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Neuro Rehab 2 > TBI - 1b Mild TBI > Flashcards

TBI - 1b Mild TBI Flashcards

1
Q

how is the SCAT used as a tool

A

eval concussion by assessing cognition, physical damage, and memory recall

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2
Q

what is chronic traumatic encephalopathy (CTE)

A

progressive degenerative disease of brain found in athletes (and others) w hx of repetitive brain trauma - including symptomatic concussions and asymptomatic concussive hits to head

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3
Q

what is the pathophysiology behind CTE

A

trauma triggers progressive degeneration of brain tissue
- including build-up of abnormal protein called tau

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4
Q

when is the onset of CTE in athletes w hx of repetitive brain trauma

A

changes in brain can begin months, years, or even decades after last brain trauma or end of active athletic involvement

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5
Q

what sx is the brain degeneration seen in CTE associated with (7)

A

memory loss
confusion
impaired judgment
impulse control problems
aggression
depression
progressive dementia

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6
Q

how can the presence of tau be assessed

A

biopsy of brain

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7
Q

what type of TBI is the most common of all TBIs

A

mild

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8
Q

what sports have the highest concussion incidence for males vs females

A

males - football
females - soccer

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9
Q

what is a major factor in the incidence of sports-related concussions

A

likely under-reported

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10
Q

why are sports-related concussions likely under-reported

A

LOC is rare (<10%)
close to 50% of athletes don’t feel sx immediately after injury -> go back on field

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11
Q

why would mTBIs be seen in the elderly

A

falls

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12
Q

what gender has a higher incidence of mTBI and why

A

males > females
may be d/t riskier behaviors

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13
Q

why is there a growing number of combat veterans w mTBIs

A

large number of IEDs and better armor
-> more veterans surviving serious attacks

not necessarily from head force, but being in close vicinity to IED that when exploded rattled the brain

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14
Q

what are mTBIs complicated by in combat veterans

A

polytrauma
PTSD

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15
Q

what are the 4 categories of s/sx of mTBIs

A

physical
cognitive
emotional
sleep

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16
Q

what are physical s/sx associated w mTBIs

A

HA, dizziness, balance disturbance, n/v
vestib/ocular disturbances
sensitivity to light/noise

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17
Q

what are s/sx that you should go to the ER for (11)

A

changes in alertness/LOC
persisting confusion
mood changes
HA persists/worsens
seizures
dizziness
walking or balance problems
unequal pupils / unusual mvmts
slurred speech
ms weakness on one/both sides
repeated vomiting

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18
Q

why do you want to keep someone awake or arouse at intervals after a head trauma

A

to check cognition
if feel sleepy and can’t stay alert -> go to ER

from pharm management - want to avoid meds w SE of drowsiness/confusion
- would rather take Tylenol over motrin bc avoid blood thinners

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19
Q

what are 3 components of medical management of a mTBI

A

greater awareness and inc dx
prevent re-injury and manage sx
rest

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20
Q

what is the biggest thing for PTs in terms of medical management of mTBIs

A

education on when to report
- coaches, ATs, athletes

baseline neurotesting for comparison

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21
Q

how does legislation prevent re-injury after a mTBI

A

protects young athletes as coaches required to screen, remove from play until medically cleared

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22
Q

what is the NFL doing to prevent re-injury and manage mTBI sx

A

“Madden rule” and funds for studying concussion & CTE

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23
Q

what is the current recommendation for rest after a mTBI

A

minimize rest to 1-2days and then guide into suitable activity

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24
Q

why is rest an important part of medical management of a mTBI

A

physical and cognitive rest will result in recovery in <2wks for the majority of people

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25
Q

what is the consensus post-concussion

A

no agreed consensus on what the appropriate amt of rest is

clear consensus that some degree of rest is important for a period of time

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26
Q

what was the old approach to post-concussion rest that should be avoided now

A

shut-down/dark closet

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27
Q

what is the risk of too much rest post-concussion

A

social isolation
anxiety
depression

looks a lot like post-concussive syndrome - dizziness, confusion, etc.

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28
Q

what is a likely reason for no agreed consensus on the amt of rest needed post-concussion

A

no RCTs evaluating rest in concussed athletes immediately following a concussion

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29
Q

what is relative rest

A

degree of activity that is reached by careful eval of sx exacerbation brought on by any particular activity

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30
Q

what are 3 components of continued medical management

A

protection
neurocognitive assessment
meds

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31
Q

how should protection be integrated into the medical management of a mTBI in an athlete

A

prevent first injury, protect against additional injury

better helmet
delayed return to play
non-impact practices

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32
Q

how should neurocognitive assessment be integrated into medical management of mTBIs

A

as soon as possible after injury

best if baseline taken preinjury
- management should begin before a pt is injured!

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33
Q

how should meds be integrated into medical management for mTBIs

A

used for sx management
- avoid meds that might effect pts mental status
- avoid anti-inflammatory pain meds bc inc bleeding risk (acetominaphens and tylenol are okay)

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34
Q

what are 3 standardized test/measures used in mTBIs

A
  1. standardized assessment of concussion (SAC)
  2. immediate post-concussion assessment and cognitive testing (ImPACT)
  3. Sport concussion assessment tool - 2 (SCAT-2)
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35
Q

what is a standardized test that can be done immediately on the sidelines of a game

A

SAC

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36
Q

what are the 4 things that the SAC assesses

A

immediate memory
orientation
concentration
delayed recall

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37
Q

what is the ImPACT

A

computerized neuropsychological test battery that measures effects of concussion on brain
- taken preseason for baseline scores
- post-injury scores can be compared to aid concussion dx

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38
Q

what 4 areas does the ImPACT assess

A

verbal memory
visual memory
reaction time
processing ability

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39
Q

who is not appropriate to take the ImPACT

A

if recently sustained head injury and/or currently experiencing acute sx

40
Q

what is the SCAT-2

A

standardized method of evaluating injured athletes for concussion

41
Q

what pt population is appropriate for the SCAT-2

A

athletes ages 13yo+

42
Q

what other tests does the SCAT-2 integrate into the calculation

A

enables calculation of SAC score and the Maddocks questions for sideline concussion assessment

43
Q

what does the SCAT-2 assess

A
  1. sx
  2. cog and physical eval
    - cog assessment
    - physical signs
    - balance and coordination
    - GCS
    - Maddocks score
44
Q

what is a balance test that can be done on the sidelines

A

BESS - balance error scoring system

45
Q

what balance test includes high level tasks (ie dual task, coordination) and doesn’t need pre-data

A

HIMAT - high-level mobility assessment tool

46
Q

what balance test is a self-report on confidence of steadiness/risk of fall

A

ABC - activity specific balance confidence scale

47
Q

what balance test is a self-report on confidence in various balance activities

A

DHI - dizziness handicap inventory

48
Q

what are 5 vestibular tests

A

oculomotor exam
vestib ocular reflex tests
dynamic visual acuity
positional testing
vestib/ocular motor screening (VOMS)

49
Q

what are the 3 conditions of the BESS test

A

double leg stance (feet tg)
single leg stance (non-dom foot)
tandem stance (non-dom foot back)

50
Q

how do you interpret the score from the BESS

A

lower score = better balance

51
Q

who is the HIMAT appropriate for

A

assess high-level motor performance
- min mobility requirement is independent amb over 20m w/o ADs (orthoses permitted)

52
Q

how do you interpret the score from the HIMAT

A

higher the score = better balance

53
Q

what is the purpose of the mCTSIB

A

means to quantify postural control under various sensory conditions
- can determine reliance of systems (visual, somatosensory, vestib)

54
Q

what does the DHI assess

A

quantify impact of dizziness on daily life by measuring self-perceived handicap

55
Q

what 3 domains does the DHI assess

A

functional
emotional
physical

56
Q

how do you interpret a DHI score

A

the higher the score, the greater the perceived handicap d/t dizziness

57
Q

how do you interpret a ABC score

A

higher the score = higher the self-perceived confidence

58
Q

what does the VOMS assess

A

looks at systems in charge of integrating:
- balance
- vision
- movement

59
Q

the VOMS screening tests what 5 areas of vestib (balance) and ocular (vision) motor impairment

A

smooth pursuits
rapid eye movements
near point convergence
balance vision reflex
visual motor sensitivity

60
Q

what are the 3 components of PT for mTBI

A
  1. on site assessment
  2. PT interventions - specific to sx
  3. return to play and activity
61
Q

what is part of the PT on-site assessment for mTBI

A

screening
use appropriate standardized measure
remove from play if mTBI suspected

62
Q

what are examples of PT interventions for mTBI (4)

A

endurance
vestib function
cervical dysfunction (ie cervicogenic issues)
balance

63
Q

what is the return to play protocol

A

most able to return in 2-4wks if sustained simple concussion and asymptomatic

64
Q

what type of objective tests are indicated for a pt complaining of: HAs, numbness, neck pain

A

ortho assessment of cervical and thoracic spine

65
Q

what type of objective tests are indicated for a pt complaining of: dizziness, difficulty concentrating, visual problems, sensitivity to light

A

oculomotor and vestib screening tests

66
Q

what type of objective tests indicated for all mTBIs

A

postural stability/balance tests

67
Q

what is the timeline associated with the phases included in return to play protocol

A

no activity
some light activity
light practice
“yellow shirt”
full contact practice
full contact play

each phase is 24hrs
progress to next phase if sx are improving after 24hrs
- if sx worsen regress to preceding level and wait 24hrs

68
Q

what are 6 types of PT interventions for mTBIs

A
  1. pt/family ed
  2. gradual return to activity/sport
  3. vestib rehab
  4. sport-specific high-level balance activities
  5. dual task training
  6. modalities for HA and pain
69
Q

what should you educate the pt and family on as part of a PT intervention

A

rest! (as tolerated)

70
Q

what are the 5 typical phases of a gradual return to activity/sport protocol

A
  1. no activity and complete/relative rest
  2. light exercise for 10-15min
  3. sport-specific aerobic activity for 20-30min, no contact
  4. on field practice drills, no contact
  5. game play with contact
71
Q

why should vestib rehab be included in PT interventions for mTBI

A

vestib impairment occurs in >1/2 of all athletes s/p concussion

72
Q

what are ex of modalities for HA and pain after a mTBI

A

ice
heat
relaxation
biofeedback

73
Q

what is the most important thing/goal that PT interventions should work toward

A

prevent a second injury

74
Q

why is dual-task training an important component to include in PT interventions

A

combine cognitive and sensorimotor demands can better reveal deficits after mTBI

75
Q

what is a common presentation of individuals w a mTBI when a dual task is introduced

A

lower gait speed

76
Q

what are examples of a dual task to integrate

A

obstacle avoidance
verbal fluency
arithmetic

77
Q

what is a common secondary injury in individuals w a mTBI and why

A

LE MSK injury

awareness might be off
impaired NM control
- esp higher risk for athletes
altered neurocognition

78
Q

what does the literature say about “typical” recovery time

A

few longitudinal studies of both physio dysfunction & clinical measures

physiological dysfunction probably lasts longer than we think

79
Q

how is a post-concussive syndrome dx

A

if 3 or more of the following sx are present beyond “usual recovery period”:
- HA
- dizziness
- irritability
- insomnia
- difficulty memory/concentration
- balance impairments
- inc/return of sx w activity

80
Q

how long can sx persist in post-concussive syndrome

A

weeks, months, years

81
Q

what are 4 negative prognostic factors that could lead to a lengthened recovery from a mTBI

A

hx of previous concussion
lack of sufficient rest
comorbid psych hx
comorbid physical sx

82
Q

why is a hx of previous concussion a negative prognostic factor that could lead to a lengthened recovery from a mTBI

A

brain takes longer to heal

83
Q

what comorbid psych hx are negative prognostic factors that could lead to a lengthened recovery from a mTBI (3)

A

anxiety
depression
substance abuse

84
Q

what comorbid physical sx are negative prognostic factors that could lead to a lengthened recovery from a mTBI (5)

A

neck pain
HAs
TMJ pain
migraines
seizures

85
Q

why is a comorbid psych hx a negative prognostic factor that could lead to a lengthened recovery from a mTBI

A

physiologic process in brain altered

86
Q

what are risk factors for post-concussive syndrome

A

more common in females
inc w age

87
Q

why is post-concussive syndrome more common in females

A

less neck ms
- dec ability to protect head from wild blows

88
Q

why are sports related injuries less likely than other injuries to result in post-concussive syndrome

A

athletes tend to have stronger neck ms in general

89
Q

what is the relationship of severity of the blow to post-concussive syndrome

A

not directly related

90
Q

what are the 3 buckets of treatment for post-concussive syndrome and how do you choose which direction to go

A

physiologic
vestibulo-ocular
cervicogenic

depends on sx

91
Q

what is a common MOI resulting in cervicogenic sx in post-concussive syndrome

A

whiplash

92
Q

what causes physiologic sx associated w post-concussive syndrome

A

d/t continued alterations in global cerebral metabolism

93
Q

what is an intervention to treat physiologic sx associated w post-concussive syndrome

A

sub-sx threshold aerobic activity exercise

94
Q

what causes vestibulo-ocular sx associated w post-concussive syndrome

A

dysfunction in vestibulo-ocular system

95
Q

what is an intervention to treat vestibulo-ocular sx associated w post-concussive syndrome

A

vestibular rehab program

96
Q

what causes cervicogenic sx associated w post-concussive syndrome

A

dysfunction of cervical spine somatosensory system

97
Q

what is are interventions to treat cervicogenic sx associated w post-concussive syndrome (3)

A

c-spine manual therapy
balance exercises
gaze stabilization exercises

Neuro Rehab 2 (48 decks)

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