adolescent
• Hx of personal or family anxiety/depression
• PMHx or family Hx of migraine
• DD or learning disorders
• Pre-existing visual dysfunction
what is the main risk factors fr post injury for PPCS
continuing to play post concussion
wh What causes persistent symptoms following concussion?
- Cervical spine
- Vestibular system
- Visual system
- Autonomic nervous system (ANS)
- Psychological factors (mood, anxiety etc.
what is the main problem for the peripheral vestibular post concussion
BBPV
concussionc can causes a direct impact on what CN and an indirect impact on what CN
- Direct impact on vision function: CN II, III, IV, VI
- Indirect impact on vision function: CN V and VII (trigmenial an facial)
what 3 things go into the sensory input for balance and postural control
vestibular
visual
proprioceptive
what 3 things go into the input integration for balance and postural control
cerebellum
cerebral cortex
brain stem
what 3 things go into the motor output for balance and postural control for PPCS
vestibular ocular reflex
motor impulses for eye
motor impulses for body posture
what are symptoms of the autonomic nervous system for PPCS
• ↑ HR, ↓HRV, ↓postural BP control
• Temperature flushes/heat tolerance
• Difficulty getting to sleep
• Exacerbation of symptoms (e.g. light headedness, dizziness, headache)
during cognitive &/or physical activity
for sub maximal aerobic exercises u want to progress by ___ bpm every __ days
5
3
what is the HR % from submax aerobic exercises 8
0-90%
what is the first thing u shoudl do for PPCS treatment
rule out cervical spine, visual and vestibular systems first.
if there treat visual then CS then vest
what is the CV exercise progression
x • Bike → cross-trainer→Mini tramp → treadmill→ outside → RTS
what is a clinical condition historically associated with chronic TBI in boxers
CTE
