Concussions Flashcards
1
Q
What are the main 2 reasons PTs should learn about concussions
A
- It is an emerging practice area
2. We see patients with concussions first hand
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
3
Q
What is sport concussion
A
A brain injury, defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces
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
5
Q
Do most concussions involve a loss of consciousness
A
no
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
7
Q
What 3 sports have the highest risk of concussion
A
- Rugby
- Ice hockey
- American football
8
Q
What 3 sports have the lower incidence of concussion
A
- Cheerleading
- Baseball
- Volleyball
9
Q
Incidence rate of concussion in NHL increase ____ from 1986 to 2012
A
10 fold
10
Q
What hockey position has highest incidence rate of concussion
A
forwards
11
Q
What mechanism has the highest rate of concussion in hockey
A
Secondary head contact
12
Q
Concussions can be caused by ___ or ____
A
direct blow or indirect blow
13
Q
Concussions result in…
A
- Rapid onset of short-lived impairment of neurologic function that resolves spontaneously
14
Q
Concussions may result in neurophathological changes but the acute clinical symptoms largely reflect…
A
A functional disturbance rather than a structural injury
15
Q
Are concussion typically associated with grossly abnormaly structural neuroimaging studies?
A
no
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
17
Q
Concussions lead to alteration in… (Pathophysiology)
A
- Ion transport regulation
- Cellular metabolism
- Cerebral blood flow
- Neurotransmitter release
- Cell membrane permeability
18
Q
The window of recovery for concussions is though to be…
A
10-14 days but some research shows up to 45 days
19
Q
When is rest most important following a concussion
A
first 24-48 hours
20
Q
Do you want to wake athletes periodically when they are sleeping post concussion
A
no! want them to get maximum rest
21
Q
what percent of concussions are resolves without complication in 7-10 days
A
80-90%
22
Q
What population may need longer rest post concussion
A
younger athletes - 4 weeks
23
Q
Are injury graded scales used in concussion management
A
no -
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
25
What is an example of a somatic symptom?
Headache
26
What is an example of a cognitive symptom?
feeling in a fog
27
What is an example of an emotional symptom
liability
28
What is an example of a behavioural change?
Irritable
29
What is an example of a cognitive impairment
slow reaction time
30
If there is a blow to the head, what other things should you rule out
- Skull fracture
- Brain bleed
- Sub-dural hematoma
31
What are mandatory signs
- LOC
- Motionless>5sec
- Tonic posturing
- Confusion/disorientation
- Amnesia
- Vacant look
- motor incoordination
- Impact seizure, ataxia
32
What occurs if someone has mandatory signs
Should be immediately removed from the field of play (no return for some sports, other sports recommend further assessment in a distraction free environment)
33
What are discretionary signs
- Clutching the head
- Slow to get up
- Suspected facial fracture
- Possible ataxia
- behaviour change
34
What occurs if someone shows discretionary signs
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
Pre-participation physical examination should include a detailed concussion history - what would you want to know ?
- 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
What are two good reasons for conducting baseline testing
- 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
What are some options for a baseline cognitive assessment
- SCAT5 or Child SCAT5
- Digital symbol substitution test
- mBESS score
- Computerized neuropsychological testing
38
What are 4 examples of computerized neuropsychological testing?
- ImPACT
- HeadCheck app
- Cogsport
- King Devick Test
39
The digit symbol substitution test is sensitve to...
decreased speed of information processing
40
what is significant of neuro deficits on the digit symbol substitution test
if score is 4-5 points below baseline!
41
Balance deficits may last... following concussion
72 hours
42
what is ImPACT
a computerized testing tool to allow more objective assessment of concussion and recovery
43
What does ImPACT consist of
- 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
What does the King Devick test assess
eye movement, attention, and language
45
When indicates a concussion on the King Devick Test
Difference of more than 5 seconds from baseline
46
What are 5 other types of concussion detection technology
- Biomarker testing
- Sideline electroencephalograms
- Wearable impact sensors
- Video analysis of the impact event
- Apps
47
What are symptoms of a concussion
- 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
Signs of an acute concussion
- 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
What should sideline evaluations contain
- brief neuropsychological test batteries
- Sport concussion Assessment tool
- Dont leave athlete alone
50
What are 2 types of Brief neuropsychological test batteries
- Maddocks questions
| - Standardized assessment of concussion
51
What are maddocks questions
- Venus?
- Half/period?
- Score last?
- last team played ?
- Who won last game?
52
What are standardized assessment of concussion
```
Month?
Day of week/
Date?
year?
Time?
```
53
The utility of SCAT5 decreases after how many days??
3-5
54
Why shouldnt you leave an athlete with a suspected concussion alone?
Need to monitor for any deterioration - "Do we need to get them to hospital?"
55
What are 4 forms of acute concussion management
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
What are some red flags of concussion management
- 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
What does a red flag mean
they should go to emergency immediately
58
what age is SCAT5 for
13 years and older
59
What does SCAT5 contain
- Concussion history
- Any pre-injury risk factors?
- Migraines
- Dizziness
- ADHD
- Learning disorders
- Dyslexia
- Sleep disorders
- GCS, Symptoms
60
What state do you do scat5 in
resting - 10+ min post exercise
61
Can an athlete have a a concussion if their CAT 5 is normal
yes
62
What are 5 differences between the SCAT5 and the SCAT5 child
- 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
What is the advice surrounding drugs following a concussion?
No prescription or non-prescription drugs without medical supervision
64
What is the return to play protocol
A symptom guided 6 step protocol where each step takes 24 hours
65
When do you begin return to play protocol
after 24-48 hrs of rest
66
What are the 6 steps of return to play
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
what commencing sport specific exercises in RTP , what are some conditions?
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
How can you progress within non-contact training drills
start with one other teammate and then by end of stage progress to full team practice with no contact
69
What occurs during RTP protocol if symptoms return
return to previous level
70
What are the 4 stages of return to learn
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
What are some modifications the school could provide following a concussion
- 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
When is second impact syndrome
rare, fatal, uncontrolled swelling of brain, minor second blow before initial symptoms have ressolvedd
73
What is post-concussion syndrome
persistent symptoms
74
What is the strongest predictor of Post concussion syndrome
Person's initial symptoms in the first few days post injury
75
In teenage years are girls or boys at greater risk of persistent symptoms
girl
76
Having 3+ concussions is associated with
- 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
Cumulative effects of concussions are well documented in who
boxers
78
What is chronic traumatic encephalopathy (CTE)
Neurodegenerative disease thought to be associated with a history of repetitive head impacts
79
What are some issues with pediatric concussions
- 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
Why are younger brains more vulnerable
- Immature CNS
- Larger head-to-body ratio
- Neck and shoulder muscles less developed
- Laxity of cervical ligaments
- Thinner cranium
81
Do younger or older athletes take longer to recover from concussions
younger
82
Younger athletes with concussions show persistent neurocognitive findings despite resolution of symptoms
true
83
What is the difference in symptoms of boy and girls
Females report more drowsiness and sensitivity to noise. Greater cognitive impairement in females, slower reaction times, Greater mortality in females
