Test 3: Concussion Exam and Eval Flashcards
red flags to screen for with concussion
upper cervical instability
SC damage
S&S of brain bleed or mod/severe TBI
polytrauma (fxs, secondary complications, etc)
what is baseline testing for concussion
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
describe the Immediate Post Concussion Assessment and Cognitive test
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
CPG categories for concussion
cervical and MSK impairments
vestibulo-oculomotor impairments
autonomic dysfunction/exertional tolerance impairments
motor function impairment
which categories of the CPG has the strongest evidence
vestibulo-oculomotor impairments
level of evidence: PT should complete a multisystem exam post concussion
Level B
moderate
level of evidence: PTs should sequence exam based on irritability and delay exam procedures as needed
Level F
expert opinion
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
level F
expert opinion
level of evidence: PTs should forst address cervical and thoracic spines for sources of MSK dysfunction, address tehse to support further exam
level F
expert opinion
level of evidence: PTs should thouroughly examine for sources of: C/S and T/S dysfunction, oculomotor dysfunction, OH/ANS dysfunction
level F
expert opinion
PTs should examine what impairments when doing a concussion eval and what are the associated levels of evidence
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)
psychological and sociological factors of CPG
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)
sequencing for concussion eval based on CPG
start with cervical
move through other categories bsed on symptoms and irritability and priority of sub category
other things to consider for concussion based on CPG
cognition
sleep
mood
migraine
cervical screen components
ligament integrity
palpation of UT/SOs (HA and dizziness generators)
clear vertebral artery + 5Ds and 3Ns
spurlings
joint mobility of cervical/thoracic spine
posture
further cervical testing following screen
ROM
mm endurance/strength
scapulothoracic mobility
PAIVMs at C and T spine
joint position error testing
vision/CNs screen
saccades
smooth pursuit
convergence/divergence
snellen chart
visual field cuts
light sensitivity
changes in vision (tunnel vision)
vestibular/CN screen
HIT
VOR (1Hz if suspect concussion)
VOR cancel
visual motion sensitivity
Horz and Post canal screen
Fukuda step test
EC on foam
DVA
autonomic/exertional test for concussion pts
orthostatics
buffalo concussion treadmill test
describe the buffalo concussion treadmill test
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
stop criteria for buffalo concussion
increase of 3+ on VAS scale for symptom exacerbation
RPE >17
searing HA
lack of responsiveness
90% or higher of age predicted max HR
motor function screen
static balance: BESS
dynamic balance: HiMAT
Dual task gait: Tug manual dual task
motor coordinaiton with complex movement
describe the balance error scoring system
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
describe HiMAT
assesses:
walking (normal, fwd, bwd, on toes, over obstacles)
running
skipping
walking
hop fwd
bounding (affected and unaffected)
stairs (up and down)
