Test 3: Concussion Exam and Eval

Question 1

red flags to screen for with concussion

Answer 1

upper cervical instability

SC damage

S&S of brain bleed or mod/severe TBI

polytrauma (fxs, secondary complications, etc)

Question 2

what is baseline testing for concussion

Answer 2

often with athletes

prior to participating in activities that could put them at risk of concussion

ImPACT test common

assesses baseline cognitive ability and finction

post concussion scores compared to baseline to determine stages of recovery and return to activity

easy to skew the tests

Question 3

describe the Immediate Post Concussion Assessment and Cognitive test

Answer 3

20-30 min

tests:
attention span
working mem
sustained/selective attention span
nonverbal problem solving
reaction time
response variability

baseline compared to post concussion

recommended to do post scores within 72 hours

repeated until athlete is cleared and returned to baseline function

Question 4

CPG categories for concussion

Answer 4

cervical and MSK impairments

vestibulo-oculomotor impairments

autonomic dysfunction/exertional tolerance impairments

motor function impairment

Question 5

which categories of the CPG has the strongest evidence

Answer 5

vestibulo-oculomotor impairments

Question 6

level of evidence: PT should complete a multisystem exam post concussion

Answer 6

Level B

moderate

Question 7

level of evidence: PTs should sequence exam based on irritability and delay exam procedures as needed

Answer 7

Level F

expert opinion

Question 8

level of evidence: PTs should proceed testing untested domains of cervical MSK dysfunction, vestibulomo-oculomotor function, ANS dysfunction/exertional tolerance, and motor function in the sequence that is based on clinical judgement

Answer 8

level F

expert opinion

Question 9

level of evidence: PTs should forst address cervical and thoracic spines for sources of MSK dysfunction, address tehse to support further exam

Answer 9

level F

expert opinion

Question 10

level of evidence: PTs should thouroughly examine for sources of: C/S and T/S dysfunction, oculomotor dysfunction, OH/ANS dysfunction

Answer 10

level F

expert opinion

Question 11

PTs should examine what impairments when doing a concussion eval and what are the associated levels of evidence

Answer 11

cervical and thoracic dysfunction = C (weak)

Cervical, thoracic, TMJ = F (expert)

Dix Hallpike/position = A (strong)

Vestibular/ocular function = B (mod)

OH and ANS dysfunction = B (mod)

Exertional test = B (mod) for graded test, C (weak) for bike

motor function impairment = B (mod)

classifying impairments to subtypes = B (mod)

Question 12

psychological and sociological factors of CPG

Answer 12

elicit, eval, and document factors related to
- self efficacy
- self management strategies
- level E (theoretical/foundational)

PTs should explain most S&S following concussion do improve (E)

Question 13

sequencing for concussion eval based on CPG

Answer 13

start with cervical

move through other categories bsed on symptoms and irritability and priority of sub category

Question 14

other things to consider for concussion based on CPG

Answer 14

cognition
sleep
mood
migraine

Question 15

cervical screen components

Answer 15

ligament integrity

palpation of UT/SOs (HA and dizziness generators)

clear vertebral artery + 5Ds and 3Ns

spurlings

joint mobility of cervical/thoracic spine

posture

Question 16

further cervical testing following screen

Answer 16

ROM
mm endurance/strength
scapulothoracic mobility
PAIVMs at C and T spine
joint position error testing

Question 17

vision/CNs screen

Answer 17

saccades
smooth pursuit
convergence/divergence
snellen chart
visual field cuts
light sensitivity
changes in vision (tunnel vision)

Question 18

vestibular/CN screen

Answer 18

HIT
VOR (1Hz if suspect concussion)
VOR cancel
visual motion sensitivity
Horz and Post canal screen
Fukuda step test
EC on foam
DVA

Question 19

autonomic/exertional test for concussion pts

Answer 19

orthostatics

buffalo concussion treadmill test

Question 20

describe the buffalo concussion treadmill test

Answer 20

assesses CV system and symptom onset and intensty with aerobic challenge

track HR, visual analogue scale, and RPE throughout pre/post

describe S&S

increase incline every min up to 15 then increase speed from baseline by 0.4mph from that point up to 20 min

Question 21

stop criteria for buffalo concussion

Answer 21

increase of 3+ on VAS scale for symptom exacerbation

RPE >17

searing HA

lack of responsiveness

90% or higher of age predicted max HR

Question 22

motor function screen

Answer 22

static balance: BESS

dynamic balance: HiMAT

Dual task gait: Tug manual dual task

motor coordinaiton with complex movement

Question 23

describe the balance error scoring system

Answer 23

test balance in 6 conditions with EC

firm surface, double leg, single leg, and tandem

foam surface, double leg, single leg, and tandem

count errors

Question 24

describe HiMAT

Answer 24

assesses:

walking (normal, fwd, bwd, on toes, over obstacles)

running

skipping

walking

hop fwd

bounding (affected and unaffected)

stairs (up and down)

Question 25

cognition screen options

Answer 25

TUG cognitive dual task

stroop

3-5 word delayed recall

executing function testing of inhibition

Question 26

immediate on field assessment portion of SCAT6

Answer 26

step 1: red flag
step 2: observable signs
step 3: memory assessment-maddocks ?s
step 4: exam (GCS, C/S)

Question 27

office or off field assessment portion of SCAT6

Answer 27

step 1: athlete background
step 2: symptom eval
step 3: cognitive screen
step 4: neuro screen
step 5: delayed recall
step 6: decision

Question 28

observable signs of SCAT6

Answer 28

lying motionless

falling unprotected

balance/gait deficits, motor incoordination, ataxia, stumbling, slow laboured movements

disoriented/confused, staring/limited responsiveness, inability to respond appropriately to questions

blank or vacant look

facial injury after trauma

impact seizure

high risk mechanism of injury

Question 29

SCAT6 red flags

Answer 29

GCS less than 15

neck tenderness or loss of ROM

coordination or ocular motor screen abnormality

memory or maddocks questions <5

Question 30

if you see red flags or observable signs what actions should be taken

Answer 30

spinal immobilization/C-collar

transport to medical center

Question 31

what makes up the cog screen portion of the off field assessment portion of SCAT6

Answer 31

orientation
immediate memory
concentration

Question 32

what makes up the balance screen portion of the off field assessment portion of SCAT6

Answer 32

BESS
timed tandem gait
dual task gait