final exam concussion exam/eval Flashcards
The following listed are yellow or red flags?
-upper cervical instability
-spinal cord damage
-signs/symptoms of a brain bleed or moderate/severe TBI
-polytrauma – Fxs/secondary complication shouldn’t be initially managed in PT
red flags
Baseline Testing for Concussion:
- baseline neuropsychologic testing of people, often athletes
- often use the ImPACT
- assess baseline cognitive ability and function
- post concussion scored are compared to baseline score to determine stages of recovery and return to activity
Is the following statement True or False:
Baseline tests for concussion testing is reliable and hard to skew?
False: easy to skew
Immediate Post Concussion Assessment and Cognitive Test (ImPACT)
(a). _____-_____ mins long ______ test
(b). test include: (7)
(c). ________ scores are compared to post concussion scores
(d). post concussion scores are recommended within ___________
a. 20-30 mins. long computerized
b.
- attention span
- working memory
- sustained and selective attention span
- nonverbal problem solving
- reaction time
- response variability
c.
baseline scores are compared to post concussion scores
d.
72 hours of concussion
Post concussion tests are ________ until the athlete is cleared and returned to baseline function
repeated
concussion CPG categories:
- cervical msk impairments
- vestibulo-ocular impairments
- autonomic dysfunction/exertional tolerance impairments
- motor function impairments
CPG for Eval/Exam: outcomes
PTs should determine and document a plan for outcome measurement
What is the strongest CPG evidence for concussion?
strong (1)
moderate (5)
Level A: dix hallpike or other positional testing
Level B: vestibulo-ocular function, orthostatic hypotension/AD, graded exertional testing, motor function impairment, classifying impairment into subtypes
CPG summary for Eval/Exam (5)
- PTs should complete a multi-system exam following concussion (B)
- PTs should sequence exam based on irritability and delay exam procedures if needed (F)
- PTs should proceed testing untested domains of the (4) CPG categories in that is based on clinical judgement (F)
- PTs should address cervical & t-spine for sources of MSK dysfunction (F)
- PTs should thoroughly examine oculomotor, orthostatic hypotension/autonomic dysfunction (F)
CPG for Eval/Exam:
-psychological and sociological factors:
- self-efficacy
- self-management strategies
- PT should explain that most symptoms following concussion do improve
Sequencing based on CPG:
Other considerations: (4)
start w/cervical –> move through the other categories based on symptoms/irritability and priority of subcategory
cognition, sleep, mood, migraine
Screening: Cervical
ligamentous integrity
palpation of UT/SO’s (headache and dizziness generators)
clear vertebral artery
-5D’s and 3N’s combined with modified vertebral artery test
Spurlings
Joint mobility (C & T spine)
Posture
Further Cervical Testing:
ROM
Muscle Endurance/Strength
Scapulothoracic mobility
PAVIM’s at C and T spine
Joint Position Error Testing
Screening Vision/Cranial Nerves:
saccades
smooth pursuit
convergence/divergence
Snellen chart
visual field cuts (quadrant testing)
light sensitivity
changes in vision (tunnel vision)
Screening Vestibular/Cranial Nerves:
HIT
VOR (do not exceed 1Hz if you suspect concussion)
VOR cancel
Visual motion sensitivity
Horizontal & Posterior canal screen
Fkuda step test
Eyes closed on foam
DVA
Vestibular: Positional Testing (2)
Hallpike
Roll test
Autonomic/Exertional Tests: (2)
Orthostatics (vitals in sitting, supine & standing)
Buffalo Concussion Treadmill Test
Buffalo Concussion Treadmill Test:
-purpose
-procedure
-symptoms description
Assesses cardiovascular system and symptom onset and intensity w/aerobic challenge - help establish a safe level of exercise for concussion treatment
track HR, visual analog scale, and RPE throughout and pre/post
vertigo, lightheadedness, duration, triggers
Buffalo Concussion Treadmill Test:
-protocol:
start at 0% incline and baseline speed.
Increase incline by 1% every minute until reaching 15%
maintain 15% incline and increase speed by 0.4 mph per minute until 20 minutes.
Buffalo Concussion Treadmill Test:
-stop criteria
increase of 3+ on VAS scale for symptom exacerbation
RPE of >17
searing headache
lack of responsiveness
90% or higher of age predicted max HR
Borgs Rating RPE Scale
6-20
Visual Analogue Scale
0-10
Concussion: Motor Function Screening
Static Balance: BESS
Dynamic Balance: HiMAT
Dual-Task/Multitasking Gait Activities: Tug Manual Dual Task
Motor Coordination w/complex movement tasks
Balance Error Scoring System:
Testing Balance w/under 6 conditions eyes closed
counting errors
double-leg firm surface
single leg firm surface
tandem firm surface
double-leg foam surface
single foam surface
tandem foam surface
HiMAT
-assesses:
Walking
-normal, backward, on toes, over obstacles
Running
Skipping
Hop Foward
Bounding
-affected and unaffected
Stairs
-up and down
Screening:
Tug cognitive dual task
Stroop (1. word not color | 2. color not word)
3-5 word delayed recall
Executing function testing of inhibition
Common Assessment Tools: SCAT6: Immediate On-Field Assessment (4)
Step 1: Red Flags
Step 2: Observable SIgns
Step 3: Memory Assessment (Maddocks Questions)
Step 4: Examination (GCS, Cervical Spine)
Common Assessment Tools: SCAT6: Office or Off-Field (6)
Step 1: athlete background
Step 2: symptom evaluation
Step 3: Cognitive Screening
Step 4: Neurological Screening
Step 5: Delayed Recall
Step 6: Decision
SCAT Red FLAGS Include:
- Lying motionless playing surface
- Falling unprotected to the surface
- Balance/gait difficulties, motor incoordination, ataxia; stumbling, slow/labored movements
- Disorientation or confusion, staring or limited responsiveness, or an inability to respond appropriately to questions
- Blank or vacant look
- Facial injury after head trauma
- Impact seizure
- High-risk mechanism of injury (sport-dependent)
SCAT 6: RED Flags
-GCS less than _____
-______ tenderness or loss of ROM
-memory/Maddocks questions less than ____
-coordination or ocular motor screen abnormality
15
neck
5
SCAT 6 Off-Field Assessment:
–Athlete Background
–Symptom Evaluation
–Cognitive Screening (3)
–Balance Assessment (3)
–Delayed Recall
–Decision on Return to Play
Cognitive Screening:
1. Orientation: Ask about the current date, time, and location.
2. Immediate Memory: Repeat a list of words or numbers immediately.
3. Concentration: Perform a serial subtraction task (e.g., count backwards from 100 by 7s).
Balance Assessment:
1. BESS: Perform three stances (double-leg, single-leg, tandem) on firm and foam surfaces.
2. Times Tandem Gait: Measure time to walk 10 steps heel-to-toe in a straight line.
3. Dual Task Gait: Walk while performing a cognitive task (e.g., reciting months backwards).
The BCTT alone should never be used to make a _______ of ________ or clearance to begin the return-to-play protocol.
diagnosis; concussion
BCTT requires 2 persons to conduct? True or False
True
BCTT is not recommended within _______ hours of concussive brain injury or if the patient is too _______ (7/10).
24; symptomatic
