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KIN 424 - Medical Aspects of Sport > Module 11 - Concussion > Flashcards

Module 11 - Concussion Flashcards

1
Q

What does the abbreviation SRC mean?

A
  • Sport-related concussion
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2
Q

What does the abbreviation TBL mean?

A
  • Traumatic Brain Injury
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3
Q

What does the abbreviation mTBL mean?

A
  • mild traumatic brain injury
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4
Q

What does the abbreviation CTE mean?

A
  • Chronic Traumatic Encepholopathy
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5
Q

What does the abbreviation RHL mean?

A
  • Repetitive Head Injury
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6
Q

What is a contrecoup injury?

A
  • Moving head strikes stationary object
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7
Q

What is a coup injury?

A
  • Moving object impacts stationary head
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8
Q

What is the mechanism of a brain injury?

A
  • Direct blow to the head (Coup or Countrecoup)
  • Movement of brain results in axonal shearing
  • Damage to neurons
  • Death of some neurons
  • Release of chemicals
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9
Q

What is axonal shearing?

A
  • Axons being stretched
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10
Q

What are the signs and symptoms of concussions? (16)

A
  • Headache
  • Dizziness
  • Nausea
  • Blurred Vision
  • Light/Sound Sensitivity
  • Imbalance
  • Ringing in the Ear
  • Seeing “stars”
  • Irritability
  • Fogginess
  • Fatigue
  • Difficulty concentrating
  • Poor memory
  • Neck Pain
  • Sadness
  • Confusion
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11
Q

Describe the initial response to a possible concussion

A
  • Respond immediately
  • Remove from activity
  • Assess for medical emergency
  • Call 911 and seek medical care if red flags
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12
Q

What are the red flags to look for when initially assessing a possible concussion?

A
  • Neck pain or tenderness
  • Double vision
  • Weakness/tingling in arms or legs
  • Severe or increasing headache
  • Seizure or convulsion
  • Loss of consciousness
  • Deteriorating conscious state
  • Vomiting
  • Increasingly restless, agitated, or combative
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13
Q

What are the steps to take if there is no medical emergency but may be a potential concussion?

A

Do not
- Leave the individual alone
- Let individual return to activity
- give individual any immediate medication
- Let individual leave themselves
- Let individual drive/bike
Do
- Monitor for red flags
- notify emergency contact person

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14
Q

What needs to be done within 48 hours of a potential concussion?

A
  • Monitor individual
  • Monitor throughout the night
  • Do not wake an individual unless concerns
  • Call 911 if an individual is slow to wake or RED FLAGS
  • Seek medical attention is signs or symptoms present
  • If no symptoms occur, monitored normal activity allowed
  • Monitor for several days
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15
Q

When should you wake someone who has a potential concussion?

A
  • concerns with breathing
  • changes in skin colour
  • Concerns with how they are sleeping
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16
Q

What should you do if someone with a potential concussion is slow to wake?

A
  • Seek immediate medical care
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17
Q

How is a concussion diagnosed?

A
  • Clinical judgment
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18
Q

Is there a test to confirm concussion?

A
  • No diagnostic test
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19
Q

Do concussions show up on imaging tests like CT scans or MRI’s? Why?

A

NO
- There is no structural damage visible

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20
Q

What are the three categories of the Glasgow Coma Scale?

A
  • Eye Opening
  • Verbal Response
  • Motor Response
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21
Q

What are the 4 ranks on the Eye Opening category of the Glasgow Coma Scale?

A

4 - Spontaneous Eye Opening
3 - Eye Opening to Speech
2 - Eye Opening to Pain
1 - No Response

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22
Q

What are the 5 Ranks of the Verbal Response Category of the Glasgow Coma Scale?

A

5 - Oriented verbal response
4 - Sentences
3 - Words
2 - Sounds
1 - No Response

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23
Q

What are the 6 Ranks of the Motor Response Category of the Glasgow Coma Scale?

A

6 - Obeys Commands
5 - Localizes Pain
4 - Flexion/Withdrawal to pain
3 - Abnormal Flexion to pain
2 - Extension to pain
1 - No response

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24
Q

What does a low score on the Glasgow Coma Scale mean?

A
  • Coma
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25
What does a high score on the Glasgow Coma Scale mean?
- Relatively awake, possible mild TBI
26
What is the concussion management protocol for the first 48 hours?
- Rest for 2 days
27
Why does someone with a concussion need to rest?
- Needs physical and cognitive rest to allow brain to heal
28
What is the concussion management protocol after 48 hours?
- Activities that do not increase heart rate or cause sweat - Restrict strenuous work, exercise, sports, running, biking, rough play - Limit cognitive activity: concentration/learning - Restrict work, reading, electronics, music
29
How long does it typically take to recover from a concussion?
2-4 weeks
30
How many individuals with a concussion will experience persistent symptoms past 2-4 weeks?
15-30%
31
What can persistent symptoms from a concussion cause?
- long-term difficulties
32
What may a physician recommend if there is no improvement or worsening symptoms of a concussion past 4-12 weeks?
- interdisciplinary clinic
33
What can influence the recovery period of a concussion? (9)
- Previous concussions - History of headaches, migraines - Learning disabilities - Mental Health Issues - ADHD - Use of Drugs/Alcohol - Return to activity too soon - Lack of family/social support - Participating in a high-risk sport
34
How many stages are a part of the return to activity protocol?
5
35
What are the stages of the return to activity concussion protocol?
Stage 1 - Initial Rest Stage 2 - Prepare to Return to Activity Stage 3 - Increase your activity Stage 4 - Gradually Resume Daily Activity Stage 5 - Full Return to Activity
36
Explain Stage 1 of the return to activity protocol for concussions
Initial Rest - Stay Home - Quiet and Calm Environment - Brief Social Visits - Sleep as much as needed - Maintain regular sleep schedule
37
When would you move from stage 1 of the return to activity concussion protocol to stage 2?
- When symptoms start to improve - After 2 days rest
38
Explain stage 2 of the return to activity concussion protocol
Prepare to Return to Activity - Simple familiar tasks - Less than 30 minutes of activity with regular breaks - Go for walks/other light physical activity - minimum day time bed rest
39
When would you move from stage 2 of the return to activity concussion protocol to stage 3?
- When you tolerate simple, familiar tasks
40
Describe stage 3 of the return to activity concussion protocol
- Gradual return to usual activity - Gradual decrease in rest breaks - Start with less demanding activities - Jogging, light weights, non-contact sports drills, etc. - Return to work/school on part-time basis
41
When would you move from stage 3 of the return to activity concussion protocol to stage 4?
- When they tolerate further increases in level of activity
42
Describe stage 4 of the return to activity concussion protocol
- Resume challenging activities - Energy and capacity should improve - Students/workers may require accommodations
43
What accommodations might students or workers require when returning post-concussion?
- Reduced Hours - Reduced Workload - Extra time for assignments - Access to quiet distraction-free work environment
44
When would someone move from stage 4 to stage 5 of the return to activity concussion protocol?
- When individual tolerates partial return or usual activities
45
Describe stage 5 of the return to activity concussion protocol
- full class/work schedule (no rest break/accommodations) - Student-athletes no return to sport until full return to school - Only return to contact sport/dangerous job when cleared by doctor
46
What happens if there are worsening or new symptoms at any stage of the return to activity protocol?
- Go back to the previous stage for at least 24 hours - Do not push through symptoms - Decrease activity level
47
What might happen during the recovery process of the return to activity concussion protocol?
- May need to move back a stage more than once
48
How many stages are in the return to sport concussion protocol?
6
49
What are the stages of the return to sport concussion protocol?
Stage 1 - No Sporting Activity Stage 2 - Light Aerobic Exercise Stage 3 - Sport-Specific Exercise Stage 4 - Non-contact drills Stage 5 - Full-contact practice Stage 6 - Back in the Game
50
What do the return to activity/sport/work protocols not replace?
- Medical Advice
51
Describe stage 1 of the return to sport concussion protocol
No Sporting Activity - Physical and cognitive rest
52
When would you transition from stage 1 of the return to sport concussion protocol to stage 2?
- Symptoms start to improve - Resting for 2 days
53
Describe stage 2 of the return to sport concussion protocol
Light Aerobic Exercise - walking/swimming/stationary cycling - No resistance training - Pace (still able to converse) - Increase heart rate
54
When should you move from stage 2 to stage 3 of the return to sport concussion protocol?
- No new or worsening symptoms for 24 hours
55
Describe stage 3 of the return to sport concussion timeline
Sport-Specific Exercise - Skating drills (ice hockey), running drills (soccer) - No head-impact activities - Add movement to activities
56
When would you transition from stage 3 to stage 4 of the return to sport concussion timeline?
- No new or worsening symptoms following stage 3 sport-specific exercises
57
Describe stage 4 of the return to sport concussion timeline?
Non-contact drills - complex training drills (ex. passing) - start resistance training - Exercise coordination, cognitive load
58
When would you move from stage 4 to stage 5 of the return to sport concussion timeline?
- When symptom-free for 24 hours following stage 4 - Requires medical clearance
59
Describe stage 5 of the return to sport concussion timeline
Full-Contact practice - normal training activities - Restore confidence: assess functional skills
60
When would you move from stage 5 to stage 6 of the return to sport concussion timeline?
- Symptoms free for 24 hours following stage 5 return to full-contact practice
61
Describe stage 6 of the return to sport concussion timeline
Back in the Game - Normal game play
62
What stage of the return to sport concussion timeline requires medical clearance?
- Stage 5
63
What can happen if there is a premature return to contact sport?
- Can cause significant setback in recovery
64
What happens if there are new or worsening symptoms during the return to sport concussion timeline?
- Move back to previous stage for minimum 24 hours - may occur more than once during recovery
65
What should be completed before return to sport concussion timeline?
- Return to School timeline
66
How many stages are there in the return to school concussion timeline?
- 6
67
What stage of the return to school concussion timeline has two parts?
- Stage 2 (a and b)
68
What are the different stages of the return to school concussion timeline?
Stage 1 - Physical & Cognitive Rest Stage 2 - Light Cognitive Activity Stage 3 - Back to School Part-time Stage 4 - Part-time School Stage 5 - Full-time School Stage 6 - Full-time school
69
Describe stage 1 of the return to school concussion timeline
Physical and Cognitive Rest - At home - Rest - Board games, crafts, talk on phone - No activities that increase heart rate/sweat - Limit computer, TV, Texting, Video Games, reading - No: school work, sports, work, driving
70
When should you switch from stage 1 to stage 2a of the return to school concussion timeline?
- Symptoms improve - Rest max 2 days
71
Describe Stage 2a of the return to school concussion timeline
Light Cognitive Activity - Gradual increase in cognitive activity (up to 30min) - Frequent breaks - Read/TV/Drawing okay - Limited peer contact/social networking - Contact school for return plan - No: school attendance, sport or work - Gradually add schoolwork at home
72
When would you transition from stage 2a to stage 2b of the return to school concussion timeline?
- When 30min cognitive activity tolerated
73
Describe stage 2b of the return to school concussion timeline
- Introduce schoolwork - Communicate with school about student's progression - No: school attendance, sport, or work
74
What stages of the return to school concussion timeline occur at home?
- Stage 1 - Stage 2a - Stage 2b
75
When would you transition from stage 2b to stage 3 of the return to school concussion timeline?
- When 60min of schoolwork in 2 30min intervals tolerated
76
Describe stage 3 of the return to school concussion timeline
- part-time school attendance (with max accommodations) - Schoolwork at school - No: PE, physical activity at lunch/recess, homework, testing, sport, assemblies, field trips - Communicate with school on student's progression - School work only at school
77
When should you transition from stage 3 to stage 4 of the return-to-school concussion protocol?
- When 120 minutes of school work in 30-45 min intervals is tolerated
78
Describe stage 4 of the return to school concussion timeline
- Increase school time - Moderate accommodations - Homework (up to 30min/day) - Testing with adaptations - No: PE/physical activity at lunch/sports/standardized testing - Communicate with school on student's progression
79
When would you switch from stage 4 to stage 5 of the return to school protocol?
- When 240min of cognitive activity tolerated in 45-60min intervals
80
Describe Stage 5 of the return to school concussion timeline
- Full days at school (minimal accommodations) - increase homework to 60min/day - Limit testing to 1/day (with adaption) - No: PE/ P activity at lunch/ sport/ standardized tests
81
When would you switch from stage 5 to stage 6 on the return to school concussion protocol?
- When tolerating full-time school with no learning acommodations
82
Describe stage 6 of the return to school concussion timeline
Full-time school - full days, no accommodations - All classes - All homework - Full extracurricular - All tests - No: full participation in PE unit return to sport completed and medical clearance - full academic load
83
What does it mean if someone is tolerating an activity?
- when symptoms are not exacerbated
84
How many stages are in the return to work concussion timeline?
6
85
What are the stages of the return to work concussion timeline?
Stage 1 - physical and cognitive rest Stage 2 - Light activity Stage 3 - Prepare for work (a: at home/b: at work) Stage 4 - Gradual return to work Stage 5 - Regular work hours (modifications) Stage 6 - Full Return to Work
86
Describe stage 1 of the return to work concussion timeline
Physical and Cognitive Rest - At home - Rest (quiet calm environment) - Low aggravation activities (quiet music/colouring) - Sleep as much as needed - Limit social visits/screen time - Avoid sports/physical activity that increase HR or sweating
87
What should be discussed with a medical professional during stage 1 of the return to work concussion timeline?
- Driving
88
When should you transition from stage 1 to stage 2 of the return to work concussion timeline?
- When symptoms improve - 2 days rest
89
Describe stage 2 of the return to work concussion timeline
- simple gradual increase in cognitive activity - Walks or other light physical activity - Frequent rest periods - Brief periods of activity (<30min) - Communicate with workplace about return to work plan
90
When should you switch from stage 2 to stage 3a of the return to work concussion protocol?
- When 30 min activity is tolerated
91
Describe stage 3a of the return to work concussion timeline
- increase cognitive activity - Return to pre-injury physical activity - Contact workplace for tailored return to work plan - Attempt commute to work (assess aggravation of symptoms) - Regular sleep schedule - Work up to 2 hour activity with breaks - Prepare for return to work
92
When should you switch from stage 3a to stage 3b of the return to work timeline?
- At work: When 120 min activity tolerated with rests
93
Describe stage 3b of the return to work concussion timeline
- Set Work accommodations - Arrange Graduated return to work plan - Work your way up to an additional 2 hours of activity. with breaks - Plan to leave work if symptoms worsen, return to stage 2
94
What accommodations can be set up at work for a return to work concussion plan?
- Flexible hours - Reduced workload - Extra time for task - Access to quiet, distraction-free work space
95
When should you transition from stage 3b to stage 4 of the return to work concussion timeline?
- When 4 hours of activity is tolerate, with breaks
96
Describe stage 4 of the return to work concussion timeline
- Return to work based on plan set - Start with less demanding activities - Gradually increase hours and difficulty - Work with accommodations
97
When would you switch from stage 4 to stage 5 of the return to work concussion timeline?
- When ready for regular work hours with accommodations
98
Describe stage 5 of the return to work concussion timeline
- decrease accommodations as energy/capacity increases - Accommodations phased out in 'trial' periods - Monitor energy levels (participate in activities after work)
99
When would you switch from stage 5 to stage 6 of the return to work concussion timeline?
- When regular work hours are tolerated with minimum accommodations
100
Describe stage 6 of the return to work concussion timeline
- Full regular work hours - usual expectations of productions
101
What requires medical clearance in stage 6 of the return to work concussion timeline?
- Return to Job-duties that have safety implications - Ex. heavy machine operation, heights, driving
102
How many people get post-concussion syndrome?
30-80% of patients with mild-moderate brain injuries
103
Does the severity of the TBI relate to the occurrence of PCS?
- NO (not clearly correlated)
104
What are the symptoms and signs of Post Concussion Syndrome? (8)
- Headache - Dizziness - Irritability - Anxiety - Sleep Impairment - Fatigue - Loss of memory / concentration - Noise Sensitivity
105
What are some possible structural changes that occur in post concussion syndrome?
- Regional Voluem loss
106
Do the structural changes that occur during post-concussion syndrome correlate with symptoms?
- No
107
What are some possible psychogenic factors that can contribute to post-concussion syndromes?
- Limited Social Support - Poor Coping Skills - Negative Perceptions - Depression - Anxiety - Panic - PTSD
108
Describe the treatment for someone with post-concussion syndrome
Individualized - Cognitive and physical rest - Headache management - Management of sleep/wake disorders - Psychological support and education
109
What are some ways to manage headaches for someone with post-concussion syndrome?
- physical therapy - pharmaceutical intervention
110
What are some ways to manage sleep/wake disorders for someone with post-concussion syndrome?
- Behavioural changes - Pharmacological intervention
111
What is second impact syndrome?
- Catastrophic injury due to a second impact while still symptomatic from prior concussion
112
What is diffuse cerebral edema?
- Increase intracranial pressure
113
When can a diffuse cerebral edema occur?
- Second Impact Syndrome
114
What can second impact syndrome lead to?
- Death - Permanent disability
115
Who is more at risk for second-impact syndrome?
- people under 20 years old
116
Where have all cases of second impact syndrome been seen?
Males - Associated with American Football
117
What is a risk factor for sport-related concussions?
- Past sport-related concussions
118
What are multiple Sport-related concussions associated with?
More - Physical - Cognitive - Emotional Symptoms before participation in sporting season
119
What is predictive of worse symptoms or prolonged recovery? is this a clear connection?
- Loss of consciousness - Retrograde amnesia - Post-traumatic amnesia UNCLEAR RELATIONSHIP
120
What may be helpful for neuropsychological assessments related to sport-related concussions? Why? When?
What? - Baseline testing pre-season Why? - Assist in Return-to-play When? - Multiple concussion situations
121
What is CTE?
Chronic Traumatic Encephalopathy - progressive/fatal brain disease
122
When might CTE occur?
- Repeated traumatic brain injuries
123
How many cases of CTE have been reported?
- only 300
124
Why is CTE hard to diagnose?
- Only diagnosed post-mortem
125
What happens to the brain from CTE?
- Patchy distribution of tau deposits throughout the brain
126
What are tau deposits?
- Neurofibrillary tangles
127
What are some other possible features of CTE aside from patchy distributions of tau deposits?
- Amyloid-B(AB) - Transactive DNA-binding protein 43 (TDP43) - Degeneration of Axons
128
Why is CTE controversial?
- Many people get mTBI, yet CTE uncommon - Dismissal of repetitive head injury in sport does not increase understanding of CTE

KIN 424 - Medical Aspects of Sport (11 decks)

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