Lecture 4 - Concussion Flashcards
Concussion =
mild brain injury
What can cause a concussion?
may be caused by either a direct blow to the head, face, neck or elsewhere on the body with an ‘impulsive’ force transmitted to the head
T or F: all concussions can be prevented with helmets
False
What happens to the brain in a concussion
- brain moves rapidly back and forth
- brain is shaken or twisted in the skull
- neurons are stretched, damaged, causing a cascade of neurochemical responses
- may or may not involve loss of consciousness
Symptoms in a concussion usually but don’t always resolve spontaneously within _______
7-10 days
Concussion is characterized by what neurological symptoms?
- LOC up to 30 min
- Amnesia for events before/after the injury
- Disorientation at time of injury
- Focal neurological deficit (may be transient)
A brain injury is considered more than mild if…
LOC > 30 min
PTA > 24 hours
GCS falling below 13/15 after 30 min
T or F standard CT or MRI generally shows structural damage following a concussion
false
With fMRI there may be evidence of functional neuronal disruption after concussion
true
There may be evidence of structural damage on diffusion tensor imaging
true
Symptoms following a concussion occur in what 4 domains?
- physical
- sleep
- emotional/mood
- cognitive
_______ concussions are diagnosed annually in Ontario by family doctors and ER
150 000
In 12-19 year olds 60% of concussions are ______ related
sports
What are the SHORT term implications of multiple concussions?
- tend to recover more slowly on subsequent injuries
- takes less impact to cause symptoms
- 3+ concussion 9 times more likely to suffer another
- 2nd impact syndrome
What are the LONG term implications of multiple concussions?
- much still unknown
- tau proteins in white and grey matter
- appears to be higher risk for Chronic traumatic encephalopathy
What is involved in initial management of a concussion
- medical tx or physical symptoms
- guidelines for CT/MRI
- education re possible symptoms, expected course
- time out from usual activities
- graduate return to physical and cognitive activity
- no return to sports without MD ok
- 85-95% no further tx necessary
What is post-concussion syndrome (PCS)?
- small # of people continue to have persistent symptoms after 3 months
- includes cognitive comm problems
What injury related factors increase likelihood of PCS
- symptom severity
- LOC > 1 min
- amnesia (equivocal)
- injury with hard surface
What non-injury related factors increase likelihood of PCS
- pre injury mental health
- substance abuse
- family support
- attitudes and beliefs about injury
- ADHD?
- age (young and old vulnerable)
- gender?
- multiple concussions
What is an SLPs role on a concussion team?
- focus on both standardized testing and education/feedback
- identify and characterize impact of concussion on CC function
- make recommendations aimed at return to roles and environments
- identify internal and external strategies
- suggestions for advocating, modifying work environment
- recommendations for therapy as appropriate
- NOT to diagnose concussion
What is involved in the SLP assessment protocol for concussion?
- interview: information re activity/participation
- evidence based cognitive communication measures
What factors must we consider during assessment of CC function?
- ecological validity
- physical recovery
- repeat testing
- culture, language
- comorbidities
What are some good tools for assessing CC?
- La Trobe Communication Questionnaire
- RNANS (screener)
- FAVRES
- TAWF
- CELF 3 concepts & directions subtest
- DCT
What treatment options are available for CC difficulties following concussion?
- compensatory cognitive training program
- study of cognitive rehabilitation effectiveness (SCORE)
