PT for individuals with Concussions Flashcards
Acquired brain injury
after birth and applies to children and adults
can occur via traumatic causes such as injury or non traumatic causes such as disease, stroke, infection
Examples of non- traumatic brain injury
stroke- hemorrhagic/ischemic
brain tumor
hypoxia/anoxia
dementia
encephalitis
Examples of traumatic Brain injuries
diffuse:
-concussion
-diffuse axonial injury
-hypoxia anoxia
focal:
-subdural hematoma
-epidural hematoma
Do you routinely image patients to diagnose mTBI
NO
Define Concussion
traumatic brain injury induced by biomechanical forces. it may be caused by either a direct blow to the head, face, neck or indirect blow to the body that transmits forces to the head
Clinical signs and symptoms reflect a _______ disturbance rather than a structural injury.
functional
Do concussions always result of a loss of consciousness?
NO
Is there a high prevalence of TBI related ED visits?
yes 2.8 million
How do we classify a TBI?
Glasgow coma scale
Score of 8 or less on GCS
severe
Score of 9-12 on GCS
moderate
Score of 13-15 on GCS
mild
What are the top 3 causes for all types of TBIs?
falls -49%
MVA- 24%
other- 25%
-unintentionally being struck by or against an object
-unintentional self harm
-assault
concussion mechanism is _____ not structural.
physiological
injury occurs resulting in alteration of neuronal membrane
increase cellular demand for ATP
increase glucose demand
deregulation of blood flow in brain
metabolic demand may be greater than supply
are abnormalities shown on a neuro-image after a person has a concussion?
No
Should an MRI be used to diagnose an MRI?
no
What is the timeframe for recovery after a concussion
24 hours to 7-10 days
What are some poor prognostic factors?
severity of acute and subacute symptoms
prior concussion
history of anxiety, depression or learning disabilities
cognitive deficits
females have greater risk than males
Dizziness on field is associated with prolonged recovery true/false
true
Dizziness can be a result of visual, peripheral and central vestibular disturbances
neck tightness, suboccipitals
Risk of subsequent concussion increases ___X after the first event
3x
What is second impact syndrome
rare but life treatening
results from a second injury when the brain is vulnerable
brain is still healing from the initial injury and is unable to regulate blood flow
Intracranial pressure builds in the brain and brainstem herniation can occur
What is Post-concussive syndrome?
Persistence of at least 3 symptoms for >4 weeks
Graded symptom checklist reliably identified mTBI for children aged____and older
6
Patients with altered mental state at time of injury have increased number and severity of ____
symptoms
What is chronic traumatic encephalopathy?
degenerative brain disease found in athletes, military veterans and others with repeated brain trauma
families may report mood behavioral or cognitive changes that progressively develop following consecutive injuries
When is Chronic traumatic encephalopathy diagnosed?
after death with autopsy
What are some signs and symptoms of concussion?
headache
nausea
vomiting
balance/dizziness
sensitivity to light/noise
fatigue
depression
trouble falling asleep
Signs and symptoms of concussion are rapidly ____ and short lived and resolve _____.
occurring
and resolve spontaneously
What is the gold standard for evaluating concussions? when does it take place
Sports concussion assessment tool (SCAT-5)
within the first 24 hours after injury
What information do you need for the Standardized assessment of concussion?
SAC needs to be compared to baseline
How many conditions are included in the balance error scoring system?
6 conditions
The high level mobility assessment tool is used to assess patients who suffer from what?
high level balance and mobility problems
13 items
What do you do in the buffalo concussion treadmill test?
obtain resting HR, BP, VAS, RPE then repeat every minute 1 point for worsening symptoms and 1 point for increasing new symptom
What are some warning signs that need immediate referral to emergency care
- cervical instability/fracture
- neurologic signs
-reflex changes
-weakness
-sensory chagnes
-CN abnormalities
-seizure - prolonged Loss of conciousness
- HA that is progressing
- altered mental status beyond acute stage or deteriorating mental status
- HTN
Autonomic dysregulation
Domaine to examine and treat: Cervical spine
Palpation
stability testing
flexibility
mobility testing
Cervical strength testing
Upper quarter screen
What are some exams for cervicogenic dizziness
smooth pursuit neck torsion test
joint position error test
head neck rotation
What are some interventions for cervical spin interventions
ROM
Stretching
Progressive resistance exercise
mobilization
suboccipital release
proprioceptive training
oculomotor and balance retraining
After concussion what exam should be used to assess balance
BESS
If you observe gaze holding nystagmus or other central signs after concussion what should you do?
refer
reflex should normalize within 48-72 hours
During VOR if target slips or blurs can be caused by two things what are they
vestibular hypofunction- infection should heal and recover within 24-48 hours
caused by central dysfunction- refer concern
What is senate bill 40
requires training of coaches on removal from play
no same day return to practice
notify parent
medical clearance for RTP
What does the colorado concussion law return to sport state
must be free of concussion symptoms >24 hours
attending full days of school
tolerating full academic workload
off any medication started for concussions
no same day return to play with or without scat-5
What are some sideline assessment red flags
neck pain tenderness
double vision
weakness tingling in arm/leg
severe or increasing headache
seizure or convulsion
loss of consciousness
deteriorating conscious state
vomiting
increasing restless
When should a kid return to school
brief 24-48 hour period of rest followed by gradual return to activity
Treatment cervical spine
soft tissue
cervical spine
cervical strengthening
cervical proprioception
treatment cardiovascular deconditioning
buffalo concussion treadmill test
graded exercise
treatment vestibular involvement
smooth pursuits, saccades, convergence and vertical VOR
teach settling technique
set patient expectations on symptom development
What is the criteria for progression in treatment
decline in symptoms
able to remain symptom free during aerobic conditioning
tolerate increasing resistance
incorporate dual task
return to running spriting and agility
