Module 11 - Concussion Flashcards
What does the abbreviation SRC mean?
- Sport-related concussion
What does the abbreviation TBL mean?
- Traumatic Brain Injury
What does the abbreviation mTBL mean?
- mild traumatic brain injury
What does the abbreviation CTE mean?
- Chronic Traumatic Encepholopathy
What does the abbreviation RHL mean?
- Repetitive Head Injury
What is a contrecoup injury?
- Moving head strikes stationary object
What is a coup injury?
- Moving object impacts stationary head
What is the mechanism of a brain injury?
- 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
What is axonal shearing?
- Axons being stretched
What are the signs and symptoms of concussions? (16)
- 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
Describe the initial response to a possible concussion
- Respond immediately
- Remove from activity
- Assess for medical emergency
- Call 911 and seek medical care if red flags
What are the red flags to look for when initially assessing a possible concussion?
- 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
What are the steps to take if there is no medical emergency but may be a potential concussion?
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
What needs to be done within 48 hours of a potential concussion?
- 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
When should you wake someone who has a potential concussion?
- concerns with breathing
- changes in skin colour
- Concerns with how they are sleeping
What should you do if someone with a potential concussion is slow to wake?
- Seek immediate medical care
How is a concussion diagnosed?
- Clinical judgment
Is there a test to confirm concussion?
- No diagnostic test
Do concussions show up on imaging tests like CT scans or MRI’s? Why?
NO
- There is no structural damage visible
What are the three categories of the Glasgow Coma Scale?
- Eye Opening
- Verbal Response
- Motor Response
What are the 4 ranks on the Eye Opening category of the Glasgow Coma Scale?
4 - Spontaneous Eye Opening
3 - Eye Opening to Speech
2 - Eye Opening to Pain
1 - No Response
What are the 5 Ranks of the Verbal Response Category of the Glasgow Coma Scale?
5 - Oriented verbal response
4 - Sentences
3 - Words
2 - Sounds
1 - No Response
What are the 6 Ranks of the Motor Response Category of the Glasgow Coma Scale?
6 - Obeys Commands
5 - Localizes Pain
4 - Flexion/Withdrawal to pain
3 - Abnormal Flexion to pain
2 - Extension to pain
1 - No response
What does a low score on the Glasgow Coma Scale mean?
- Coma
What does a high score on the Glasgow Coma Scale mean?
- Relatively awake, possible mild TBI
What is the concussion management protocol for the first 48 hours?
- Rest for 2 days
Why does someone with a concussion need to rest?
- Needs physical and cognitive rest to allow brain to heal
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
How long does it typically take to recover from a concussion?
2-4 weeks
How many individuals with a concussion will experience persistent symptoms past 2-4 weeks?
15-30%
What can persistent symptoms from a concussion cause?
- long-term difficulties
What may a physician recommend if there is no improvement or worsening symptoms of a concussion past 4-12 weeks?
- interdisciplinary clinic
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
How many stages are a part of the return to activity protocol?
5
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
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
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
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
When would you move from stage 2 of the return to activity concussion protocol to stage 3?
- When you tolerate simple, familiar tasks
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
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
Describe stage 4 of the return to activity concussion protocol
- Resume challenging activities
- Energy and capacity should improve
- Students/workers may require accommodations
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
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
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
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
What might happen during the recovery process of the return to activity concussion protocol?
- May need to move back a stage more than once
How many stages are in the return to sport concussion protocol?
6
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
What do the return to activity/sport/work protocols not replace?
- Medical Advice
Describe stage 1 of the return to sport concussion protocol
No Sporting Activity
- Physical and cognitive rest