Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

S6- Neuro 2 > Week 3- Concussion > Flashcards

Week 3- Concussion Flashcards

1
Q

PART 1: INTRO AND COGNITIVE/FATIGUE SUBTYPE

A

PART 1: INTRO AND COGNITIVE/FATIGUE SUBTYPE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Is a Concussion a brain injury?

A

YES, shearing of axons inside brain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  • What are the 3 levels of TBI?

- What category does a concussion fall under?

A
  • Mild, Moderate, Severe

- Mild

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Concussion Pathophysiology:

  • Concussion is a _________ brain injury.
  • Will we see anything on a head scan after a concussion? Why?
  • Disruption of cell membranes and axonal stretching leads to flux of ions through previously regulated channels → _________ effects on postsynaptic neurons. This then leads to widespread release of ____________, which causes even further ionic flux.
  • Na/K ATP-dependent pump increases membrane pumping to reestablish balance. This depletes ________ stores.

-____ energy demand + ____ blood supply → Metabolic crisis

A
  • Metabolic
  • No, because they are not structural changes, but rather metabolic.
  • depressive, neurotransmitters
  • energy stores

-**increased energy demand + decreased blood supply = metabolic crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do we classify concussions?

A

-Based off of their primary S/Sx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 6 subtypes of concussion?

A
  • Cognitive/Fatigue
  • Ocular/Visual
  • Vestibular
  • Anxiety/Mood
  • Cervical
  • Post-Traumatic Migraine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What subtype of concussion is most often seen EARLY ON following concussion?

A

-Cognitive/Fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the symptoms of Cognitive/Fatigue subtype?

A
  • Fatigue
  • HA with cognitive and physical activity
  • “End of Day” symptoms
  • Often see sleep disturbances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cognitive/Fatigue Exam:

  • Is their vestibular/ocular screening normal?
  • Neurocognitive test results are mild but _______/_________, deficits across all composites.
  • Deficits with ______, ______ intact.
A
  • Yes
  • global/widespread
  • retrieval, encoding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some helpful questions to see if it is consistent with cognitive/fatigue concussion?

A
  • Do you have a generalized HA that gets worse as the day progresses?
  • Do you feel more fatigued than normal at the end of the day?
  • Do you feel more distractable?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cognitive/Fatigue Treatment:

  • These patients are the ______ likely to need PT.
  • Incorporation of physical/cognitive _______ throughout the day (NOT _____!)
  • If persistent, what pharmacological agents are available?
  • _______ therapy (if symptoms linger more than a few months)
  • Monitored, structured exercise progression.
A
  • least
  • breaks (NOT naps!)
  • neurostimulants (amantadine, methylphenidate), sleep aide
  • Cognitive therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why do we not take naps?

A

-To not cause sleep disturbances and help keep sleep schedule.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PART 2: OCULAR/VISUAL SUBTYPE

A

PART 2: OCULAR/VISUAL SUBTYPE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the risk factors for Ocular/Visual subtype concussion?

A

-Family/personal history of ocular dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ocular/Visual Symptoms:

  • ______ HA driven by visual work.
  • Difficulties with visually-based classes, assignments, or activities.
  • _______ behind eyes.
  • Visual “_____” issues.
  • ______/_______ vision
A
  • Frontal HA
  • pressure
  • “focus”
  • blurry/double
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can we distinguish the difference between ocular/visual and cognitive/fatigue HA?

A

-Ocular/visual tends to be located more near the eyes while cognitive/fatigue is more general HA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ocular/Visual Exam:

  • Visual/Oculomotor Exam
      • ________, _______
    • ________ difficulties (insufficiency, spasm/excess)
    • __________ insufficiency
    • _________ visual deficits
    • __________ (tropias, phorias)
  • Neurocognitive Test Results
    • Deficits in ________ time.
    • Deficits with _______ memory. (________ rather than _______)
A
    • smooth pursuit, saccades
  • convergence difficulties
  • accommodative insufficiencies
  • binocular visual deficits
  • strabismus
  • reaction time
  • visual memory (encoding rather than retrieval)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

_________ is the most frequent exam finding with ocular/visual subtype.

A

-Convergence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
  • What is not frequently associated with ocular/vision subtype?
  • If this symptom is one of the main complaints, then our focus switches to which subtype?
A
  • Photosensitivity

- Migraine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
  • What is strabismus?

- What are the 2 primary types of ocular deviation?

A
  • Misalignment of the eyes/dysconjugate gaze at rest.

- Tropia and Phoria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
  • What is tropia?
  • Exo = ________, Eso = ________
  • Hyper = ________, Hypo = ________
A
  • Tropia = over deviation of the eye
  • Exo = outward (laterally), Eso = inward (medially)
  • Hyper = upward, Hypo = downward
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is phoria?

A

-Phoria = ocular deviation occurs when dissociation occurs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

______ tend to be present all the time while _______ show up when the eyes get more tired.

A

-tropia, phoria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Ocular Misalignment If Severe:

  • _______
  • _____ tilt
  • Noticeable ________

Ocular Misalignment If Subtle:

  • Difficulty maintaining _____
  • Cosmetically _______
  • Ocular _______
  • ________
  • Mental dullness
A
  • Diplopia
  • Head tilt
  • Noticeable eye turn
  • Difficulty maintaining focus
  • Cosmetically normal
  • Ocular soreness
  • HA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Vergence Dysfunction Symptoms:

  • ________: Ability of eyes to turn inward to focus on a near target
  • ________: Ability of eyes to move outwards to focus on a further target
  • Which one do we see more often?
A
  • Convergence
  • Divergence
  • Convergence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the main complaints of with vergence dysfunction?

A

-Gaze instability and/or double vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the general symptoms of vergence dysfunction? (5)

A
  • Asthenopia (eye fatigue) when reading
  • Frontal headaches
  • Intermittent/Constant double vision
  • Squints/closes one eye
  • Letters appear to float/move on the page
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are (3) common vergence problems?

A
  • Convergence Insufficiency
  • Convergence Excess
  • Convergence Spasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Accommodative Dysfunction:

  • What is accommodation?
  • Reduction in ability to focus at _____.
  • Accommodative ______. (overfocusing at near)
  • Struggle to coordinate accommodation and vergence, leading to difficulty in _____________.
  • COMPUTERS, PHONES, NEAR WORK
A
  • The adjustment of the optics of theeyeto keep an object in focus on the retina as its distance from theeyevaries.
  • near
  • spasm
  • spatial awareness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What does treatment of Ocular/Visual Subtype look like? (2)

A
  • Ocular Motor Training

- Physical Exertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

PART 3: VESTIBULAR, ANXIETY, MIGRAINE SUBTYPES

A

PART 3: VESTIBULAR, ANXIETY, MIGRAINE SUBTYPES

32
Q

What are the risk factors of vestibular subtype concussion?

A

-PMH of car sickness/motion sensitivity, migraine, anxiety

33
Q

Vestibular Subtype Symptoms:

  • ________
  • _________
  • Nausea
  • Overwhelmed in ____________ environments
  • _______ impairments
A
  • Vertigo
  • Dizziness
  • Nausea
  • Overwhelmed in visually-stimulating environments
  • Balance impairments
34
Q

Dizziness Post Concussion:

  • Dizziness reported in __-__% of concussed athletes.
  • Dizziness associated with ___________ recovery.
  • Undiagnosed vestibular deficits may delay recovery.
A
  • 55-80%

- protracted

35
Q

S/Sx of Vestibular Dysfunction. (8)

A
  • Dizziness
  • Blurry Vision
  • Nystagmus
  • Tinnitus
  • Hearing Loss
  • LOB and possible falls
  • Broad-based stance
  • Sweating, NV (due to ANS involvement)
36
Q

What are some common things that cause vestibular dysfunction after a concussion? (5)

A
  • Labyrinthine Concussion
  • Skull Fracture
  • Hemorrhage into Labyrinth
  • Hemorrhage into brainstem
  • Increased ICP
37
Q

What is the most common vestibular injury due to TBI?

A

-Labyrinthine concussion

38
Q

Labyrinthine Concussion:

  • Ataxia, imbalance, _______ may be present.
  • Most common _________ injury due to TBI.
A
  • BPPV

- vestibular

39
Q

Skull Fracture:

  • UVL or BVL (partial or complete)
  • ___________ hearing loss.
  • May have mixed _________ and ________ lesions.
  • Common with blows to what regions of the brain?
A
  • Conductive
  • peripheral and central
  • occiput, temporal, parietal
40
Q

Hemorrhage Into Labyrinth:

  • May create post traumatic hydrops (Meniere’s type syndrome).
  • Damage to labyrinth, may create acute ________ and ________ hearing loss.
  • Labyrinth damage may present with S/Sx similar with acute __________ vestibular damage.
A
  • acute vertigo and unilateral hearing loss

- peripheral vestibular damage

41
Q

Hemorrhage Into Brainstem:

  • _________ signs, poor smooth pursuit, vertigo, perception of tilt.
  • Damage to ________ and _________ nuclei.
A
  • Oculomotor

- vestibular and oculomotor nuclei

42
Q

Increased ICP:

  • Fluctuating _______ loss, ataxia, imbalance.
  • May cause peri-lymphatic ________.
A
  • hearing loss

- fistula

43
Q

Vestibular Subtype Exam:

  • Vestibular/Ocular Screen
    • VOR dysfunction (_________ and/or _______)
    • VOR _________
    • Can see + ___________/________
    • *Not significant + skew
  • Neurocognitive Test Results
    • Difficulty with visual motor ______, _________ time
A
  • vertical and/or horizontal
  • suppression
  • smooth pursuit/saccades

-speed, reaction time

44
Q

Why will we typically not see a + test of skew with Vestibular Subtype?

A

-It is sensitive for brainstem involvement, which is usually ok with this subtype.

45
Q

What 2 other subtypes does Vestibular Subtype coexist with frequently?

A
  • Migraine

- Anxiety

46
Q

Vestibular Treatment:

  • _______!
  • Pharmacological as needed (Meclizine, Tricyclic antidepressants, Melatonin, SSRIs)
A

-Vestibular Rehab Therapy (VRT)!

47
Q

What are the risk factors for Anxiety/Mood subtype concussion?

A
  • Personal/Family Hx of anxiety
  • Migraine
  • Vestibular disorders
48
Q

Anxiety/Mood Subtype Symptoms:

  • __________ thoughts
  • ______-vigilant
  • _________
  • Easily overwhelmed
  • Difficulties initiating/maintaining __________
A
  • Ruminative thoughts
  • Hyper-vigilant
  • Fastidious
  • Difficulties initiating/maintaining sleep
49
Q

What population is Anxiety/Mood Subtype common in and why?

A
  • Athletes

- These are a bunch of driven individuals who are being told that they cant work out and need to take breaks.

50
Q

Anxiety/Mood Subtype Exam:

  • Vestibular/Ocular Screen
    • _________
  • Neurocognitive Test Results
    • _________
A
  • normal

- normal

51
Q

Anxiety/Mood Subtype Treatment:

  • Treat _______ and/or _________ subtype, if present.
  • Supervised ________ therapy.
  • Cognitive behavior training.
  • Regulated ___________ (sleep, exercise, diet, hydration, etc.).
  • Psychotherapy/Pharmacology (antidepressants, benzodiazepines).
A
  • vestibular and/or migraine
  • exertion
  • regulated schedule
52
Q

What are the risk factors for Migraine Subtype?

A
  • Personal/family Hx of migraine
  • “ice-cream headache”
  • Motion sensitivity
  • Vestibular disorder
  • Anxiety
53
Q

Migraine Subtype Symptoms:

  • Variable ___ (often wakes with HA)
  • Nausea, _______ and or ______phobia
  • Stress, anxiety, lack of exercises
  • Sleep dysregulation
A
  • Variable HA

- photo and/or phonophobia

54
Q
  • Migraine Subtype is 1 of 2 subtypes which can have HA when the patient ______ ___.
  • What is the other subtype? How is it different?
A
  • Wakes up

- Cervical Subtype, if they wake up with HA and neck pain

55
Q

Post-traumatic Migraine Subtype:

  • What is a migraine?
  • __/__ patients will experience preceding aura. What is the most common aura that makes up about 50% of all cases?
A
  • Neurovascular event involving failure of central modulation of trigeminovascular system.
  • 1/3, visual aura most common (followed by sensory, language, and motor)
56
Q

Migraine Subtype Exam:

  • Vestibular/Ocular Screen
    • __________
  • Neurocognitive Test Results
    • ______ and ________ memory deficits.
A
  • normal

- Verbal and visual memory deficits.

57
Q

Migraine Subtype Treatment:

  • Medications (pain, sleep regulation)
  • Diet
  • Stress Management
  • Avoid migraine “________” (alcohol, caffeine, poor sleep
A

-“triggers”

58
Q

When will we as PTs not treat Migraine Subtype patients?

A

-When it is in isolation from other subtypes.

59
Q

PART 4: CERVICAL SUBTYPE, OUTCOME MEASURES, PROGNOSIS

A

PART 4: CERVICAL SUBTYPE, OUTCOME MEASURES, PROGNOSIS

60
Q

What are the risk factors for Cervical Subtype?

A
  • Prior c-spine injury
  • High-velocity injury
  • Strong rotational component to injury
61
Q

Cervical Subtype Symptoms:

  • _____ pain, stiffness, soreness
  • HA radiating forward from upper cervical spine (precipitated/aggravated by specific ______ movements or sustained _______)
A
  • neck pain

- specific neck movements or sustained postures

62
Q

What is a good way to remember the HA pattern with cervical subtype?

A

-LA Rams helmet

63
Q

Cervical Subtype Exam:

  • Vestibular/Ocular Screen and Neurocognitive Test Results are _______.
  • …but + ________ screen.
A
  • normal

- + cervical screen

64
Q

Cervical Subtype Treatment:

  • Obtain _________.
  • Cervical ____________ exercises.
  • Medication (muscle relaxants, anelgesics)
  • Injection/nerve block
  • Massage, acupuncture
A
  • imaging

- stabilization

65
Q

10 Most Commonly Reported Symptoms in Post Concussive Athletes.

A
  1. ) HA (71%)
  2. ) Feeling Slowed Down (58%)
  3. ) Difficulty Concentrating (57%)
  4. ) Dizziness (55%)
  5. ) Fogginess (53%)
  6. ) Fatigue (50%)
  7. ) Visual Blurring/Double Vision (49%)
  8. ) Light Sensitivity (47%)
  9. ) Memory Dysfunction (43%)
  10. ) Balance Problems (43%)
66
Q

What are (5) commonly used Sideline Concussion Assessments?

A
  • SCAT5
  • Sideline Impact Test
  • NFL Sideline Tool
  • Standardized Assessment of Concussion (SAC)
  • King-Devick Test
67
Q

What is the gold standard test in determining exercise tolerance in post concussive patients?

A

-Buffalo Concussion Treadmill Test

68
Q

Buffalo Concussion Treadmill Test: Purpose:

  • To investigate exercise tolerance in patients with post-concussive symptoms > __ weeks.
  • To help establish appropriate levels of exercise to aid in return to play/activity.
  • To aid in __________ between possible diagnoses for concussive symptoms.
  • To identify physiological variables associated with exacerbation of symptoms and the patient’s level of recovery.
A
  • 3 weeks

- differentiating

69
Q

Buffalo Concussion Treadmill Test Stopping Criteria:

  1. ) Symptom exacerbation (defined as an increase in ___ or more points on the VAS scale from resting VAS score).
  2. ) Voluntary exhaustion (defined as an RPE of >___ without significant symptom exacerbation).
  3. ) Patient demo’s rapid progression of complaints, patient appears faint, has stopped communicating, or continuing the test constitutes a significant health risk for the patient.
  4. ) Patient reaches ___% or more of age-predicted HRmax (with or without any increase in symptoms and still reporting low RPE).
A
  • 3 or more
  • > 17 RPE
  • 90% HRmax
70
Q

Do we still usually perform Buffalo Concussion Treadmill Test if patient has a resolve in symptoms? Why?

A

-Yes, because sometimes it will bring on the symptoms.

71
Q

BCTT Exercise Prescription:

  • ___% of the maximum heart rate reached without symptom exacerbation.
  • ___ minutes daily without exceeding the time or HR constraints.
  • Swimming, walking or stationary cycling – _______ attempt resistance training.

-If any post-concussion symptoms return along the progression, the patient must do what?

A
  • 80%
  • 20 minutes
  • DO NOT attempt resistance training

-Return to the previous asymptomatic stage/maximum HR

72
Q

What is the VOMS?

A
  • Vestibular/Ocular-Motion Screening

- Go to on field and clinic layout for the vestibular and ocular exam. Great use acutely for screening.

73
Q

What are the (5) things measured with the VOMS?

A
  • Smooth Pursuits
  • Saccades (vertical and horizontal)
  • Convergence (near point)
  • VOR (vertical and horizontal)
  • Visual Motion Sensitivity Test
74
Q

What is the difference between performing these tests for the VOMS and just a regular screen?

A

The VOMS looks at symptoms in regards to HA, Diziness, Nausea, and Fogginess on a scale from 0-10.

75
Q

Concussion Typical Recovery:

  • 85-90% Concussions show signs of recovery in first __-__ days… but newer research says it may be more like __-__ days for full biophysiological process.
  • Recovery from sports-related concussion in children is approximately __ weeks.
  • Early identification of impairments aids in return to activity/sport without prolonged ___________.
A
  • 10-14, 21-28
  • 4 weeks
  • sequelae
76
Q

What are the predictors of prolonged recovery with concussions? (6)

A
  • INITIAL SYMPTOMS
  • Sex
  • Age
  • LOC
  • Amnesia
  • Premorbid comorbidities (psych dx, migraines, vestibular dysfunction)

S6- Neuro 2 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions