Lecture 4 - Concussion Flashcards

1
Q

Concussion =

A

mild brain injury

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2
Q

What can cause a concussion?

A

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

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3
Q

T or F: all concussions can be prevented with helmets

A

False

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4
Q

What happens to the brain in a concussion

A
  • 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
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5
Q

Symptoms in a concussion usually but don’t always resolve spontaneously within _______

A

7-10 days

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6
Q

Concussion is characterized by what neurological symptoms?

A
  • LOC up to 30 min
  • Amnesia for events before/after the injury
  • Disorientation at time of injury
  • Focal neurological deficit (may be transient)
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7
Q

A brain injury is considered more than mild if…

A

LOC > 30 min
PTA > 24 hours
GCS falling below 13/15 after 30 min

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8
Q

T or F standard CT or MRI generally shows structural damage following a concussion

A

false

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9
Q

With fMRI there may be evidence of functional neuronal disruption after concussion

A

true

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10
Q

There may be evidence of structural damage on diffusion tensor imaging

A

true

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11
Q

Symptoms following a concussion occur in what 4 domains?

A
  • physical
  • sleep
  • emotional/mood
  • cognitive
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12
Q

_______ concussions are diagnosed annually in Ontario by family doctors and ER

A

150 000

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13
Q

In 12-19 year olds 60% of concussions are ______ related

A

sports

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14
Q

What are the SHORT term implications of multiple concussions?

A
  • 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
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15
Q

What are the LONG term implications of multiple concussions?

A
  • much still unknown
  • tau proteins in white and grey matter
  • appears to be higher risk for Chronic traumatic encephalopathy
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16
Q

What is involved in initial management of a concussion

A
  • 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
17
Q

What is post-concussion syndrome (PCS)?

A
  • small # of people continue to have persistent symptoms after 3 months
  • includes cognitive comm problems
18
Q

What injury related factors increase likelihood of PCS

A
  • symptom severity
  • LOC > 1 min
  • amnesia (equivocal)
  • injury with hard surface
19
Q

What non-injury related factors increase likelihood of PCS

A
  • pre injury mental health
  • substance abuse
  • family support
  • attitudes and beliefs about injury
  • ADHD?
  • age (young and old vulnerable)
  • gender?
  • multiple concussions
20
Q

What is an SLPs role on a concussion team?

A
  • 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
21
Q

What is involved in the SLP assessment protocol for concussion?

A
  • interview: information re activity/participation

- evidence based cognitive communication measures

22
Q

What factors must we consider during assessment of CC function?

A
  • ecological validity
  • physical recovery
  • repeat testing
  • culture, language
  • comorbidities
23
Q

What are some good tools for assessing CC?

A
  • La Trobe Communication Questionnaire
  • RNANS (screener)
  • FAVRES
  • TAWF
  • CELF 3 concepts & directions subtest
  • DCT
24
Q

What treatment options are available for CC difficulties following concussion?

A
  • compensatory cognitive training program

- study of cognitive rehabilitation effectiveness (SCORE)