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6 Neurological Dysfunction > L16 Mild TBI > Flashcards

L16 Mild TBI Flashcards

1
Q

mTBI is synonymous with

A

concussion

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2
Q

mTBI

A

injury that affects the brain, induced by biomechanical forces, that does not result in extended period of unconsciousness, amnesia, or other significant neuro signs

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3
Q

Two guiding documents for exam and treatment of mTBI

A
  1. Concussion CPG
  2. Consensus statement on concussion in sport
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4
Q

Epidemiology mTBI

A

1.6 to 3.8 million per year
many do not seek medical care, underestimate

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5
Q

MOI of mTBI

A

sports
falls
MVA
military

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6
Q

Medical management of mTBI

A

-rest for 24 to 48 hours
-limit activities that require high mental load
-limit PA that causes S/S

slowly progress back to normal load, without triggering symptoms

avoid ibuprofen and aspirin

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7
Q

S/S after mTBI

A

headache
fatigue
balance issues
sensitivity
vomiting
feeling foggy
memory problems
irritability
sadness
drowsiness

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8
Q

Natural course of recovery

A

lots of variability
usually 7-14 days
not a linear progression

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9
Q

Chronic Traumatic Encephalopathy

A

linked to buildup of proteins that damage brain tissue and cause cell death

associated with long term exposure t repeated hits to head

can only be confirmed by autopsy

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10
Q

S/S of CTE

A

problems with thinking, emotions, mood
sucidial thoughts
behaviors that interefere with normal life

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11
Q

Component 1 of CPG

A

process for determining appropriateness of PT concussive event/exam

helps to triage to be sure pt is appropriate for PT

patient must not have emergent S/S, needs to have S/S of concussion, and msk, VOM, autonomic dysfunction

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12
Q

Should a patient continue with PT if there is alar ligament pathology present?

A

NO. This is determined to be an emergent situation because they cervical spine is unstable

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13
Q

Component 2 of CPG

A

PT exam and eval processes for pts after a concussive event

determining probable movement related impairments and levels of irritability

evaluating cervical MSK, movement related impairments, and VOM, hypotension to determine how to best treat patient

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14
Q

if patient reports neck pain

A

test for cervical musculoskeletal impairments

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15
Q

If patient reports dizziness or headache

A

test for cervical MSK, VOM, and orthostatic hypotension

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16
Q

If patient does not report headache, dizziness, or neck pain

A

test for movement related impairments

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17
Q

Component 3 of CPG

A

develop and implement a PT POC for patients after concussive event

should be based on findings from PT clinical exam in combo with patient and family needs

involves education about self management, activity levels, rest, pacing, reassurance of recovery, referrals for other HCP

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18
Q

For VOM impairments, test

A

-BPPV with dix-hallpike
-Ocular alignment
-Vergence and accommodation
-visual motion sensitivity
-smooth pursuits
-saccades
-gaze stability

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19
Q

For motor function impairments, test

A

static balance
dynamic balnce
dual task
motor coordination

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20
Q

For autonomic dysfunction, test

A

heart rate
BP in different positions

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21
Q

For cervical MSK impairments, test

A

ROM
muscle MMT
tenderness
passive motion of spine

(all have poor/expert opinion level)

22
Q

Strong Evidence for testing

A

Dix-hallpike
ocular alignment

23
Q

HiMat

A

developed as outcome measure to quantify motor performance in individuals with high level balance and mobility impairments

must have at least independent walking over 20 m without ADs, can use orthoses before test

24
Q

What does HiMat test?

A

walking, running
jumping
balance
stairs
skipping

items are scored using 5 point scale, with higher score meaning better performance. 54 is the highest

25
Q

Buffalo Treadmill Test

A

assesses the degree of exercise tolerance

identifies the HF at which concussion specific symptoms occurs

establish safe level of exercise

help differentiate between concussion and other diagnoses

identify variables associated with exacerbation of S/S and patient’s level of recovery

26
Q

Tests of autonomic/exertional tolerance

A

Dix-Hallpike
Orthostatic Hypotension
BCTT
VOMS

27
Q

Tests of Vertigo/Dizziness

A

Dix-Hallpike
Supine Rol
BCTT
Gaze holding nystagmus
oculomotor screen
VOR screen
DHI, ABC

28
Q

Prognosis of mTBI is influenced by

A

pre-injury factors
injury-related factors
post-injury factors
psychosocial factors
early concussion mgt

29
Q

Pre-injury factors

A

hx of prior concussion
ADHD
hx of migraines

30
Q

Injury-related factors

A

LOC
amnesia
delayed removal from sport

31
Q

Post-injury factors

A

perceived competence
tenacity
tolerance
acceptance

32
Q

Early concussion mgt factors

A

strict rest vs relative rest vs active rehab

33
Q

VOM impairments tx

A

Canalith reposition
individualized VOM rehab

34
Q

Motor function impairment tx

A

different types of balance
motor coordination
dual tasking

use progression to help pt towards goal

35
Q

Autonomic dysfunction impairments tx

A

progressive aerobic exercise
education
delaying exertional testing until pts s/s stabilize

36
Q

Cervical musculoskeletal impairment tx

A

ROM, strength, posture
sensorimotor function
manual therapy

all low grade evidence

37
Q

Communication and Education (CPG)

A
  1. must education about S/S, functional limitations, stress, and recovery
  2. must educate about self-management, importance of rest, safe return, pacing, exertional signs, following up with HCP
38
Q

For movement-related impairments,

A
  1. should design intervention plan that is personalized
  2. should refer patients for follow-up
    (3. Not as important to triage patients into has movement impairment vs does not)
39
Q

For cervical msk,

A

should implement interventions aimed at addressing dysfunction of spine

40
Q

For VOM

A
  1. should use canalith repositioning
  2. should implement VOM rehab
  3. Individualizied VOM habituation plan
41
Q

Exertional tolderance and aerobic exercise

A
  1. Use symptom guided aerobic exercise
  2. (Don’t focus too much on deconditioning)
42
Q

Documenting/monitoring pts

A

level F evidence = monitoring and documenting, using outcome measures as needed or indicated

43
Q

Sports Related Concussion

A

TBI caused by direct blow to head resulting in impulsive force being transmitted to brain that occurs in sports

possible axonal injury, inflammation, altered blood flow

S/S onset is immediate, commonly resolves in days

no abnormal imaging

may or may not result in loss of consciousness

44
Q

11 Rs of sports related concussion

A

recognize
reduce
remove
refer
re-eval
rest
rehab
recover
return to sport
reconsider
residual effects

45
Q

Who should be evaluated for concussions in sport?

A
  1. any player with concussive event or suspected concussion
  2. SCAT=6 should be used on sidelines
  3. SCOAT-6 is a follow up
  4. S/S longer than 4 weeks should be evaled with clinical assessment
46
Q

SCAT 6

A

sidelines and up to first 72 hours

standardized tool for those 13 and older

helps decide if individual needs to be removed from play and if they need immediate care

includes immediate and off-field assessment

47
Q

Immediate assessment of SCAT

A

-observation
-glasgow coma
-cervical spine assessment
-coordination and ocular motor screeen
-memory assessment

48
Q

Off-field assessment

A

symptoms
cognitive screen
coordination and balance
dual task (opt)

49
Q

Questions in SCAT indicating immediate care

A

yes to any indicates for immediate care

  1. positive observable signs
  2. glasgow coma scale <15
  3. neck pain, tenderness, changes in ROM
  4. Coordination or ocular motor screen abnormality
  5. Memory <5?
50
Q

SCOAT-6

A

designed to better guide eval and management in an office setting from 72 hours after injury and for serial evals

intential overlap with SCAT-6

51
Q

What does SCOAT-6 include?

A

History
Symptom Eval
Verbal/Cognitive Tests
Orthostatic/Vital Signs
Cervical Spine Assess
Neuro Exam
Gait
VOM
Emotional
Sleep

52
Q

Return to Sport Steps

A
  1. Daily activities that do not result in more than mild exacerbation
  2. School activities
  3. Return to school part time
  4. Return to school full time
  5. Symptoms limited activity
  6. Aerobic Exercise
  7. Sport Specific Exercise
  8. Non-contact training drills
  9. Full contact practice
  10. Return to game play

6 Neurological Dysfunction (16 decks)

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