Post concussion

Question 1

definition: short-term alternation of consciousness due to a trauma that caused movement of the brain inside the skull

Answer 1

concussion

Question 2

(true/false) concussions involve metabolic changes

Answer 2

true

Question 3

What is the regular recovery time period for concussions?

Answer 3

2-4 weeks

Question 4

definition: A constellation of concussion symptoms that persist beyond 4 weeks

• May involve multiple separate pathologies or “diagnoses”
• Mood and sleep disturbances
• Physical symptoms such as visual changes, HA, and dizziness
• visual and cognitive difficulties

Answer 4

post concussion syndrome

Question 5

definition: A decrease in glucose which may be neuro protective

Answer 5

metabolic cascade

Question 6

How long does it take metabolic cascade with post concussion syndrome to normalize?

Answer 6

couple days

Question 7

Where did the idea of multiple week rest periods originate from? Why?

Answer 7

Metabolic cascade because there is a greater risk of increased brain injury if a second concussion occurs before normalizing (second impact syndrome)

Question 8

If dizziness, neck pain and/or headaches persist for more than 10 days, ________ rehabilitation is recommended.

Answer 8

cerebrovestibular reha

Question 9

(true/false) If symptoms persist beyond 4 weeks in children and adolescents, active rehabilitation and collaborative care may be of benefit.

Answer 9

true

Question 10

For children, adolescents and adults with dizziness/balance problems, either _____ rehabilitation or _______ rehab. may be of benefit.

Answer 10

vestibular or cervicovestibular rehab

Question 11

What are on-field assessments used to detect concussion?

Answer 11

SCAT 6 (GOLD STANDARD)
Cognitive assessments
Balance and tandem walk
King Devick (reading saccades) –> a baseline is needed prior to play
oculomotor testing

Question 12

Who developed the IMPACT test?

Answer 12

UPMC

Question 13

What age range is IMPACT testing validated for?

Answer 13

12-59 y/o

Question 14

A patient with a concussion should rest until symptoms resolve but not more than ___ days due to the risk of physical deconditioning and reactive depression.

–> follow step-wise approach for RTA

Answer 14

3 days

Question 15

(true/false) School age children kept out of school 5 days vs 2 days had more post concussive symptoms and had longer time of recovery

Answer 15

true

Question 16

Pt’s with predominant symptoms were (less/more) likely to remain symptomatic 10 days after injury if they were prescribed rest

Answer 16

more

Question 17

Patients with physical signs such as LOC, confusion and POST traumatic amnesia, benefitted from relative rest for ____ days

Answer 17

5 days

Question 18

___% of individuals who experience a concussion normally have no symptoms after 1 month

Answer 18

80%

Question 19

What should you start with when evaluating a patient with a concussion/post-concussion syndrome?

Answer 19

Post concussion grading score (PCGS)

–> physical, cognitive, emotional, and sleep disturbance symptoms

Question 20

What are questionnaires to use when considering referral to another provider?

Answer 20

DHI: Dizziness Handicap Index
BVQ: Binocular Vision Questionnaire
GAD 7: General Anxiety Disorder Assessment
PHQ 9: Patient Health Questionnaire for depression
Pittsburg Sleep Quality Index

Question 21

What high-tech tool is the gold standard for assessment of balance in a concussion patient?

Answer 21

Neurocom smart balance master

Question 22

Where was the Balance Error scoring system (BESS) developed? Why?

Answer 22

UNC
–> designed to be sensitive to mild static balance instability

Question 23

When is the BESS tool most useful?

Answer 23

Most useful as Pre/post concussion or Rehab to detect large differences in ability.

Question 24

What are contraindications for participation in exercise after a concussion?

Answer 24

SBP > 140
DBP > 90
BMI > 30

Question 25

What is a priority post-concussion when exercising?

Answer 25

Controlling post-concussive HA

Question 26

What are the criteria for return to play?

Answer 26

- Tolerates BCTT to exhaustion without increase in symptoms and tolerates 85-90% max HR. - Resting HR return to normal - HR Recovery is WNL (2-5 minutes)

Question 27

(Males/females) are at greater risk for concussions

Answer 27

females

Question 28

For every ___ pound increase in neck strength, there is a 5% decrease in concussion risk.

Answer 28

1 pound

Question 29

____ areas of the brain play a part in vision. There are _____ intracortical connections between those areas.

Answer 29

32; 300

Question 30

Visual, Vestibular, somatosensory inputs all cross at the _______ in the mid brain.

Answer 30

superior colliculus

Question 31

What occurs if visual, vestibular, and somatosensory systems are not organized properly?

Answer 31

dizziness

Question 32

What does VOMS (Vestibular oculomotor screen) assess for?

Answer 32

binocular vision disorders

Question 33

A VOMS score above ___ indicates possible concussion and should be further evaluated.

Answer 33

2

Question 34

What symptoms are indications for a possible binocular vision disorder?

Answer 34

- Difficulty with near work - Words jump on page/ can’t keep place - Scrolling on computer bothers patient - Eye strain head ache , blinking or watering eyes - Blurry vision or double vision (variable) - Anxiety with near or far tasks - Nausea - Difficulty with motion sensitivity in crowds, visually stimulating situations and driving

Question 35

What indicates a Abducens nerve (VI) palsy?

Answer 35

eye does not abduct resulting in double vision particularly during lateral gaze

Question 36

What indicates an oculomotor nerve (III) palsy?

Answer 36

eye deviated out and down

Question 37

What indicates a trochlear nerve (CN VI) palsy?

Answer 37

Up and out, vertical diplopia, head tilt

Question 38

definition: horizontal deviation of the eye(s) with cover test

Answer 38

tropia

Question 39

definition: horizontal or vertical movement with uncover test

Answer 39

large phoria

Question 40

definition: a misalignment of the two eyes when a patient is looking with both eyes uncovered.

Answer 40

tropia

Question 41

When does phoria appear?

Answer 41

only appears when binocular viewing is broken (breaking fusion). What the eye does when it is covered

Question 42

What can affect eye alignment?

Answer 42

nerve injury underlying strabismus or former uncompensated injury

Question 43

What test assesses for tropia?

Answer 43

cover test

Question 44

What test assesses for phoria?

Answer 44

uncover and cross cover tests

Question 45

What test is more sensitive for phorias (especially vertical phorias)?

Answer 45

Maddox Rod

Question 46

definition: Either one or both eyes do not adduct resulting in diplopia or monocular vision.

Answer 46

near-point convergence

Question 47

definition: once near point convergence achieved eyes do not return to normal position as the target gets further away. (takes more than 2 cm to recover single vision)

Answer 47

convergence spasm

Question 48

What test is recognized as the Standard for stereo depth perception testing?

Answer 48

Stereo fly test

Question 49

What was the stereo fly test designed for?

Answer 49

designed for the evaluation of both gross stereopsis and fine depth perception --> poor near vision = test failure

Question 50

What is our most used central visual task? What test uses this?

Answer 50

Saccades --> king deverick

Question 51

You should refer a patient to another professional if they have a lack of progress with reasonable effort or symptoms that persist after at least ___.

Answer 51

1 month

Question 52

(true/false) Vertical phoria is indicative for referral

Answer 52

true

Question 53

What oculomotor deficits are beyond our scope?

Answer 53

- abducens nerve palsy - oculomotor nerve palsy - trochlear nerve palsy - visual field cuts -persistent symptoms without progress - passing standardized functional tests with continuing functional deficits - tropias - phorias - skew deviation - double vision in one eye - resting/intermittent nystagmus - pupil irregularities - ptosis - acuity troubles - eye fatigue w/o nystagmus

Question 54

Incidence of BPPV is > ___% post-concussion

Answer 54

> 5%

Question 55

What are s/s of migraine?

Answer 55

- PMH - disabling throbbing/pulsating - photosensitivity - nausea - increased with mild exertion - rebound HA after visual stimulation/exertion

Question 56

Prevalence of Migraine post concussion is HIGH – Particularly when symptoms last post ____ weeks.

Answer 56

6 weeks

Question 57

What medications are recommended for management of migraines?

Answer 57

anti seizure, beta blockers and antidepressants

Question 58

(true/false) Post concussive symptoms very similar to PTSD, GAD, MDD, and Somatization disorder

Answer 58

true

Question 59

(true/false) The presence of anxiety disorders in PCS pt’s more than 3 months after concussion was higher than PTSD and presence of life stressors

Answer 59

true