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NMR II > Mild Traumatic Brain Injury/ Concussion > Flashcards

Mild Traumatic Brain Injury/ Concussion Flashcards

1
Q

When diagnosing mTBI (Concussion) what is the:
- GCS score?
- LOC time length?
- PTA time length?
- Acute abnormalities on neuroimaging (yes or no?)

A
  • GCS score: 13-15
  • LOC time length: 0 - 30 min
  • PTA time length: <24 hour
  • Acute abnormalities on neuroimaging: no
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2
Q

How is a concussion clinically diagnosed?

A

Based on sign & symptoms

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3
Q

Name some common causes of Mild TBI

A
  • Sports injures
  • Military injuries
  • Falls, MVA, assault
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4
Q

in regards to the mTBI pathophysiology:
T/F: there is a decreased cerebral metabolism and an increased cerebral blood flow

A

False:
- Increased cerebral metabolism
- Decreased cerebral blood flow

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5
Q

in regards to the mTBI pathophysiology:
T/F: Microstructural changes leading to disruption of typical neural circuits occur. And there is a dysregulation of sodium potassium pumps.

A

True

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6
Q

in regards to the mTBI pathophysiology:
T/F: There is altered neurotransmitter release and an example of this is a decrease in excitatory neurotransmitters such as glutamate.

A

False
- There is altered neurotransmitter release but there is an increase in glutamate

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7
Q

What are the 4 domain of mTBI symptoms?

A
  • Cervical musculature impairments
  • vestibule-ocular impairments
  • autonomic dysfunction & exertional intolerance
  • motor function impairments
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8
Q

Name some cervical musculature impairments

A
  • Neck pain
  • headaches
  • dizziness
  • Impaired postural control
  • Limited proprioceptive inputs
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9
Q

Name some vestibulo-ocular impairments

A
  • vertigo
  • blurred vision
  • light sensitivity
  • headaches
  • sensitivity to sound
  • balance impairments
  • fatigue
  • tinnitus
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10
Q

What are some symptoms of autonomic dysfunction & exertional intolerance?

A
  • Pounding headache
  • Fatigue
  • Dizziness
  • Nausea
  • Increasing symptoms w/ activity
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11
Q

Exercise intolerance is a physiological sign of (chronic or acute) concussion.

A

Acute

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12
Q

What does poor autonomic regulation present as post concussion?

A
  • Inability to regulate HR, BP, cerebral blood flow in response to exercise/activity/positional changes
  • impaired cerebral metabolism & altered cerebrovascular physiology
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13
Q

Name some motor function impairments

A
  • Impairments in postural control
  • limited motor coordination
  • Impaired dual task motor abilites
  • Increased reaction time
  • Increased risk of musculoskeletal injuries
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14
Q

What is the typical course of prognosis of mTBI?

A
  • Symptom resolution usually occurs within 7-10 days
  • Unclear percentage of individual present with residual impairments
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15
Q

What is the prognosis of persistent post-concussion symptoms?

A
  • Residual symptoms (>4 weeks in children & > 14 days in adults)
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16
Q

What are some baseline risk factors that might indicate a slower recovery?

A
  • Younger
  • Female
  • Prior concussion history
  • Migraine history
  • ADHD diagnosis
  • genetic factors
  • Psychosocial factors
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17
Q

What are some injury severity factors that may indicate a slower recovery?

A
  • PTA
  • LOC
  • Delayed removal from sports
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18
Q

What are some post injury related factors that increase recovery time?

A
  • Vestibular-ocular findings
  • Exervise intolerance/autonomic dysregulation
  • Total Rest vs Relative Rest vs Acute Rehab
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19
Q

What are some psychological & sociological resilience factors that indicate a better recovery?

A
  • Strong social support
  • Higher SSE
  • Higher educational level
  • High self-efficacy
  • Positive beliefs
  • Resilience
  • Good general health
  • Positive health behaviors
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20
Q

What are some psychological & social vulnerabilities that indicate a slower recovery?

A
  • Low self efficacy
  • Comorbid health conditions
  • anxiety
  • depression
  • poor coping strategies
  • lower SSE
  • poor health behaviors at baseline (sedentary, poor nutrition, poor sleep hygiene)
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21
Q

What is second impact syndrome?

A
  • second concussion before a patient has fully recovered from the first
  • can have devastating effects
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22
Q

What are the pathophysiological effects of second impact syndrome?

A
  • Cerebral edema & cerebral metabolism has not returned to baseline
  • Brain is unable to regulate intracranial & cerebral perfusion pressures, resulting in resulting in rapid accumulation of edema & brain herniation
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23
Q

what is Chronic Traumatic Encephalopathy (CTE)?

A

Progressive degenerative disease associated with repetitive mild brain injury

24
Q

What is ImPact and what is it used for?

A
  • Immediate Post- Concussion Assessment & Cognitive Testing
  • Assessment performed to establish baseline
25
Q

What are the acute management strategies for concussion?

A
  • Remove from play/work/activity
  • Bring to safe, quiet are to screen
  • Monitor for acute medical emergency
  • Observe for worsening function
26
Q

If someone is diagnosed with a concussion is the athlete allowed to return to play the same day?

A

No

27
Q

T/F: Someone can return to work, physical activity or school that day if diagnosed with a concussion

A

False

28
Q

What are the goals of immediate screening for concussions?

A
  • Screen multi-system involvement (cervical spine pathology)
  • Identify individuals who may present with moderate-severe brain injury & get these individual emergency medical attention
  • Perform as early as possible
29
Q

During acute management of concussion when should you send someone for emergency care?

A
  • Deteriorating cognition (within 4 hours post injury)
  • GCS <13
  • Cervical spinal injury
  • Open skull fx or signs of one
  • Progressive sx or new neurologic signs
  • Severe or rapidly worsening headache
30
Q

What are some progressive symptoms or new neurological signs that may indicate they need to be sent to emergency care?

A
  • Repeated vomiting (more than 2x)
  • Seizures
  • Pupil asymmetry
31
Q

A concussion diagnosis can be made when a patient has a direct force to the head, face, neck followed by what signs/symptoms?

A
  • Decreased orientation or LOC
  • PTA
  • Alteration in cognition
  • physiological symptoms
  • Emotional or behavioral changes
  • GCS 13-15 in first 24 hours
32
Q

What are some physiological symptoms that may indicate a concussion diagnosis?

A
  • Headache
  • Dizziness
  • Balance problems
  • Tonic posturing
  • Nausea
  • Vomiting
  • Fatigue
  • Blurred vision
  • Sensitivity to light/noise
  • Seizure
33
Q

Name some sideline evaluation screening tools

A
  • Sports Concussion Assessment Tool (SCAT6)
  • Balance Error Scoring System (BESS)
  • Visual Ocular Motor Screen (VOMS)
34
Q

T/F: SCAT 6 can be used for all ages

A

False
- Ages 13 & up use SCAT 6
- 12 and under use Child SCAT 6

35
Q

What does the SCAT 6 include?

A
  • On field & Off field testing
36
Q

When is the optimum utility for SCAT 6?

A

First 72 hours

37
Q

Where does the SCAT 6 Off Field assessment need to take place?

A

Distraction free environment

38
Q

What does the visual ocular motor screen examine?

A
  • Smooth pursuits
  • Saccades
  • Convergence
  • VOR
  • Visual motion sensitivity
39
Q

What are the recommendations after an acute concussion?

A
  • Diagnose ASAP
  • Monitor for worsening function
  • Do not return to play on same day
  • Refer to medical provider
  • Relative rest 24-48 hours
  • Communication with patient encouraging positive prognosis
40
Q

T/F: After 24-48 hours naps are highly discouraged

A

True

41
Q

What activities are permitted during relative rest?

A
  • ADLs & activities that do not exacerbate symptoms
  • Reduce screen time for first 48 hours
42
Q

How long should relative rest last post concussion?

A

24- 48 hours

43
Q

Why is relative rest prescribed to patients?

A

Excessive physical or cognitive activity in this period may prolong rehab

44
Q

What is the role of a PT in mild TBI/ concussion?

A
  • Perform thorough exam
  • Provide recommendations & interventions for balancing rest & activity
  • Refer as needed
  • Guide return to life
45
Q

When examining a patient after mild TBI/ concussion what should the environment be like and what should be expected?

A
  • Environment: Consider low light, quiet room, less visually complex environments to minimize sx
  • Expect patient sx & limit repetition of testing
46
Q

Why is it important to examine the cervical spine if a patient comes to you post concussion?

A
  • No significant separation of symptoms
  • Ocular motor dysfunction, headache, & autonomic dysfunction is observed in whiplash injuries too
47
Q

What should be included in a cervical spine examination?

A
  • ROM, trigger portion assessment, cervical reproduction of dizziness, TMJ
  • Muscular strength & endurance
  • Proprioceptive awareness
  • NDI or Headache Disability index
48
Q

What are some examination procedures for the Vestibular system?

A
  • Smooth pursuits
  • saccades
  • vergence, & accomadation
  • ocular alignment
  • VOR (gaze stability)
  • HIT
  • BPPV exam
  • visual motion sensitivity
  • VOR cancellation
  • dynamic visual acuity test
  • Parts of VOMS
49
Q

What are the symptoms that might indicate vestibular system issues?

A
  • Headache
  • Dizziness
  • Vertigo
  • Fatigue
  • balance problems
  • Nausea
  • Blurred vision
  • Dizziness handicap inventory
50
Q

What is the prognosis when there is vestibular/ocular abnormalities after concussion?

A

2-3 weeks after concussion associated with delayed recovery

51
Q

How can autonomic dysfunction be measured?

A
  • Take BP & HR at rest
  • Then take BP & HR with positional changes
52
Q

If a patients has exercise intolerance what may you see?

A
  • May not see appropriate increase in HR (>20mmHg drop in SBP or > 10 mmHg DBP)
  • Longer recovery time
53
Q

Describe the Buffalo Concussion Treadmill Test

A
  • Systematically evaluates exercise tolerance to guide rehab
  • Pt wears HR monition & speed starts at 3 mph
  • Each minute the treadmill incline is increased by 1 degree
  • Pt rates effort & sx each min & record HR
  • Once treadmill reaches maximal treadmill incline, speed is increased
54
Q

What should you look at when examining motor function?

A
  • Balance
  • Coordination
  • Reaction time
55
Q

When is Sport Concussion Office Assessment 6 used?

A

After day 3

56
Q

What does the Sport Concussion Office Assessment (SCOAT) include?

A
  • Cognitive function
  • BP & HR
  • Cervical spine exam
  • Neuro exam
  • Tandem gait & dual task
  • Modified VOM

NMR II (14 decks)

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