PT Management of Concussion

Question 1

What is a concussion?

Answer 1

A mild traumatic brain injury (mTBI) affecting cognitive, physical, and emotional functioning.

Question 2

What should PT’s always test in patients who have sustained a concussion?

Answer 2

Physical therapists should test for orthostatic hypotension and autonomic dysfunction (eg.resting and postural tachycardia) in patients who have sustained a concussion.

Question 3

What is VOMS?

Answer 3

Vestibular/Ocular Motor Screening used to identify symptoms and impairments after concussion.

Question 4

What are the key components of the Buffalo Concussion Treadmill Test (BCTT)?

Answer 4

Record resting HR, set treadmill speed, increase incline each minute, stop when symptoms increase by 3 points.

Question 5

How is the Balance Error Scoring System (BESS) test conducted?

Answer 5

Three positions tested on solid and foam surfaces: Romberg stance, Tandem stance, Single leg stance, with eyes closed and hands on hips.

Question 6

What is considered a higher score in the PCSS?

Answer 6

A higher score indicates more severe post-concussion symptoms.

Question 7

What is the purpose of the HiMat (High-Level Mobility Assessment Tool)?

Answer 7

To assess motor performance in higher-level patients post-concussion.

Question 8

List common symptoms of autonomic involvement after concussion.

Answer 8

Sleep disturbances, exercise intolerance, lightheadedness, elevated heart rate, fatigue, hypersensitivity to stimuli, brain fog.

Question 9

What are common vestibular symptoms post-concussion?

Answer 9

Dizziness, balance problems, nausea, blurry vision, fatigue.

Question 10

What symptoms are associated with cervical involvement after concussion?

Answer 10

Headache, neck pain, dizziness, fogginess, nausea, fatigue.

Question 11

What symptoms are common with oculomotor involvement post-concussion?

Answer 11

Blurred vision, double vision, photophobia, headache, dizziness.

Question 12

What is the recommended approach to addressing cognitive/fatigue symptoms?

Answer 12

Exertional exercise, improving ocular issues, and patient education.

Question 13

What are common findings in vestibular assessment post-concussion?

Answer 13

VOR impairment, motion sensitivity, impaired balance, BPPV.

Question 14

What symptoms are linked to convergence insufficiency?

Answer 14

Headaches, trouble reading, double vision, eye strain, squinting.

Question 15

What are the symptoms of accommodative dysfunction?

Answer 15

Blurred vision, visual fatigue, headaches, difficulty with near-far gaze shifts.

Question 16

What are common signs of sleep disturbances after a concussion?

Answer 16

Difficulty falling asleep, staying asleep, waking up too early, non-restorative sleep.

Question 17

What are the common symptoms in patients with anxiety/mood involvement post-concussion?

Answer 17

Irritability, sadness, anxiety, emotional instability.

Question 18

What are the benefits of aerobic exercise post-concussion?

Answer 18

Improves cardiovascular conditioning, normalizes sleep, reduces anxiety/depression, helps with dizziness, brain fog, and lowers risk of persistent symptoms.

Question 19

When is it safe to begin aerobic exercise post-concussion?

Answer 19

2-10 days following the concussion.

Question 20

Describe the symptom-based approach for exercise prescription post-concussion.

Answer 20

Patients should return to activity slowly, monitor symptoms to stay below the threshold, and stop exercise if symptoms increase by more than 2 points.

Question 21

Describe the heart rate-based approach for exercise prescription post-concussion.

Answer 21

Use during exertion testing (e.g., Buffalo Concussion Treadmill Test) and prescribe exercise at 80-90% of max HR reached without symptom exacerbation.

Question 22

What interventions are recommended for cervical involvement?

Answer 22

Manual therapy, strengthening exercises, postural education, neuromuscular control, proprioception exercises.

Question 23

What interventions are used for vestibular rehabilitation post-concussion?

Answer 23

VOR exercises, visual motion sensitivity training, balance training.

Question 24

What oculomotor exercises can be used post-concussion?

Answer 24

Convergence exercises, saccades training, smooth pursuit exercises, accommodative exercises.

Question 25

What is the general guideline for managing concussion?

Answer 25

Find the impairments, treat them, and emphasize progressive re-engagement in activities.

Question 26

What is the importance of neuroplasticity in concussion management?

Answer 26

Use it or lose it, use it and improve it, specificity, repetition, intensity, and time matter in rehabilitation.

Question 27

What should be emphasized in patient education post-concussion?

Answer 27

Sleep hygiene, nutrition, hydration, relaxation techniques, social interaction, and gradual return to activities.

Question 28

What does the VOR (Vestibular-Ocular Reflex) test assess?

Answer 28

Gaze stability with head movement. Abnormal findings indicate vestibular involvement.

Question 29

What is the Dix-Hallpike test used for?

Answer 29

Assessing BPPV (Benign Paroxysmal Positional Vertigo) in patients post-concussion.

Question 30

What is the BESS (Balance Error Scoring System) used for?

Answer 30

Assessing postural stability and helping with return-to-play decisions post-concussion.

Question 31

What is the significance of the HiMat test?

Answer 31

Used in outpatient settings for higher-level patients post-concussion to assess motor performance.

Question 32

What are the goals of vestibular training post-concussion?

Answer 32

Improve gaze stability, reduce symptoms, improve balance, and enhance functional mobility.

Question 33

Why is sleep hygiene important post-concussion?

Answer 33

Sleep is crucial for recovery, and poor sleep can prolong symptoms and recovery time.

Question 34

What should you monitor during exercise post-concussion?

Answer 34

Heart rate, symptom severity, and any exacerbation of symptoms during and after exercise.

Question 35

How should you adjust exercise if symptoms increase?

Answer 35

Return to the previous asymptomatic stage and adjust the exercise intensity or duration.

Question 36

What are contraindications for the Buffalo Concussion Treadmill Test?

Answer 36

Use of beta blockers, serious vestibular/balance problems, inability to walk safely, high symptom severity (>7/10).

Question 37

What are the principles of neuroplasticity?

Answer 37

Use it or lose it, use it and improve it, repetition matters, intensity matters, time matters, salience matters, age matters, transference, interference.

Question 38

What role do physical therapists play in concussion management?

Answer 38

PTs are movement, exercise, and neuromuscular specialists involved in managing clinical profiles/subtypes like vestibular, ocular, cervical, etc.

Question 39

What is the Buffalo Concussion Treadmill Test (BCTT)?

Answer 39

A validated test to assess exercise intolerance post-concussion and measure safe levels of aerobic exercise.

Question 40

What are the common interventions for autonomic dysfunction?

Answer 40

Monitor heart rate, orthostatic hypotension, graded exertional tolerance assessment, and symptomatic treatment.

Question 41

Why is interdisciplinary collaboration important in concussion management?

Answer 41

Collaboration with teachers, athletic trainers, and healthcare providers ensures comprehensive management and recovery.

Question 42

What is the purpose of the ABC (Activities-specific Balance Confidence) Scale?

Answer 42

To assess a patient’s confidence in performing various activities without losing balance.

Question 43

2 ways to advance patients back to exercise and activity = ?

Answer 43

(1) Prescribe exercise/activity based on symptoms.

(2) Prescribe exercise/activity based on heart rate (as well as symptoms) during exertion testing (Buffalo Concussion Treadmill Test)