mTBI

Question 1

Pathophysiology of mTBI

Answer 1

whats the pathophysiology for a mTBI
BASICALLY - neurometabolic cascade is the thing that is messed up which disrupts the metabolic pathway that are required for good communication between neruons

worse cerebral profusion (less blood flow to brain) couple weeks after mTBI, along side ionic influx (more permeability of neruons), increased flow of CA2+, pumps increase, pumps need to be going bc ions are a mess, but we cant bc we need more energy

Question 2

Prognosis for mTBI

Answer 2

-20% of Individuals experience symptoms longer than 1 month
-Children return to school after 2-4 days
-Adults return to work after 1-2 weeks
-Gender, history of concussion, intracranial abnormalities, etc. may affect prognosis
-Symptom burden may be predictive of recovery
-Preinjury mental health probs and post injury psychological distress (symptoms of depression and anxiety) are robust predictors of prolonged recovery

Question 3

Goals of early support mTBI

Answer 3

-Education: what to expect, now to manage symptoms
-Return to activity guidelines: rest 24-48 hrs (strict sensory deprivation not required), then gradual symptom guided resumption of cog. and physical activities (note our change in understanding in recent yrs)

Question 4

mTBI role of the SLP

Answer 4

-Persistent post-concussive issues
Require multidisciplinary team
Must consider pre- morbid factors
Should look at accommodations and identification of underlying issues
-Treatment from SLP perspective: guided by particular strengths and weaknesses, be sure assessments sensitive to mTBI

Question 5

mTBI military specific info

Answer 5

•375,230 US service members sustained TBI from 2000-2016
•~75% mild (may be higher)
•Males twice as likely to sustain TBI
•Etiologies in combat theater
•Explosive devices (blast)- estimates of up to 80% of mTBI in combat zones
•Origin of the term “shell shock”
•Head impact
•Penetrating ballistic injuries

Question 6

Blast injuries 4 levels

Answer 6

-Primary injury: direct impact from over-pressure wavel compress air filled organs, catapults body backwards
-Secondary injury: energized debris or explosive fragments impacts head/body
-Tertiary injury: body impacts wall, ground, or object
-Quarternary injury: inhalation of toxic gasses/substances

Question 7

Blast injury co-morbid PTSD

Answer 7

intrusive thoughts
avoiding reminders
negative thoughts and feelings
arousal and reactive symptoms
Executive function deficits predictive of poorer outcome
Combined psychological interventions (CBT) PLUS cognitive rehab has shown reduction in symptoms

Question 8

is it best practice to get a CT for concussion

Answer 8

no, not just for suspected concussion bc its radiation exposure
- need to know the why of a CT and resources

Question 9

when should a head CT be considered for ages 5-18

Answer 9

vomiting
loss of consciousness
severe headache
dangerous MOI
GCS <15
agitation somnolence
slow response
repetitive questions

Question 10

when should a head CT be indicated for ages 5-18

Answer 10

GCS <15
agitation somnolence
slow response
repetitive questions

Question 11

when should a head CT be considered for ages 16-64

Answer 11

amnesia before impact > 30 or equal to
dangerous MOI

Question 12

immediate referral for CT

Answer 12

• seizures
• double vision
• slurred speech
• worsening headache
• vomiting
• motor or sensory deficit

Question 13

3 steps for clinical presentation and diagnosis for mTBI

Answer 13

1 establish plausible injury mechanism
2 query signs and symptoms
3 rule out confounding factors

Question 14

what are premorbid factors that may impact mTBI recovery

Answer 14

history of concussion
other diagnosis (learning disabilities’)
medication (blood thinners)
depression
anxiety
diet
sleep

Question 15

considerations for mTBI military population

Answer 15

return to duty
high comorbidity rates of mTBI, PTSD, and substance abuse