final exam concussion exam/eval Flashcards by Demond Fleming

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

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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

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Is the following statement True or False:
Baseline tests for concussion testing is reliable and hard to skew?

False: easy to skew

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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

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Post concussion tests are ________ until the athlete is cleared and returned to baseline function

repeated

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concussion CPG categories:

cervical msk impairments
vestibulo-ocular impairments
autonomic dysfunction/exertional tolerance impairments
motor function impairments

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CPG for Eval/Exam: outcomes

PTs should determine and document a plan for outcome measurement

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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

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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)

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CPG for Eval/Exam:
-psychological and sociological factors:

self-efficacy
self-management strategies
PT should explain that most symptoms following concussion do improve

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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

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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

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Further Cervical Testing:

ROM
Muscle Endurance/Strength
Scapulothoracic mobility
PAVIM’s at C and T spine
Joint Position Error Testing

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Screening Vision/Cranial Nerves:

saccades
smooth pursuit
convergence/divergence
Snellen chart
visual field cuts (quadrant testing)
light sensitivity
changes in vision (tunnel vision)

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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

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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:

1. Lying motionless playing surface 2. Falling unprotected to the surface 3. Balance/gait difficulties, motor incoordination, ataxia; stumbling, slow/labored movements 4. Disorientation or confusion, staring or limited responsiveness, or an inability to respond appropriately to questions 5. Blank or vacant look 6. Facial injury after head trauma 7. Impact seizure 8. 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