exam 2 - concussion Flashcards
what kind of neuro imaging do we find
normal
how long do concussion sympmtom last
is it varible depends on the presentation and the pt
cellular what happens during a concuntion
K+ leaves the cell
Ca runs in - this leads to a metabolic dysfunction
metabolic dysfuntion - energy crisis
massive release of NT interfere with the cell communication
period after conccusion what are the cells are risk for
they are venerable for a undefined amount of time that if they sustain a second insult there could be irreversible damage or death of the cells
who do we diagnosis conculsion
clinical diagnosis - there is not specific test that we can do
can we rely on imaging for the diagnosis of a concussion
no the result are not stable enough
side line /acute assessments
sideline assessment of concussion
SCAT
MACE - military
how do we diagnosis a concussion using clinical information
side line assessment
symptoms assessment
neurocognitive testing
vestibular/ocular testing
balance training
many of these tools are only helpful at the time of injury
what can wrong during the recovery of a concussion
second impact syndrome
chronic traumatic encephalopathy
post concussion syndrome
what is post concussion syndrome
after recovery of concussion the deficts persist after normal window of recoverey
what is the precent of people who have PCS
20%
does the hit predict how bad a con will be
no
on field signs and symptoms
LOC
retrograde
confusion
dizziness
numbness
fatigue
personality chnages
head ache
vomiting
light and noise sensitivity
visual issues
what happen with dizziness is associated with a concusion
sole factor that is associated with prolonged recovery
6x more likely to take more then 3 weeks to recover
what did the study show about vomiting and LOC
predictive of quick recovery <7days
what acute symptoms are not important for recovery
seizure
brief LOC
on-field vomiting
when is imaging and additional test indicated
ID serious cerbral injury
ID sersious cervical spine issue
what is a focal neurologic deficit
A problem with nerve, spinal cord, or brain function.
It affects a specific location, such as the left side of the face
what to do immediatly following a conccusion
remove from play
prohibit activity that would lead to further risk of concus
modify physical and cognitive activity
what does modified physical and cognitive activity look like
accomadtions at school and work - moderate workload
moderate high stimulus activity
make sure to provide regular assesments to monitor symptoms and recovery
what was shown when people continued to play with a concussion
playing doubled the recovery time
pre-exiting risk factors to concusion
female
age (teens and older adults)
migraine history
visual dys
mood disorder
concus hx
learning disablities/adah
injury specific risk factors
removal from play
on flied dizziness
post injury risk factors
miagraines
visual dys
mood disorders
high initial sym burden
multiple areas involved
return to play criteria - contact
sym free at rest
sym free with exertion
normal testing - cog, physical
normal testing
this is not the same for noncontact activity
are all concus the same
no
cognitive fatigue profile
fatigue/reduced energy
feels best in the am with cognitive and physical activity
end of day sym
may have sleep deficts
cognitive impairment generalized
vestibular profile
dizzy
nausea/motion sickness
ons step behind
symptomatic in a busy area
off balance
ocular/visual profile
frontal headache with visual work
hard time with visually based activity in classes
pressure behind both eyes
visual focus issues
blurry vision
double vision
anxiety mood profile
hypervigilance and rumination
overwhlemed
hard time going to bed - unable to turn off thoughts
hard time staying asleep
obsessive thoughts on invertory symptoms
limited socialization
rumination
a deep or considered thought about something.
post traumatic mirgraine profile
varible headache
often awake with a headache
nausea, photo and phonophobia
stress, anxiety, lack of exercise
sleep dysregulation
ay also present wiht vetsibular migraines
do the concus subtype ever occur alone
no, rarely
the key is to find the driving subtype
what are the three part of concus management
activity modification
therapies
medication needed?
what is the issue with sym checklist
magnifying
underreporting
what is neurocog testing used for
assist in determining presence of severity of of concus and establishing recovery from concussion
do you just use neurocog testing alone when looking at a concus patient
no
what is one computerized neurocog test
imPACT
what do you do to screen for vestibular and ocular concussions
VOMS
SM and saccades
NPC
horizontal and vertical VOR
visual motion sensitivity
what does VOMS stand for
vestibular ocular motor screening
what is VOMS used for
used with other test to diagnosis a concussion
guide referral and treatment
what is included in the VOMS - pre and post
5min screen
pre test symptoms assessed
head ache, dizzy, nausea, foginess
post VOMS assessment
for VOMS NPC
convergence and sym provocation
what is needed for the VOMS assessment
tape measure
metranome
target with 14 pt font
VOMS scoring
individual sx score totaling 2> ID signifgantly for concus
score of >5 cm is sig for a concusion
is VOMS related to BESS
no
visual system deficits with concus
blurred vision
double vision
jumping image
eye strain
hard time taking notes in class
what does we see with saccades and concussion
undershoot
what is a overshooting issue in saccades
cerebellum
what are the issues we can see with convergence
convergence spasm
5 cm
what is a convergence spasm - concus
spontaneous spasm
pupillary constriction
inability to abd the eye
pt can describe dizziness associated with spasm
what is accommodation
the ability of the eye to focus on a near target, moves the focal point of the eye forward
what is age dependent accommadation or convergence
accommodation
> 30 yrs
what is an accommodation insufficiency
amp of acc is lower the expected for that age
inability to focus or sustain focus for near vision
what is accommodation used for
testing that goes beyond VOMS
how do you test accommodation
monocular test
14 pt font - bring thsi forward toward pt until it blurs
measure from bridge of the nose
compare to age related outcomes
do you have ocuclar misalignment after concussion yes
strabismus
tropia or phoria
can be preexisting
what is diplopia
double vision
PT options for ocular problems
brock
pencil push ups
2 dots card
smooth pursuits
saccades
what is part of the peri vestibualr system
SSC
otolith organs
vestibular ganglion
vestibular canal
central vestibular system
vest nuclei
cere
ANS
thalamus
CC
what is the function of the VOR
stablize vision while the head moves
what is the function of vestibular spinal reflex - when is it most active
when vision and somosensation is reduced
common vest issue following concussion - peri
BPPV
labyrinthine concussion
common vest issue following concussion - central
brainstem concussion
post traumatic migraine
common non-vestibular causes of dizziness
cervicogenic dizzy
oculomotor
autonomic/othrostatic
visual motion sensityvity is often associated with
migraine and anxiety
is a balance impairment common following a concussion
very common acutely
often related to abnormalities in sensory organization
what three system do you need to work to have good balance
vest
visual
somosensory
what is a posturgarphy test
sensory orgnaization test
what is the BESS
balance tool designed for concussion
3 stance posture - double leg, single leg, and tandem standing
as standing test like BESS, ctsib, SOT sensitive to change the first few days after concussion
no
what is more sensitive in first few days following concussion
dual task paradigms
COBALT, HITMAN
treatment for vestibular concussion
1x/week and daily HEP
gaze stabilization
treatment for migraine concussion
regulated sleep schedule
avoid dietary triggers
light exertion
- walking/stationary bike 20 min a day without symptom reproduction
treatment for conginitive concussion
academic accommodations
- school breaks
- extra time for tests
formal extertion rehab
- start once base line symptoms improve
