PT Management of Concussion Flashcards
What is a concussion?
A mild traumatic brain injury (mTBI) affecting cognitive, physical, and emotional functioning.
What should PT’s always test in patients who have sustained a concussion?
Physical therapists should test for orthostatic hypotension and autonomic dysfunction (eg.resting and postural tachycardia) in patients who have sustained a concussion.
What is VOMS?
Vestibular/Ocular Motor Screening used to identify symptoms and impairments after concussion.
What are the key components of the Buffalo Concussion Treadmill Test (BCTT)?
Record resting HR, set treadmill speed, increase incline each minute, stop when symptoms increase by 3 points.
How is the Balance Error Scoring System (BESS) test conducted?
Three positions tested on solid and foam surfaces: Romberg stance, Tandem stance, Single leg stance, with eyes closed and hands on hips.
What is considered a higher score in the PCSS?
A higher score indicates more severe post-concussion symptoms.
What is the purpose of the HiMat (High-Level Mobility Assessment Tool)?
To assess motor performance in higher-level patients post-concussion.
List common symptoms of autonomic involvement after concussion.
Sleep disturbances, exercise intolerance, lightheadedness, elevated heart rate, fatigue, hypersensitivity to stimuli, brain fog.
What are common vestibular symptoms post-concussion?
Dizziness, balance problems, nausea, blurry vision, fatigue.
What symptoms are associated with cervical involvement after concussion?
Headache, neck pain, dizziness, fogginess, nausea, fatigue.
What symptoms are common with oculomotor involvement post-concussion?
Blurred vision, double vision, photophobia, headache, dizziness.
What is the recommended approach to addressing cognitive/fatigue symptoms?
Exertional exercise, improving ocular issues, and patient education.
What are common findings in vestibular assessment post-concussion?
VOR impairment, motion sensitivity, impaired balance, BPPV.
What symptoms are linked to convergence insufficiency?
Headaches, trouble reading, double vision, eye strain, squinting.
What are the symptoms of accommodative dysfunction?
Blurred vision, visual fatigue, headaches, difficulty with near-far gaze shifts.
What are common signs of sleep disturbances after a concussion?
Difficulty falling asleep, staying asleep, waking up too early, non-restorative sleep.
What are the common symptoms in patients with anxiety/mood involvement post-concussion?
Irritability, sadness, anxiety, emotional instability.
What are the benefits of aerobic exercise post-concussion?
Improves cardiovascular conditioning, normalizes sleep, reduces anxiety/depression, helps with dizziness, brain fog, and lowers risk of persistent symptoms.
When is it safe to begin aerobic exercise post-concussion?
2-10 days following the concussion.
Describe the symptom-based approach for exercise prescription post-concussion.
Patients should return to activity slowly, monitor symptoms to stay below the threshold, and stop exercise if symptoms increase by more than 2 points.
Describe the heart rate-based approach for exercise prescription post-concussion.
Use during exertion testing (e.g., Buffalo Concussion Treadmill Test) and prescribe exercise at 80-90% of max HR reached without symptom exacerbation.
What interventions are recommended for cervical involvement?
Manual therapy, strengthening exercises, postural education, neuromuscular control, proprioception exercises.
What interventions are used for vestibular rehabilitation post-concussion?
VOR exercises, visual motion sensitivity training, balance training.
What oculomotor exercises can be used post-concussion?
Convergence exercises, saccades training, smooth pursuit exercises, accommodative exercises.
What is the general guideline for managing concussion?
Find the impairments, treat them, and emphasize progressive re-engagement in activities.
What is the importance of neuroplasticity in concussion management?
Use it or lose it, use it and improve it, specificity, repetition, intensity, and time matter in rehabilitation.
What should be emphasized in patient education post-concussion?
Sleep hygiene, nutrition, hydration, relaxation techniques, social interaction, and gradual return to activities.
What does the VOR (Vestibular-Ocular Reflex) test assess?
Gaze stability with head movement. Abnormal findings indicate vestibular involvement.
What is the Dix-Hallpike test used for?
Assessing BPPV (Benign Paroxysmal Positional Vertigo) in patients post-concussion.
What is the BESS (Balance Error Scoring System) used for?
Assessing postural stability and helping with return-to-play decisions post-concussion.
What is the significance of the HiMat test?
Used in outpatient settings for higher-level patients post-concussion to assess motor performance.
What are the goals of vestibular training post-concussion?
Improve gaze stability, reduce symptoms, improve balance, and enhance functional mobility.
Why is sleep hygiene important post-concussion?
Sleep is crucial for recovery, and poor sleep can prolong symptoms and recovery time.
What should you monitor during exercise post-concussion?
Heart rate, symptom severity, and any exacerbation of symptoms during and after exercise.
How should you adjust exercise if symptoms increase?
Return to the previous asymptomatic stage and adjust the exercise intensity or duration.
What are contraindications for the Buffalo Concussion Treadmill Test?
Use of beta blockers, serious vestibular/balance problems, inability to walk safely, high symptom severity (>7/10).
What are the principles of neuroplasticity?
Use it or lose it, use it and improve it, repetition matters, intensity matters, time matters, salience matters, age matters, transference, interference.
What role do physical therapists play in concussion management?
PTs are movement, exercise, and neuromuscular specialists involved in managing clinical profiles/subtypes like vestibular, ocular, cervical, etc.
What is the Buffalo Concussion Treadmill Test (BCTT)?
A validated test to assess exercise intolerance post-concussion and measure safe levels of aerobic exercise.
What are the common interventions for autonomic dysfunction?
Monitor heart rate, orthostatic hypotension, graded exertional tolerance assessment, and symptomatic treatment.
Why is interdisciplinary collaboration important in concussion management?
Collaboration with teachers, athletic trainers, and healthcare providers ensures comprehensive management and recovery.
What is the purpose of the ABC (Activities-specific Balance Confidence) Scale?
To assess a patient’s confidence in performing various activities without losing balance.
2 ways to advance patients back to exercise and activity = ?
(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)
