Head and Neuro

Question 1

sport-related concussion
1. overview
2. signs and symptoms onset
3. clinical presentation

Answer 1

1. lowest severity of traumatic brain inj
2. range of signs and symptoms may present immediately or evolve over minutes, hours, or days; usually resolve within days but may be prolonged, may not involve loss of consciousness
3. physical, mental, and emotional symptoms, cognitive deficits like difficulty orientation self, memory or concentration issues, motor deficits with coordination and balance (can’t control body like normal)

Question 2

structure of brain
1. brain overview
2. matter of the brain

Answer 2

1. brain is tethered to sp cd with texture like almost ripe avocado, sits in CSF, has high water content thus can’t compress well since water tension inside resists
2. white matter (axon) inside with gray matter (cell body) outside, different layers react differently to ext forces, cell bodies pull away from axons

Question 3

biomechanics of concussion

Answer 3

1. moving object hits head
2. head hits stationary object
3. head acceleration-deceleration without direct head contact from whiplash of trunk
4. in all cases mech E transferred to brain with angular acceleration of brain around axis of rotation in the cervical spine

Question 4

pathophysiology of concussion
1. mechnoporation
2. physiological recovery
3. HR variabilty

Answer 4

1. separation of the layers of the brain stretches the axons generating mechanical distension of the ion channels (mechanoporation) for influx of Na+ and Ca2+ and outflux of K+ causes disruption in ion balance, acute release of glutamate results in mass depolarization; to return to homeostasis Na+/K+ pumps require lots of ATP to restore homeostasis but due to influx of Ca2+, mitochondrial function of oxidative processes disputed and can’t use glycolytic processes due to acute decrease in cerebral blood flow and decrease in blood glucose, therefore can’t regulate ion concentration
2. often takes longer than symptom recovery
3. measured as RR interval, decrease variability after concussion, change in HRV reflect greater SNA after concussion, imbalance between SNA and PNA cause inability to sleep since body can’t relax

Question 5

emergency concussion situations

Answer 5

1. skull fractures, usually caused by small fast object since high focused E
2. intracranial hematoma increases intracranial pressure and put pressure on brain can force fluid to leak and bruises to form
3. other symptoms of emergency are severe and worsening headache, vomiting, and impaired pupil response

Question 6

preventing concussion
1. mouthguards
2. days until symptom free and return to sport

Answer 6

1. 26% lower concussion rate with mouthguard, IRR 0.74
2. 14 days symptom free and 19.8 days return to sport

Question 7

return to sport after concussion strategy
1. overview
2. stage 1
3. stage 2
4. stage 3
5. stage 4
6. stage 5
7. stage 6

Answer 7

1. each stage takes minimum 24 hours
2. symptom limited activity, ADL that do not exacerbate symptoms, gradual reintro of work/school
3. light (up to 55% maxHR) to moderate (up to 70% maxHR) aerobic exercise, start light res training that does not result in more than mild and brief exacerbation of symptoms, can increase HR
4. invidual sport-specific exercise, sport specific training away from part of team, no activities risking head impact, add movement and change of direction
5. step 4-6 should begin after symptoms and cognitive abnormalities end, non-contact training, high intensity and can integrate into team to resume usual intensity, coordination, and increase thinking
6. full contact practice, participate in normal training activities and restore confidence and functional skills
7. return to sport

Question 8

buffalo concussion tread mill test
1. purpose
2. when to not do test?
3. running the rest
4. three reasons to stop test

Answer 8

1. used to assess exercise tolerance, identify HR which concussion-specific symptom exacerbation occurs (HR threshold), identify physiological variables associated with exacerbation of symptoms, and the level of recovery
2. Within 24 hours of the concussive event or symptom severity is 7/10 or higher
3. RPE using Borg scale, HR, and symptoms using VAS are assessed every minute; progression by increasing incline by 1% every min
4. VAS symptom rating ↑ by 3 or more, RPE exceeds 17 (out of 20) without significant exacerbation (exhaustion), athlete has reached 90% or more of age-predicted max HR without increase in symptoms

Question 9

SCAT6
1. overview
2. modified BESS
3. timed tandem gait
4. dual task gait

Answer 9

1. diagnostic tool with rating 0-6 with symptoms of concussion
2. balance in barefoot on firm surface in three stances, optional to use foam surface; double leg, single leg, and tandem gait
3. tandem walking 3 m as fast as possible for 3 trials
4. tandem walking 3 m as fast as possible while coundting backwards out loud by 7 from 100

Question 10

how do neurological stories occur?

Answer 10

1. axial load through spine + hyerflexion of cervical spine can destabilize the vertebrae resulting in a dislocation which can dmg sp cd or a fracture; a fracture of the vertebral spine without dislocation is a teardrop fracture
2. fall onto lumbar or thoracic spine in flexed pos

Question 11

spinal cord inj
1. mechanism of inj
2. symptoms
3. prevalence

Answer 11

1. compression, contusion (brusing), or distraction (stretch) of sp cd
2. complete or incomplete loss; sensory if dmg to dorsal root or dorsal horn and, motor if dmg to ventral root or horn; level of injury determines where deficits are (and everything below it)
3. in majority of sports cervical spine inj is the most prevalent

Question 12

cervical cord neuropraxia
1. mechanism of inj
2. symptoms
3. risk factors

Answer 12

1. spinal cord concussion, high E hyperext or flexion stretches or pinches sp cd disrupting it, may or may not have axial load, typically not
2. physiological disruption but struc integrity intact, mimics signs and symptoms of SCI but is transiet and will usually resolve within 48 hours fully but can have residual symptoms up to 2 weeks
3. connected to cogenital spinal stenosis since narrower spinal canal means less space for spcd to move, spincal canal usually >=80% of vertebral body, less than 80% usually stenosis; cervical spinal cord is larger than lumbar thus fits tighter and has higher risk

Question 13

levels of nerve dmg
1. neuropraxia
2. axonotmesis
3. neurotmesis

Answer 13

1. axon intact but epineurium has some dmg but retains high struc integrity, up to 2 weeks to recover CNS and PNS
2. axon struc fail (discontinuity) but can still grow back since outer epinuerium intact, up to 3 months recovery for PNS, CNS does not recover well
3. potential to recover from axon and epineurium failure, 1 year or more for PNS

Question 14

brachial plexus neuropraxia
1. mechanism of inj
2. symptoms

Answer 14

1. traction mech most common separate ends of brachial plexus by depressing shoulder and forcing head into side flex in opp dir, compression mech pinches beginning of brachial plexus by ext and lat flexing to same side, direct blow between SCM and upper traps
2. burns or stings into arms and hands, usually affecting C7-C8, unliat pain esp when moving neck, paresthesia (alt sensation), numbness, weakness, decreased cervical ROM, most return to play <24 hours

Question 15

neurological evaluation
1. dermatomes
2. dermatome testing
3. myotomes
4. myotome testing

Answer 15

1. area of skin that spinal nerve collects sensory info from
2. test by running sharp and soft object over skin and testing if they can feel and differentiate between the two; C5 lat elbow and upper arm, C6 rad forearm and fingers 1 and 2, C7 finger 3, C8 fingers 4 and 5, T1 ulnar side of elbow and forearm
3. joint action(s) produced by group of muscles relying on motor messages from spinal nerve
4. test using graded resistance testing out of 5; C5 elbow flex, C6 wrist ext, C7 elbow ext, C8 finger flex, T1 finger abduction