Test 3: Into to Mild TBI

Question 1

what is a mild TBI vs concussion

Answer 1

they are synonymous

traumatic injury that affects brain

induced by BM forces by direct blow or forces on the body

no extended period of unconsciousness, amnesia, or other significant neuro signs

DO NOT HAVE TO HAVE POSITIVE IMAGING OR BRAIN BLEED TO HAVE SEVERE OR MOD TBI; NOT A DIFFERENTIATION

Question 2

LOC for mild, mod, and severe TBI

Answer 2

mild = 0-30 min

mod = >30 min but less than 24 hours

severe = >24 hours

Question 3

PTA for mild, mod, severe TBI

Answer 3

mild = 0-1 day

mod = >1 day and <7

severe >7 days

Question 4

GCS scores for mild, mod, severe TBI

Answer 4

mild = 13-15

mod = 9-12

severe = <9

Question 5

neuro imaging findings for mild, mod, severe TBI

Answer 5

mild = normal

mod = normal or abnormal

severe = normal or abnormal

Question 6

AOC for mild, mod, severe TBI

Answer 6

mild = brief >24hrs

mod = >24 hours

severe = >24 hours

Question 7

components of GCS

Answer 7

1. eye opening
2. best motor response
3. verbal response

Question 8

stages of ranchos

Answer 8

I. no response
II. generalized response
III. localized response
IV. confused-agitated
V. confused-inappropriate
VI. confused appropriate
VII. automatic- appropriate
VIII. purposeful-appropriate

Question 9

describe ranchoes levels 1-3

Answer 9

1. no response = deep sleep, unresponsive
2. generalized response = inconsistent, non purposeful response to stimuli
3. localized response = inconsistent localized response to stimulus

Question 10

describe ranchos levels 4-6

Answer 10

4. confused/agitated = heighteded state of activity; nonpurposeful/confusion
5. confused inappropriate = can follow simple commands inconsistently; minimal attention; inappropriate verbalizations
6. confused appropriate = can show goal directed behavior but need external cueing follows simple directions inconsistently

Question 11

describe ranchos levels 7 and 8

Answer 11

7. automatic appropriate = can get through daily activities but robotically and needs routine
8. purposeful/appropriate = responsive to environment; has carry over for new learning

Question 12

PTA is measured with what tools

Answer 12

orientation log (O-log)

Galvaston Orientation and Amnesia Test (GOAT)

Question 13

incidence of mTBI

Answer 13

1.6-3.8 million sports related TBIs per year in US

12% military personnel - blast related

older adults = 32% TBI related hospitalizations

men 2x more likely to be hospitalized

Question 14

mechanisms of injury for concussion

Answer 14

blow to head = direct trauma

forces on body
- pressure = barotrauma from blast injury
- movement of brain inside (coup/contrecoup)

Question 15

5 subtypes of concussion

Answer 15

anxiety/mood
cognitive
migraine
ocular
vestibular

case could be made for 6th and 7th (cervical and sleep disturbance)

Question 16

decsribe the chemical cascade with a concussoin

Answer 16

depolarization leads to
- influx of glutamate (excitatory) to brain
- increase in Na and Ca (controls mitochondria)
- decrease potassium
- decreased cerebral blood flow

these things lead to energy crisis
- ATP is needed for ion pumps to stabilize, this is in overdrive
- less ATP now bc less blood flow
- influx of calcium impairs function of mitochondria which are vital for aerobic energy production

Question 17

what is important to remember about structures involved with concussion and S&S

Answer 17

damage is diffuse and many systems can be involved

can present different ways

cant oversimplify

there is a lot to screen and treat!

Question 18

timeline for mTBI recovery

Answer 18

7-10 days to recover from metabolic cascade

60% resolved in 1 week

collegiate athletes = 28 days

can range from 7 days to 1 month!

Question 19

what is post concussive syndrome/how to diagnose

Answer 19

when S&S persist

diagnosis involves:

cognitive deficits in attention and memory and at least 3 of the following:
- fatigue
- sleep disturbance
- dizzy
- irritable
- affective disturbance
- apathy or personality changes past 3 months

symptoms persist past typical healing times (>3 months)

Question 20

subjective hx for concussion

Answer 20

mechanism of injury
baseline levels
questions surrounding subtypes

Question 21

symptoms to ask about for concussion pts during subjective

Answer 21

dizziness
room spin
confusion
HA
feeling off
balance/coordination
gait changes
neck pain
difficulty problem solving
feeling irritable
vision changes
sleep changes

**trying to identify subtype

Question 22

things to screen

Answer 22

C spine
check for cognitive deficits
check for PTA
check vitals
vision
cranial nerves
S&S of additional injuries or more severe injury

Question 23

per CPG, concussion eval should include what

Answer 23

cervical/MSK
vestibular/oculomotor
autonomic/exertion tolerance
motor function: balance and gait

Question 24

vestibular ocular exam should include

Answer 24

ocular alignment
smooth pursuit
cascades
vergence and accommodation
gaze stability
dynamic and visual acuity
vertigo caused by BPPV
light headedness die to OH

Question 25

balance and gait exam should include what per CPG

Answer 25

static and dynamic balance
motor coordination and control
dual/multitask tests

Question 26

outcome measures specific to concussion

Answer 26

Sports concussion assessment tool-6 (SCAT-6)

High level mobility assessment tool (HiMAT)

Buffalo Concussion treadmill test (BCTT)

Balance error scoring system (BESS)

Question 27

general rules of thumb for concussion intervention

Answer 27

should be specific to subtype of concussion and individual

follow CPG recs

do it within symptom tolerance; you CAN push too hard (want to avoid this)

Question 28

things to keep in mind when determining intervention by subtype

Answer 28

best evidence is for vestibular ocular subtype

consider head turns; want to slow down to 1Hz for concussion

think about MOI for concussion

Question 29

CPG says to educate pt on

Answer 29

self management of S&S
importance of relative rest
importance of sleep
gradual progressive return to activities with pacing strategies
S&S that warrant further follow up care
POC and expected time for recovery

Question 30

things PTs need to consider/factor in for intervention

Answer 30

irritability of pt
self management ability of pt

PT needs to know when to refer out

Question 31

type/amount of rest needed for concussion

Answer 31

want relative rest not strict rest

strict rest prolongs recovery; bed rest = bad

original rec was to not fall asleep; looking for brain bleed; this could generally be ruled out by CT and is also very uncommon with concussion

stimulation schedules!
- manages circadian rhythm
-

Question 32

return to sport protocol

Answer 32

*must have full 24 hours between each stage; have to be completely symptom free to move to the next stage; physician approval is needed to initiate full contact and return to competition

1. back to regular activity (i.e. school)
2. back to light aerobic actiivity (walking, light jog, exercise bike)
3. moderate activity (mod jog, brief run, mod intensity weight lifting)
4. heavy, non contact activities (sprint, high intensity stationary bike, regular weight lift, etc)
5. practice and full contact
6. competition

Question 33

settings you may see concussion

Answer 33

sports - on field
military
outpatient (all types)
emergency department
acute care (obs or if secondary injuries)
acute rehab (if secondary injuries most likely)