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Neuromus 1 > exam 2 - concussion > Flashcards

exam 2 - concussion Flashcards

1
Q

what kind of neuro imaging do we find

A

normal

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2
Q

how long do concussion sympmtom last

A

is it varible depends on the presentation and the pt

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3
Q

cellular what happens during a concuntion

A

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

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4
Q

period after conccusion what are the cells are risk for

A

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

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5
Q

who do we diagnosis conculsion

A

clinical diagnosis - there is not specific test that we can do

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6
Q

can we rely on imaging for the diagnosis of a concussion

A

no the result are not stable enough

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7
Q

side line /acute assessments

A

sideline assessment of concussion
SCAT
MACE - military

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8
Q

how do we diagnosis a concussion using clinical information

A

side line assessment
symptoms assessment
neurocognitive testing
vestibular/ocular testing
balance training

many of these tools are only helpful at the time of injury

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9
Q

what can wrong during the recovery of a concussion

A

second impact syndrome
chronic traumatic encephalopathy
post concussion syndrome

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10
Q

what is post concussion syndrome

A

after recovery of concussion the deficts persist after normal window of recoverey

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11
Q

what is the precent of people who have PCS

A

20%

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12
Q

does the hit predict how bad a con will be

A

no

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13
Q

on field signs and symptoms

A

LOC
retrograde
confusion
dizziness
numbness
fatigue
personality chnages
head ache
vomiting
light and noise sensitivity
visual issues

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14
Q

what happen with dizziness is associated with a concusion

A

sole factor that is associated with prolonged recovery

6x more likely to take more then 3 weeks to recover

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15
Q

what did the study show about vomiting and LOC

A

predictive of quick recovery <7days

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16
Q

what acute symptoms are not important for recovery

A

seizure
brief LOC
on-field vomiting

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17
Q

when is imaging and additional test indicated

A

ID serious cerbral injury

ID sersious cervical spine issue

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18
Q

what is a focal neurologic deficit

A

A problem with nerve, spinal cord, or brain function.

It affects a specific location, such as the left side of the face

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19
Q

what to do immediatly following a conccusion

A

remove from play

prohibit activity that would lead to further risk of concus

modify physical and cognitive activity

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20
Q

what does modified physical and cognitive activity look like

A

accomadtions at school and work - moderate workload

moderate high stimulus activity

make sure to provide regular assesments to monitor symptoms and recovery

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21
Q

what was shown when people continued to play with a concussion

A

playing doubled the recovery time

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22
Q

pre-exiting risk factors to concusion

A

female
age (teens and older adults)
migraine history
visual dys
mood disorder
concus hx
learning disablities/adah

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23
Q

injury specific risk factors

A

removal from play
on flied dizziness

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24
Q

post injury risk factors

A

miagraines
visual dys
mood disorders
high initial sym burden
multiple areas involved

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25
Q

return to play criteria - contact

A

sym free at rest
sym free with exertion
normal testing - cog, physical
normal testing

this is not the same for noncontact activity

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26
Q

are all concus the same

A

no

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27
Q

cognitive fatigue profile

A

fatigue/reduced energy

feels best in the am with cognitive and physical activity

end of day sym

may have sleep deficts

cognitive impairment generalized

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28
Q

vestibular profile

A

dizzy

nausea/motion sickness

ons step behind

symptomatic in a busy area

off balance

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29
Q

ocular/visual profile

A

frontal headache with visual work

hard time with visually based activity in classes

pressure behind both eyes

visual focus issues

blurry vision

double vision

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30
Q

anxiety mood profile

A

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

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31
Q

rumination

A

a deep or considered thought about something.

32
Q

post traumatic mirgraine profile

A

varible headache

often awake with a headache

nausea, photo and phonophobia

stress, anxiety, lack of exercise

sleep dysregulation

ay also present wiht vetsibular migraines

33
Q

do the concus subtype ever occur alone

A

no, rarely

the key is to find the driving subtype

34
Q

what are the three part of concus management

A

activity modification

therapies

medication needed?

35
Q

what is the issue with sym checklist

A

magnifying

underreporting

36
Q

what is neurocog testing used for

A

assist in determining presence of severity of of concus and establishing recovery from concussion

37
Q

do you just use neurocog testing alone when looking at a concus patient

A

no

38
Q

what is one computerized neurocog test

A

imPACT

39
Q

what do you do to screen for vestibular and ocular concussions
VOMS

A

SM and saccades

NPC

horizontal and vertical VOR

visual motion sensitivity

40
Q

what does VOMS stand for

A

vestibular ocular motor screening

41
Q

what is VOMS used for

A

used with other test to diagnosis a concussion

guide referral and treatment

42
Q

what is included in the VOMS - pre and post

A

5min screen

pre test symptoms assessed
head ache, dizzy, nausea, foginess

post VOMS assessment

43
Q

for VOMS NPC

A

convergence and sym provocation

44
Q

what is needed for the VOMS assessment

A

tape measure

metranome

target with 14 pt font

45
Q

VOMS scoring

A

individual sx score totaling 2> ID signifgantly for concus

score of >5 cm is sig for a concusion

46
Q

is VOMS related to BESS

A

no

47
Q

visual system deficits with concus

A

blurred vision

double vision

jumping image

eye strain

hard time taking notes in class

48
Q

what does we see with saccades and concussion

A

undershoot

49
Q

what is a overshooting issue in saccades

A

cerebellum

50
Q

what are the issues we can see with convergence

A

convergence spasm

5 cm

51
Q

what is a convergence spasm - concus

A

spontaneous spasm

pupillary constriction

inability to abd the eye

pt can describe dizziness associated with spasm

52
Q

what is accommodation

A

the ability of the eye to focus on a near target, moves the focal point of the eye forward

53
Q

what is age dependent accommadation or convergence

A

accommodation

> 30 yrs

54
Q

what is an accommodation insufficiency

A

amp of acc is lower the expected for that age

inability to focus or sustain focus for near vision

55
Q

what is accommodation used for

A

testing that goes beyond VOMS

56
Q

how do you test accommodation

A

monocular test

14 pt font - bring thsi forward toward pt until it blurs

measure from bridge of the nose

compare to age related outcomes

57
Q

do you have ocuclar misalignment after concussion yes

A

strabismus
tropia or phoria

can be preexisting

58
Q

what is diplopia

A

double vision

59
Q

PT options for ocular problems

A

brock
pencil push ups
2 dots card
smooth pursuits
saccades

60
Q

what is part of the peri vestibualr system

A

SSC
otolith organs
vestibular ganglion
vestibular canal

61
Q

central vestibular system

A

vest nuclei
cere
ANS
thalamus
CC

62
Q

what is the function of the VOR

A

stablize vision while the head moves

63
Q

what is the function of vestibular spinal reflex - when is it most active

A

when vision and somosensation is reduced

64
Q

common vest issue following concussion - peri

A

BPPV
labyrinthine concussion

65
Q

common vest issue following concussion - central

A

brainstem concussion
post traumatic migraine

66
Q

common non-vestibular causes of dizziness

A

cervicogenic dizzy

oculomotor

autonomic/othrostatic

67
Q

visual motion sensityvity is often associated with

A

migraine and anxiety

68
Q

is a balance impairment common following a concussion

A

very common acutely

often related to abnormalities in sensory organization

69
Q

what three system do you need to work to have good balance

A

vest

visual

somosensory

70
Q

what is a posturgarphy test

A

sensory orgnaization test

71
Q

what is the BESS

A

balance tool designed for concussion

3 stance posture - double leg, single leg, and tandem standing

72
Q

as standing test like BESS, ctsib, SOT sensitive to change the first few days after concussion

A

no

73
Q

what is more sensitive in first few days following concussion

A

dual task paradigms

COBALT, HITMAN

74
Q

treatment for vestibular concussion

A

1x/week and daily HEP

gaze stabilization

75
Q

treatment for migraine concussion

A

regulated sleep schedule

avoid dietary triggers

light exertion
- walking/stationary bike 20 min a day without symptom reproduction

76
Q

treatment for conginitive concussion

A

academic accommodations
- school breaks
- extra time for tests

formal extertion rehab
- start once base line symptoms improve

Neuromus 1 (15 decks)

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