Week 9 - Concussions Flashcards
Which gender is more susceptible to concussions?
Women
True or False
A - Helmets and mouthguards are an important part of prevention
B - Concussions often involve a blow to the head and loss of consciousness
C - Multiple concussions predispose you to further concussion
D - CT scans are used to confirm diagnoses
A - False
B - False
C - True
D - False
Brain injury that can be caused by a sudden acceleration of the head and/or neck resulting from a blow to the head or contact to the body
Concussion
Describe prognostic factors for concussions.
No definitive factors, but if more severe symptoms manifest early, recovery will often be delayed
When do concussion symptoms appear?
Immediately, or hours to days following the initial injury
Describe rest in concussion management.
Rest is encouraged for the first 24-48 hours, then gradual return to activity
Who notices concussions the most?
People around the person, rather than the person
What are the 4 symptom clusters for concussions?
Physical, cognitive, emotional, sleep
What are the big-ticket items for common symptoms of concussions?
Headache, balance issues, irritability, nervousness, disruption of sleep patterns
The majority of concussions are related to what?
sports
Describe the importance of baseline assessments.
No evidence supports their administration
Why might an athlete not report their symptoms?
Do not want to end their season Do not want to be restricted from play Don't want to let the team down May not recognize it as a concussion May not recognize the severity of a concussion
What are some questions to ask if someone comes to a walk-in following a potential concussion?
Whether they had one before
What was the mechanism of injury
What are the symptoms
Ask if the person returned to play
When you witness an initial injury which may be a concussion, what is important?
Follow basic first-aid principles
Do not attempt to move the athlete (Except for airway management) unless trained to do so
Assessment of a spinal cord injury is critical part of the assessment
Do not remove a helmet or other equipment unless trained to do so
What are tools for sideline assessment of concussion?
SCAT 5 (13+)
Child SCAT 5 (5-12)
Post-concussion symptom scale
How long should the SCAT-5 take to administer?
at least 10 minutes
We don’t we rely on the GCS?
not as sensitive as the SCAT and most people with concussions will still score 14/15
What is an important consideration for the post-concussion symptom scale?
when athletes complete the tool individually, tend to do it more honestly than if they were asked the questions
How is a diagnosis of concussion accomplished?
Clinical diagnosis supported by:
- Hx (mechanism of injury and previous concussion Hx)
- comprehensive physical examination
- assessment of cognitive function
- assessment of balance
- recognize and remove
- baseline testing
For concussion management, describe physical rest.
For the first 24-48 hours - rest until symptoms resolve
Then, gradual return
Return to learn first
For concussion management, describe cognitive rest.
24-48 hours full rest - no screen time, reading
if the person is not photophobic or sound-sensitive, the room doesn’t have to be pitch dark
Describe the concussion recovery pattern.
Follow up with PCP - majority recover over a few days to weeks, with education about symptom management
Follow-up required, further assessment may be required if symptoms do not resolve fully or considered to be high risk for prolonged recovery
Persistent symptoms, interdisciplinary care required
What is the usual recovery course for concussions?
> 2 weeks for adults
>4 weeks for children/youth
For what cohorts may recovery from a concussion take longer?
older adults or teens Females Return to work/school/play too quickly Concussion hx Hx of migraine, depression or anxiety Hx of sleep difficulties Showing signs of vestibular and/or visual abnormalities
Describe the return to learn/physical activity.
Staged approach
Light exercise which ramps up - a little bit each day without symptom involvement
Describe a yellow-shirted athlete.
Way to distinguish from other players - not to be touched; indicates the player is gradually getting back to full play
What is a serious risk of entertaining another concussion while the first is still healing?
Diffuse cerebral swelling, a rare condition that is more common in children and frequently fatal
What does Rowan’s law state?
Medical clearance of all concussed athletes before they return to play
Mandatory concussion education for all young athletes, parents and coaches
The immediate removal of young athletes from play if a concussion is suspected
Strict adherence to return-to-learn and return-to-play protocols for youth athletes with concussions
How can concussion rates be reduced or prevented?
Education and awareness (coaches, parents, athletes)
Change in bodychecking age
Protocols in sports
Change in culture
Unique neurodegenerative condition which is associated with repetitive mild traumatic brain injury.
CTE - chronic trumatic encephalopathy
CTE was previously reported in boxes under what name?
Dementia pugilistica
What are Sx’s of CTE?
Loss of attention/concentration, depression, mood swings, explositivity, ST memory loss, aggression, dementia
Describe the link between CTE and concussion.
Correlation, but no definitive proof
What are the 11 Rs of SRC management?
What are the 5 most important?
Recognize* remove (From play)* re-evaluate* rest* rehabilitation refer (for persistent Sx) recovery return to sport* reconsider Residual effects and sequelae Risk prevention
