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PHTH 514 - Sport > Concussions > Flashcards

Concussions Flashcards

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1
Q

What are the main 2 reasons PTs should learn about concussions

A
  1. It is an emerging practice area

2. We see patients with concussions first hand

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2
Q

What are some PT skills that can help with concussions

A
  • Manual therapy for CSP/TMJ
  • Vestibular rehab skills
  • Education on RTP and RTL
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3
Q

What is sport concussion

A

A brain injury, defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces

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4
Q

Concussion = mild traumatic brain injury. A concussion must have at least one or more of the following

A
  • Loss of consciousness
  • Loss of memory of events immediately before or after the accident
  • Any alteration in mental state
  • Focal neurological deficit
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5
Q

Do most concussions involve a loss of consciousness

A

no

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6
Q

Why is there an increased rate of concussions over the last 20 years? (4 reasons)

A
  • Heightened awareness (media attention)
  • Improved diagnoses
  • Reporting biases
  • Athletes getting bigger, stronger, faster
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7
Q

What 3 sports have the highest risk of concussion

A
  • Rugby
  • Ice hockey
  • American football
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8
Q

What 3 sports have the lower incidence of concussion

A
  • Cheerleading
  • Baseball
  • Volleyball
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9
Q

Incidence rate of concussion in NHL increase ____ from 1986 to 2012

A

10 fold

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10
Q

What hockey position has highest incidence rate of concussion

A

forwards

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11
Q

What mechanism has the highest rate of concussion in hockey

A

Secondary head contact

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12
Q

Concussions can be caused by ___ or ____

A

direct blow or indirect blow

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13
Q

Concussions result in…

A
  • Rapid onset of short-lived impairment of neurologic function that resolves spontaneously
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14
Q

Concussions may result in neurophathological changes but the acute clinical symptoms largely reflect…

A

A functional disturbance rather than a structural injury

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15
Q

Are concussion typically associated with grossly abnormaly structural neuroimaging studies?

A

no

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16
Q

What is the sequence of pathophysiology of concussion

A

Biomechanical injury to the brain -> Metabolic and ionic changes -> Acute energy crisis -> numerous neurological deficits

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17
Q

Concussions lead to alteration in… (Pathophysiology)

A
  • Ion transport regulation
  • Cellular metabolism
  • Cerebral blood flow
  • Neurotransmitter release
  • Cell membrane permeability
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18
Q

The window of recovery for concussions is though to be…

A

10-14 days but some research shows up to 45 days

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19
Q

When is rest most important following a concussion

A

first 24-48 hours

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20
Q

Do you want to wake athletes periodically when they are sleeping post concussion

A

no! want them to get maximum rest

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21
Q

what percent of concussions are resolves without complication in 7-10 days

A

80-90%

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22
Q

What population may need longer rest post concussion

A

younger athletes - 4 weeks

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23
Q

Are injury graded scales used in concussion management

A

no -

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24
Q

A concussion should be suspected in one or more of the following

A

1 - Symptoms - somatic, cognitive and/or emotional
2 - Signs - loss of consciousness, amnesia, neurological deficit
3 - Balance impairment
4 - Behavioural changes
5 - Cognitive impairment
6 - Sleep disturbances

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25
Q

What is an example of a somatic symptom?

A

Headache

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26
Q

What is an example of a cognitive symptom?

A

feeling in a fog

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27
Q

What is an example of an emotional symptom

A

liability

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28
Q

What is an example of a behavioural change?

A

Irritable

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29
Q

What is an example of a cognitive impairment

A

slow reaction time

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30
Q

If there is a blow to the head, what other things should you rule out

A
  • Skull fracture
  • Brain bleed
  • Sub-dural hematoma
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31
Q

What are mandatory signs

A
  • LOC
  • Motionless>5sec
  • Tonic posturing
  • Confusion/disorientation
  • Amnesia
  • Vacant look
  • motor incoordination
  • Impact seizure, ataxia
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32
Q

What occurs if someone has mandatory signs

A

Should be immediately removed from the field of play (no return for some sports, other sports recommend further assessment in a distraction free environment)

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33
Q

What are discretionary signs

A
  • Clutching the head
  • Slow to get up
  • Suspected facial fracture
  • Possible ataxia
  • behaviour change
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34
Q

What occurs if someone shows discretionary signs

A

Should be immediately removed from the field of play and have further assessment in distraction free environment (can RTP if concussion diagnosis ruled out)

35
Q

Pre-participation physical examination should include a detailed concussion history - what would you want to know ?

A
  • how many concussions
  • Most recent concussion
  • Previous head, face, or CSP injuries?
  • Length of recovery following most recent concussion?
  • Imaging?
  • Risk factors? - Previous concussion, genetic, headache disorder, ADD/ADHD, Dx of depression, anxiety or other psychiatric disorder
  • Has the athlete had any type of concussion treatment
  • Baseline assessment?
36
Q

What are two good reasons for conducting baseline testing

A
  • To get accurate assessment of concussion and guide RTP decisions
  • Good method to educate athletes, parents, coaches, and education about how to manage concussion and the role of PT post injury
37
Q

What are some options for a baseline cognitive assessment

A
  • SCAT5 or Child SCAT5
  • Digital symbol substitution test
  • mBESS score
  • Computerized neuropsychological testing
38
Q

What are 4 examples of computerized neuropsychological testing?

A
  • ImPACT
  • HeadCheck app
  • Cogsport
  • King Devick Test
39
Q

The digit symbol substitution test is sensitve to…

A

decreased speed of information processing

40
Q

what is significant of neuro deficits on the digit symbol substitution test

A

if score is 4-5 points below baseline!

41
Q

Balance deficits may last… following concussion

A

72 hours

42
Q

what is ImPACT

A

a computerized testing tool to allow more objective assessment of concussion and recovery

43
Q

What does ImPACT consist of

A
  • Demographic/concussion history questionnaire
  • Concussion symptom scale
  • Eight neurocognitive measures (attention, reaction time, mental speed, verbal memory, visual memory, processing speed)
  • Detailed clinical report
44
Q

What does the King Devick test assess

A

eye movement, attention, and language

45
Q

When indicates a concussion on the King Devick Test

A

Difference of more than 5 seconds from baseline

46
Q

What are 5 other types of concussion detection technology

A
  • Biomarker testing
  • Sideline electroencephalograms
  • Wearable impact sensors
  • Video analysis of the impact event
  • Apps
47
Q

What are symptoms of a concussion

A
  • Headache or pressure in the head
  • Neck pain
  • Balance problems or dizziness
  • nausea
  • Vision problem
  • Hearing problems (ringing)
  • Fatigue or drowsiness
  • Difficulty remembering
  • Difficulty concentrating
  • Iriitability or emotional changes
  • Feeling dinged, foggy, dazed
  • Confusion, sadness, nervous, anxious
48
Q

Signs of an acute concussion

A
  • Personality changes
  • Loss of consciousness/impaired conscious state
  • Poor coordination or balance
  • Concussive convulsion/impact seizure
  • Gait unsteadiness/loss of balance
  • Slow to answer questions or follow directions
  • Inappropriate playing behaviour/decreased playing ability
  • Easily distracted/poor concentration
  • inappropriate emotions
  • Vomiting
  • Vacant stare
  • Slurred speech
49
Q

What should sideline evaluations contain

A
  • brief neuropsychological test batteries
  • Sport concussion Assessment tool
  • Dont leave athlete alone
50
Q

What are 2 types of Brief neuropsychological test batteries

A
  • Maddocks questions

- Standardized assessment of concussion

51
Q

What are maddocks questions

A
  • Venus?
  • Half/period?
  • Score last?
  • last team played ?
  • Who won last game?
52
Q

What are standardized assessment of concussion

A 
Month? 
Day of week/
Date?
year?
Time?
53
Q

The utility of SCAT5 decreases after how many days??

A

3-5

54
Q

Why shouldnt you leave an athlete with a suspected concussion alone?

A

Need to monitor for any deterioration - “Do we need to get them to hospital?”

55
Q

What are 4 forms of acute concussion management

A
  1. Player not allowed to return to play on day of injury
  2. Should not be left alone, regular monitoring over initial few hours
  3. Player should be medically evaluated - send off to GP
  4. Return to play must be medically supervised, stepwise process
56
Q

What are some red flags of concussion management

A
  • Headaches that worsen
  • Weakness, numbness, or decreased coordination
  • Repeated vomiting or nausea
  • One pupil larger than the other
  • Very drowsy or cannot be awakened
  • Slurred speech
  • Convulsions or seizures
  • Cannot recognize people or places
  • Becomes increasingly confused, restless or agitated
  • Has unusual behaviour
  • Loses consciousness
  • Significant neck pain
57
Q

What does a red flag mean

A

they should go to emergency immediately

58
Q

what age is SCAT5 for

A

13 years and older

59
Q

What does SCAT5 contain

A
  • Concussion history
  • Any pre-injury risk factors?
    • Migraines
    • Dizziness
    • ADHD
    • Learning disorders
    • Dyslexia
    • Sleep disorders
  • GCS, Symptoms
60
Q

What state do you do scat5 in

A

resting - 10+ min post exercise

61
Q

Can an athlete have a a concussion if their CAT 5 is normal

A

yes

62
Q

What are 5 differences between the SCAT5 and the SCAT5 child

A
  • Child reporting is just 0-3 for severity (0-6 for adult)
  • There is room for a parent to report child’s signs
  • Instead of months in reverse order child does days of the week
  • balance testing - single leg stance on for 10-12 year olds
  • neuro-screening - if they dont yet have reading skills they can describe what they see in a picture
  • Has return to school guidelines
  • Includes statements about computer, electronics and gaming
63
Q

What is the advice surrounding drugs following a concussion?

A

No prescription or non-prescription drugs without medical supervision

64
Q

What is the return to play protocol

A

A symptom guided 6 step protocol where each step takes 24 hours

65
Q

When do you begin return to play protocol

A

after 24-48 hrs of rest

66
Q

What are the 6 steps of return to play

A
  1. Symptom limited after ADLs that dont provoke symptoms
  2. light aerobic exercise - start with 10-15 min 1-2x per day
  3. Sport specific exercise - limitations exists
  4. Non-contact training drills
  5. Full contact training after medical clearance
  6. Return to play
67
Q

what commencing sport specific exercises in RTP , what are some conditions?

A

20-30 mins
max 2x per day
No body head contact, spins, dives, jumps, high speed stops, hitting a baseball with a bat or other jarring motions

68
Q

How can you progress within non-contact training drills

A

start with one other teammate and then by end of stage progress to full team practice with no contact

69
Q

What occurs during RTP protocol if symptoms return

A

return to previous level

70
Q

What are the 4 stages of return to learn

A
  1. Home - ADLs that do not worsen symptoms
  2. Home - Homework, reading or other cognitive activities
  3. Return to school part time
  4. Return to school full time
71
Q

What are some modifications the school could provide following a concussion

A
  • Shortened days/Schedule built in breaks
  • No tests
  • Quiet place for breaks
  • Avoid music, gym, cafeteria, taking the bus
  • modify rather than postpone
  • Provide extra time, extra help
  • Limit screen/tv time
  • Reassurance from teachers that child will be supported
72
Q

When is second impact syndrome

A

rare, fatal, uncontrolled swelling of brain, minor second blow before initial symptoms have ressolvedd

73
Q

What is post-concussion syndrome

A

persistent symptoms

74
Q

What is the strongest predictor of Post concussion syndrome

A

Person’s initial symptoms in the first few days post injury

75
Q

In teenage years are girls or boys at greater risk of persistent symptoms

A

girl

76
Q

Having 3+ concussions is associated with

A
  • Changes in neurophysiology
  • Subjective symptoms
  • Impaired neuropsychological test results
  • Greater risk for future concussion
  • Slower recovery
  • Later in life memory impairment, AD, and CTE
77
Q

Cumulative effects of concussions are well documented in who

A

boxers

78
Q

What is chronic traumatic encephalopathy (CTE)

A

Neurodegenerative disease thought to be associated with a history of repetitive head impacts

79
Q

What are some issues with pediatric concussions

A
  • Children may not be fully aware of their symptoms
  • Little concussion data on pre-high school age
  • under reporting
  • Less medical personnel events
  • Younger brains more vulnerable
80
Q

Why are younger brains more vulnerable

A
  • Immature CNS
  • Larger head-to-body ratio
  • Neck and shoulder muscles less developed
  • Laxity of cervical ligaments
  • Thinner cranium
81
Q

Do younger or older athletes take longer to recover from concussions

A

younger

82
Q

Younger athletes with concussions show persistent neurocognitive findings despite resolution of symptoms

A

true

83
Q

What is the difference in symptoms of boy and girls

A

Females report more drowsiness and sensitivity to noise. Greater cognitive impairement in females, slower reaction times, Greater mortality in females

PHTH 514 - Sport (2 decks)

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