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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
What are the acute management strategies for concussion?
- Remove from play/work/activity - Bring to safe, quiet are to screen - Monitor for acute medical emergency - Observe for worsening function
26
If someone is diagnosed with a concussion is the athlete allowed to return to play the same day?
No
27
T/F: Someone can return to work, physical activity or school that day if diagnosed with a concussion
False
28
What are the goals of immediate screening for concussions?
- 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
During acute management of concussion when should you send someone for emergency care?
- 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
What are some progressive symptoms or new neurological signs that may indicate they need to be sent to emergency care?
- Repeated vomiting (more than 2x) - Seizures - Pupil asymmetry
31
A concussion diagnosis can be made when a patient has a direct force to the head, face, neck followed by what signs/symptoms?
- Decreased orientation or LOC - PTA - Alteration in cognition - physiological symptoms - Emotional or behavioral changes - GCS 13-15 in first 24 hours
32
What are some physiological symptoms that may indicate a concussion diagnosis?
- Headache - Dizziness - Balance problems - Tonic posturing - Nausea - Vomiting - Fatigue - Blurred vision - Sensitivity to light/noise - Seizure
33
Name some sideline evaluation screening tools
- Sports Concussion Assessment Tool (SCAT6) - Balance Error Scoring System (BESS) - Visual Ocular Motor Screen (VOMS)
34
T/F: SCAT 6 can be used for all ages
False - Ages 13 & up use SCAT 6 - 12 and under use Child SCAT 6
35
What does the SCAT 6 include?
- On field & Off field testing
36
When is the optimum utility for SCAT 6?
First 72 hours
37
Where does the SCAT 6 Off Field assessment need to take place?
Distraction free environment
38
What does the visual ocular motor screen examine?
- Smooth pursuits - Saccades - Convergence - VOR - Visual motion sensitivity
39
What are the recommendations after an acute concussion?
- 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
T/F: After 24-48 hours naps are highly discouraged
True
41
What activities are permitted during relative rest?
- ADLs & activities that do not exacerbate symptoms - Reduce screen time for first 48 hours
42
How long should relative rest last post concussion?
24- 48 hours
43
Why is relative rest prescribed to patients?
Excessive physical or cognitive activity in this period may prolong rehab
44
What is the role of a PT in mild TBI/ concussion?
- Perform thorough exam - Provide recommendations & interventions for balancing rest & activity - Refer as needed - Guide return to life
45
When examining a patient after mild TBI/ concussion what should the environment be like and what should be expected?
- Environment: Consider low light, quiet room, less visually complex environments to minimize sx - Expect patient sx & limit repetition of testing
46
Why is it important to examine the cervical spine if a patient comes to you post concussion?
- No significant separation of symptoms - Ocular motor dysfunction, headache, & autonomic dysfunction is observed in whiplash injuries too
47
What should be included in a cervical spine examination?
- ROM, trigger portion assessment, cervical reproduction of dizziness, TMJ - Muscular strength & endurance - Proprioceptive awareness - NDI or Headache Disability index
48
What are some examination procedures for the Vestibular system?
- 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
What are the symptoms that might indicate vestibular system issues?
- Headache - Dizziness - Vertigo - Fatigue - balance problems - Nausea - Blurred vision - Dizziness handicap inventory
50
What is the prognosis when there is vestibular/ocular abnormalities after concussion?
2-3 weeks after concussion associated with delayed recovery
51
How can autonomic dysfunction be measured?
- Take BP & HR at rest - Then take BP & HR with positional changes
52
If a patients has exercise intolerance what may you see?
- May not see appropriate increase in HR (>20mmHg drop in SBP or > 10 mmHg DBP) - Longer recovery time
53
Describe the Buffalo Concussion Treadmill Test
- 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
What should you look at when examining motor function?
- Balance - Coordination - Reaction time
55
When is Sport Concussion Office Assessment 6 used?
After day 3
56
What does the Sport Concussion Office Assessment (SCOAT) include?
- Cognitive function - BP & HR - Cervical spine exam - Neuro exam - Tandem gait & dual task - Modified VOM

NMR II (14 decks)

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