Test 3: Concussion Interventions

Question 1

Common concussion S&S/complaints

Answer 1

HA
dizziness
N&V
poor balance
fatigue
disrupted sleep
visual deficits
fogginess
emotional liability
noise sensitivity
light sensitivity
poor concentration
memory impairments
neck pain

Question 2

areas of intervention for concussion

Answer 2

cervical
ocular
vestibular
exertional
motor function
edu

Question 3

best practice concussion standards apply to what age groups

Answer 3

8 years and up

Question 4

rest/activity guidelines from best practice standards

Answer 4

rest for 24-48 hours

after 48-72 hours initiate light activity based on tolerance

avoid high risk activities that would be a high risk for another concussion

in acute phase stay away from extremes (i.e. strict rest and intense cognitive/physical activity)

Question 5

5 domains for concussion intervention

Answer 5

exertional tolerance and aerobic
cervical MSK
vestibular oculomotor
motor function
education

Question 6

level of evidence for exertional tolerance and aerobic intervention

Answer 6

grade A

symptom guided

when pt exhibits extertional intolerance and/or are planning to return to vigorous activity

Question 7

recs for aerobic/exertional exercise guidelines

Answer 7

based on exertional testing

rec below 90% HR threshold for 20-30 min daily

Question 8

how to progress aerobic exercise post concussion

Answer 8

may increase HR by 5-10 bpm every 1-2 weeks; want no new S&S or mild increase in S&S that is transient in nature

goal is to reach APMHR for 20 min w/o symptom exacerbation

Question 9

cervical MSK intervention level of evidence post concussion

Answer 9

grade B

can address cervical and thoracic

Question 10

C/S dysfunction can contribute to what S&S

Answer 10

HA
dizziness
TMJ disorder

Question 11

treatment options for C/S dysfunction

Answer 11

manual therapy
dry needling
modalities
stretching
postural control exercises
cervcial kinesthesia exercises

Question 12

what makes vestibular ocular interventions grade A vs grade B

Answer 12

grade A = if BPPV is a potential impairment then PT can use canalith repositioning maneuvers

Grade B = PTs with appropriate VRT/VOR expertise can implement an individualized vestibular and oculomotor rehab plan

Question 13

BPPV treatment considerations post concussion

Answer 13

can be bilateral or multi canal

consider cervical pain and/or ROM limits

be mindful of order of treatment

Question 14

convergence insufficiency exercises

Answer 14

brock string
dot card
pencil push up
shuttle pass
barrel cards

Question 15

oculomotor exercises

Answer 15

marsden ball (pursuits)
michigan tracking (saccades)
column jumps (saccades)
HART charts (saccades)

Question 16

when to refer oculomotor issues to vision specialist or OT

Answer 16

moderate to severe impairments i.e.:

ocular misalignment
diplopia
>1 month since onset

Question 17

VOR 1 and 2 considerations

Answer 17

vary plane of head movement

consider C/S irritability

Question 18

vestibular oculomotor exercise progression

Answer 18

seating to standing
wide to narrow BOS
firm to compliant surface
simple to complex background
add cog task
increase reps and speed of mvmt

Question 19

motor function intervention level of evidence post concussion

Answer 19

grade C

PTs should implement interventions that address identified or suspected motor function impairments and help progress the pt towards higher level functional performance

i.e. static/dynamic balance, coordination, and dual/multi-tasking

Question 20

cognitive tasks to add to balance challenges

Answer 20

counting
serial subtraction by 6s or 7s
reciting months bwd
spell word bwd
imediate word recall/delayed recall
list generation
tell a story

Question 21

athletes post concussion gait speed compared to age matched norm

Answer 21

slower gait speeds when doing a dual task compared to norms

Question 22

Grade B evidence for pt edu examples

Answer 22

self management of S&S
relative rest vs strict
importance of sleep
pacing strategies
S&S that may require additional med care

Question 23

grade A evidence for pt and family/caregiver edu

Answer 23

impairments
functional limits
reinforce that most people have quick recovery

Question 24

treatment considerations for concussion pts

Answer 24

environment (light sensitivity, noise, emotional liability, etc)

pacing of session (S&S irritability, recovery time, etc)

time of day

age

fall risk

Question 25

recovery for concussion pts

Answer 25

time will vary

pt may still have S&S during movement system and performance optimization

contextual factors can play a + or - role

Question 26

stages of graduated return to play protocol

Answer 26

1. no activity
2. light aerobic exercise
3. sport specific exercise
4. noncontact training drills
5. full contact practice
6. return to play

Question 27

what formal report services might a kid with repeated concussions need for return to school accomodations

Answer 27

response to intervention protocol (RTI)
504 plan
individual edu plan (IEP)

examples:
- note taker
- sit in front of class
- excused absence
- quiet test environment
- additional test time

Question 28

goal of return to work and common challenges

Answer 28

return to work without negatively impacting concussion recovery

challenges:
- background noise
- multiple screens
- overhead lights
- multi-tasking

Question 29

example return to work accomodations

Answer 29

avoid work under direct light
allowed to take scheduled breaks
hour reduction
work from home part time
additional time for task completion
quiet work environment