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kin 424 - medical aspects of sport > Module 11 - Concussion > Flashcards

Module 11 - Concussion Flashcards

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1
Q

What does the abbreviation SRC mean?

A
  • Sport-related concussion
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2
Q

What does the abbreviation TBL mean?

A
  • Traumatic Brain Injury
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3
Q

What does the abbreviation mTBL mean?

A
  • mild traumatic brain injury
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4
Q

What does the abbreviation CTE mean?

A
  • Chronic Traumatic Encepholopathy
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5
Q

What does the abbreviation RHL mean?

A
  • Repetitive Head Injury
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6
Q

What is a contrecoup injury?

A
  • Moving head strikes stationary object
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7
Q

What is a coup injury?

A
  • Moving object impacts stationary head
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8
Q

What is the mechanism of a brain injury?

A
  • Direct blow to the head (Coup or Countrecoup)
  • Movement of brain results in axonal shearing
  • Damage to neurons
  • Death of some neurons
  • Release of chemicals
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9
Q

What is axonal shearing?

A
  • Axons being stretched
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10
Q

What are the signs and symptoms of concussions? (16)

A
  • Headache
  • Dizziness
  • Nausea
  • Blurred Vision
  • Light/Sound Sensitivity
  • Imbalance
  • Ringing in the Ear
  • Seeing “stars”
  • Irritability
  • Fogginess
  • Fatigue
  • Difficulty concentrating
  • Poor memory
  • Neck Pain
  • Sadness
  • Confusion
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11
Q

Describe the initial response to a possible concussion

A
  • Respond immediately
  • Remove from activity
  • Assess for medical emergency
  • Call 911 and seek medical care if red flags
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12
Q

What are the red flags to look for when initially assessing a possible concussion?

A
  • Neck pain or tenderness
  • Double vision
  • Weakness/tingling in arms or legs
  • Severe or increasing headache
  • Seizure or convulsion
  • Loss of consciousness
  • Deteriorating conscious state
  • Vomiting
  • Increasingly restless, agitated, or combative
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13
Q

What are the steps to take if there is no medical emergency but may be a potential concussion?

A

Do not
- Leave the individual alone
- Let individual return to activity
- give individual any immediate medication
- Let individual leave themselves
- Let individual drive/bike
Do
- Monitor for red flags
- notify emergency contact person

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14
Q

What needs to be done within 48 hours of a potential concussion?

A
  • Monitor individual
  • Monitor throughout the night
  • Do not wake an individual unless concerns
  • Call 911 if an individual is slow to wake or RED FLAGS
  • Seek medical attention is signs or symptoms present
  • If no symptoms occur, monitored normal activity allowed
  • Monitor for several days
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15
Q

When should you wake someone who has a potential concussion?

A
  • concerns with breathing
  • changes in skin colour
  • Concerns with how they are sleeping
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16
Q

What should you do if someone with a potential concussion is slow to wake?

A
  • Seek immediate medical care
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17
Q

How is a concussion diagnosed?

A
  • Clinical judgment
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18
Q

Is there a test to confirm concussion?

A
  • No diagnostic test
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19
Q

Do concussions show up on imaging tests like CT scans or MRI’s? Why?

A

NO
- There is no structural damage visible

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20
Q

What are the three categories of the Glasgow Coma Scale?

A
  • Eye Opening
  • Verbal Response
  • Motor Response
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21
Q

What are the 4 ranks on the Eye Opening category of the Glasgow Coma Scale?

A

4 - Spontaneous Eye Opening
3 - Eye Opening to Speech
2 - Eye Opening to Pain
1 - No Response

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22
Q

What are the 5 Ranks of the Verbal Response Category of the Glasgow Coma Scale?

A

5 - Oriented verbal response
4 - Sentences
3 - Words
2 - Sounds
1 - No Response

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23
Q

What are the 6 Ranks of the Motor Response Category of the Glasgow Coma Scale?

A

6 - Obeys Commands
5 - Localizes Pain
4 - Flexion/Withdrawal to pain
3 - Abnormal Flexion to pain
2 - Extension to pain
1 - No response

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24
Q

What does a low score on the Glasgow Coma Scale mean?

A
  • Coma
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25
Q

What does a high score on the Glasgow Coma Scale mean?

A
  • Relatively awake, possible mild TBI
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26
Q

What is the concussion management protocol for the first 48 hours?

A
  • Rest for 2 days
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27
Q

Why does someone with a concussion need to rest?

A
  • Needs physical and cognitive rest to allow brain to heal
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28
Q

What is the concussion management protocol after 48 hours?

A
  • Activities that do not increase heart rate or cause sweat
  • Restrict strenuous work, exercise, sports, running, biking, rough play
  • Limit cognitive activity: concentration/learning
  • Restrict work, reading, electronics, music
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29
Q

How long does it typically take to recover from a concussion?

A

2-4 weeks

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30
Q

How many individuals with a concussion will experience persistent symptoms past 2-4 weeks?

A

15-30%

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31
Q

What can persistent symptoms from a concussion cause?

A
  • long-term difficulties
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32
Q

What may a physician recommend if there is no improvement or worsening symptoms of a concussion past 4-12 weeks?

A
  • interdisciplinary clinic
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33
Q

What can influence the recovery period of a concussion? (9)

A
  • Previous concussions
  • History of headaches, migraines
  • Learning disabilities
  • Mental Health Issues
  • ADHD
  • Use of Drugs/Alcohol
  • Return to activity too soon
  • Lack of family/social support
  • Participating in a high-risk sport
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34
Q

How many stages are a part of the return to activity protocol?

A

5

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35
Q

What are the stages of the return to activity concussion protocol?

A

Stage 1 - Initial Rest
Stage 2 - Prepare to Return to Activity
Stage 3 - Increase your activity
Stage 4 - Gradually Resume Daily Activity
Stage 5 - Full Return to Activity

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36
Q

Explain Stage 1 of the return to activity protocol for concussions

A

Initial Rest
- Stay Home
- Quiet and Calm Environment
- Brief Social Visits
- Sleep as much as needed
- Maintain regular sleep schedule

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37
Q

When would you move from stage 1 of the return to activity concussion protocol to stage 2?

A
  • When symptoms start to improve
  • After 2 days rest
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38
Q

Explain stage 2 of the return to activity concussion protocol

A

Prepare to Return to Activity
- Simple familiar tasks
- Less than 30 minutes of activity with regular breaks
- Go for walks/other light physical activity
- minimum day time bed rest

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39
Q

When would you move from stage 2 of the return to activity concussion protocol to stage 3?

A
  • When you tolerate simple, familiar tasks
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40
Q

Describe stage 3 of the return to activity concussion protocol

A
  • Gradual return to usual activity
  • Gradual decrease in rest breaks
  • Start with less demanding activities
  • Jogging, light weights, non-contact sports drills, etc.
  • Return to work/school on part-time basis
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41
Q

When would you move from stage 3 of the return to activity concussion protocol to stage 4?

A
  • When they tolerate further increases in level of activity
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42
Q

Describe stage 4 of the return to activity concussion protocol

A
  • Resume challenging activities
  • Energy and capacity should improve
  • Students/workers may require accommodations
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43
Q

What accommodations might students or workers require when returning post-concussion?

A
  • Reduced Hours
  • Reduced Workload
  • Extra time for assignments
  • Access to quiet distraction-free work environment
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44
Q

When would someone move from stage 4 to stage 5 of the return to activity concussion protocol?

A
  • When individual tolerates partial return or usual activities
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45
Q

Describe stage 5 of the return to activity concussion protocol

A
  • full class/work schedule (no rest break/accommodations)
  • Student-athletes no return to sport until full return to school
  • Only return to contact sport/dangerous job when cleared by doctor
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46
Q

What happens if there are worsening or new symptoms at any stage of the return to activity protocol?

A
  • Go back to the previous stage for at least 24 hours
  • Do not push through symptoms
  • Decrease activity level
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47
Q

What might happen during the recovery process of the return to activity concussion protocol?

A
  • May need to move back a stage more than once
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48
Q

How many stages are in the return to sport concussion protocol?

A

6

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49
Q

What are the stages of the return to sport concussion protocol?

A

Stage 1 - No Sporting Activity
Stage 2 - Light Aerobic Exercise
Stage 3 - Sport-Specific Exercise
Stage 4 - Non-contact drills
Stage 5 - Full-contact practice
Stage 6 - Back in the Game

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50
Q

What do the return to activity/sport/work protocols not replace?

A
  • Medical Advice
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51
Q

Describe stage 1 of the return to sport concussion protocol

A

No Sporting Activity
- Physical and cognitive rest

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52
Q

When would you transition from stage 1 of the return to sport concussion protocol to stage 2?

A
  • Symptoms start to improve
  • Resting for 2 days
53
Q

Describe stage 2 of the return to sport concussion protocol

A

Light Aerobic Exercise
- walking/swimming/stationary cycling
- No resistance training
- Pace (still able to converse)
- Increase heart rate

54
Q

When should you move from stage 2 to stage 3 of the return to sport concussion protocol?

A
  • No new or worsening symptoms for 24 hours
55
Q

Describe stage 3 of the return to sport concussion timeline

A

Sport-Specific Exercise
- Skating drills (ice hockey), running drills (soccer)
- No head-impact activities
- Add movement to activities

56
Q

When would you transition from stage 3 to stage 4 of the return to sport concussion timeline?

A
  • No new or worsening symptoms following stage 3 sport-specific exercises
57
Q

Describe stage 4 of the return to sport concussion timeline?

A

Non-contact drills
- complex training drills (ex. passing)
- start resistance training
- Exercise coordination, cognitive load

58
Q

When would you move from stage 4 to stage 5 of the return to sport concussion timeline?

A
  • When symptom-free for 24 hours following stage 4
  • Requires medical clearance
59
Q

Describe stage 5 of the return to sport concussion timeline

A

Full-Contact practice
- normal training activities
- Restore confidence: assess functional skills

60
Q

When would you move from stage 5 to stage 6 of the return to sport concussion timeline?

A
  • Symptoms free for 24 hours following stage 5 return to full-contact practice
61
Q

Describe stage 6 of the return to sport concussion timeline

A

Back in the Game
- Normal game play

62
Q

What stage of the return to sport concussion timeline requires medical clearance?

A
  • Stage 5
63
Q

What can happen if there is a premature return to contact sport?

A
  • Can cause significant setback in recovery
64
Q

What happens if there are new or worsening symptoms during the return to sport concussion timeline?

A
  • Move back to previous stage for minimum 24 hours
  • may occur more than once during recovery
65
Q

What should be completed before return to sport concussion timeline?

A
  • Return to School timeline
66
Q

How many stages are there in the return to school concussion timeline?

A
  • 6
67
Q

What stage of the return to school concussion timeline has two parts?

A
  • Stage 2 (a and b)
68
Q

What are the different stages of the return to school concussion timeline?

A

Stage 1 - Physical & Cognitive Rest
Stage 2 - Light Cognitive Activity
Stage 3 - Back to School Part-time
Stage 4 - Part-time School
Stage 5 - Full-time School
Stage 6 - Full-time school

69
Q

Describe stage 1 of the return to school concussion timeline

A

Physical and Cognitive Rest
- At home
- Rest
- Board games, crafts, talk on phone
- No activities that increase heart rate/sweat
- Limit computer, TV, Texting, Video Games, reading
- No: school work, sports, work, driving

70
Q

When should you switch from stage 1 to stage 2a of the return to school concussion timeline?

A
  • Symptoms improve
  • Rest max 2 days
71
Q

Describe Stage 2a of the return to school concussion timeline

A

Light Cognitive Activity
- Gradual increase in cognitive activity (up to 30min)
- Frequent breaks
- Read/TV/Drawing okay
- Limited peer contact/social networking
- Contact school for return plan
- No: school attendance, sport or work
- Gradually add schoolwork at home

72
Q

When would you transition from stage 2a to stage 2b of the return to school concussion timeline?

A
  • When 30min cognitive activity tolerated
73
Q

Describe stage 2b of the return to school concussion timeline

A
  • Introduce schoolwork
  • Communicate with school about student’s progression
  • No: school attendance, sport, or work
74
Q

What stages of the return to school concussion timeline occur at home?

A
  • Stage 1
  • Stage 2a
  • Stage 2b
75
Q

When would you transition from stage 2b to stage 3 of the return to school concussion timeline?

A
  • When 60min of schoolwork in 2 30min intervals tolerated
76
Q

Describe stage 3 of the return to school concussion timeline

A
  • part-time school attendance (with max accommodations)
  • Schoolwork at school
  • No: PE, physical activity at lunch/recess, homework, testing, sport, assemblies, field trips
  • Communicate with school on student’s progression
  • School work only at school
77
Q

When should you transition from stage 3 to stage 4 of the return-to-school concussion protocol?

A
  • When 120 minutes of school work in 30-45 min intervals is tolerated
78
Q

Describe stage 4 of the return to school concussion timeline

A
  • Increase school time
  • Moderate accommodations
  • Homework (up to 30min/day)
  • Testing with adaptations
  • No: PE/physical activity at lunch/sports/standardized testing
  • Communicate with school on student’s progression
79
Q

When would you switch from stage 4 to stage 5 of the return to school protocol?

A
  • When 240min of cognitive activity tolerated in 45-60min intervals
80
Q

Describe Stage 5 of the return to school concussion timeline

A
  • Full days at school (minimal accommodations)
  • increase homework to 60min/day
  • Limit testing to 1/day (with adaption)
  • No: PE/ P activity at lunch/ sport/ standardized tests
81
Q

When would you switch from stage 5 to stage 6 on the return to school concussion protocol?

A
  • When tolerating full-time school with no learning acommodations
82
Q

Describe stage 6 of the return to school concussion timeline

A

Full-time school
- full days, no accommodations
- All classes
- All homework
- Full extracurricular
- All tests
- No: full participation in PE unit return to sport completed and medical clearance
- full academic load

83
Q

What does it mean if someone is tolerating an activity?

A
  • when symptoms are not exacerbated
84
Q

How many stages are in the return to work concussion timeline?

A

6

85
Q

What are the stages of the return to work concussion timeline?

A

Stage 1 - physical and cognitive rest
Stage 2 - Light activity
Stage 3 - Prepare for work (a: at home/b: at work)
Stage 4 - Gradual return to work
Stage 5 - Regular work hours (modifications)
Stage 6 - Full Return to Work

86
Q

Describe stage 1 of the return to work concussion timeline

A

Physical and Cognitive Rest
- At home
- Rest (quiet calm environment)
- Low aggravation activities (quiet music/colouring)
- Sleep as much as needed
- Limit social visits/screen time
- Avoid sports/physical activity that increase HR or sweating

87
Q

What should be discussed with a medical professional during stage 1 of the return to work concussion timeline?

A
  • Driving
88
Q

When should you transition from stage 1 to stage 2 of the return to work concussion timeline?

A
  • When symptoms improve
  • 2 days rest
89
Q

Describe stage 2 of the return to work concussion timeline

A
  • simple gradual increase in cognitive activity
  • Walks or other light physical activity
  • Frequent rest periods
  • Brief periods of activity (<30min)
  • Communicate with workplace about return to work plan
90
Q

When should you switch from stage 2 to stage 3a of the return to work concussion protocol?

A
  • When 30 min activity is tolerated
91
Q

Describe stage 3a of the return to work concussion timeline

A
  • increase cognitive activity
  • Return to pre-injury physical activity
  • Contact workplace for tailored return to work plan
  • Attempt commute to work (assess aggravation of symptoms)
  • Regular sleep schedule
  • Work up to 2 hour activity with breaks
  • Prepare for return to work
92
Q

When should you switch from stage 3a to stage 3b of the return to work timeline?

A
  • At work: When 120 min activity tolerated with rests
93
Q

Describe stage 3b of the return to work concussion timeline

A
  • Set Work accommodations
  • Arrange Graduated return to work plan
  • Work your way up to an additional 2 hours of activity. with breaks
  • Plan to leave work if symptoms worsen, return to stage 2
94
Q

What accommodations can be set up at work for a return to work concussion plan?

A
  • Flexible hours
  • Reduced workload
  • Extra time for task
  • Access to quiet, distraction-free work space
95
Q

When should you transition from stage 3b to stage 4 of the return to work concussion timeline?

A
  • When 4 hours of activity is tolerate, with breaks
96
Q

Describe stage 4 of the return to work concussion timeline

A
  • Return to work based on plan set
  • Start with less demanding activities
  • Gradually increase hours and difficulty
  • Work with accommodations
97
Q

When would you switch from stage 4 to stage 5 of the return to work concussion timeline?

A
  • When ready for regular work hours with accommodations
98
Q

Describe stage 5 of the return to work concussion timeline

A
  • decrease accommodations as energy/capacity increases
  • Accommodations phased out in ‘trial’ periods
  • Monitor energy levels (participate in activities after work)
99
Q

When would you switch from stage 5 to stage 6 of the return to work concussion timeline?

A
  • When regular work hours are tolerated with minimum accommodations
100
Q

Describe stage 6 of the return to work concussion timeline

A
  • Full regular work hours
  • usual expectations of productions
101
Q

What requires medical clearance in stage 6 of the return to work concussion timeline?

A
  • Return to Job-duties that have safety implications
  • Ex. heavy machine operation, heights, driving
102
Q

How many people get post-concussion syndrome?

A

30-80% of patients with mild-moderate brain injuries

103
Q

Does the severity of the TBI relate to the occurrence of PCS?

A
  • NO (not clearly correlated)
104
Q

What are the symptoms and signs of Post Concussion Syndrome? (8)

A
  • Headache
  • Dizziness
  • Irritability
  • Anxiety
  • Sleep Impairment
  • Fatigue
  • Loss of memory / concentration
  • Noise Sensitivity
105
Q

What are some possible structural changes that occur in post concussion syndrome?

A
  • Regional Voluem loss
106
Q

Do the structural changes that occur during post-concussion syndrome correlate with symptoms?

A
  • No
107
Q

What are some possible psychogenic factors that can contribute to post-concussion syndromes?

A
  • Limited Social Support
  • Poor Coping Skills
  • Negative Perceptions
  • Depression
  • Anxiety
  • Panic
  • PTSD
108
Q

Describe the treatment for someone with post-concussion syndrome

A

Individualized
- Cognitive and physical rest
- Headache management
- Management of sleep/wake disorders
- Psychological support and education

109
Q

What are some ways to manage headaches for someone with post-concussion syndrome?

A
  • physical therapy
  • pharmaceutical intervention
110
Q

What are some ways to manage sleep/wake disorders for someone with post-concussion syndrome?

A
  • Behavioural changes
  • Pharmacological intervention
111
Q

What is second impact syndrome?

A
  • Catastrophic injury due to a second impact while still symptomatic from prior concussion
112
Q

What is diffuse cerebral edema?

A
  • Increase intracranial pressure
113
Q

When can a diffuse cerebral edema occur?

A
  • Second Impact Syndrome
114
Q

What can second impact syndrome lead to?

A
  • Death
  • Permanent disability
115
Q

Who is more at risk for second-impact syndrome?

A
  • people under 20 years old
116
Q

Where have all cases of second impact syndrome been seen?

A

Males
- Associated with American Football

117
Q

What is a risk factor for sport-related concussions?

A
  • Past sport-related concussions
118
Q

What are multiple Sport-related concussions associated with?

A

More
- Physical
- Cognitive
- Emotional
Symptoms before participation in sporting season

119
Q

What is predictive of worse symptoms or prolonged recovery? is this a clear connection?

A
  • Loss of consciousness
  • Retrograde amnesia
  • Post-traumatic amnesia
    UNCLEAR RELATIONSHIP
120
Q

What may be helpful for neuropsychological assessments related to sport-related concussions? Why? When?

A

What?
- Baseline testing pre-season
Why?
- Assist in Return-to-play
When?
- Multiple concussion situations

121
Q

What is CTE?

A

Chronic Traumatic Encephalopathy
- progressive/fatal brain disease

122
Q

When might CTE occur?

A
  • Repeated traumatic brain injuries
123
Q

How many cases of CTE have been reported?

A
  • only 300
124
Q

Why is CTE hard to diagnose?

A
  • Only diagnosed post-mortem
125
Q

What happens to the brain from CTE?

A
  • Patchy distribution of tau deposits throughout the brain
126
Q

What are tau deposits?

A
  • Neurofibrillary tangles
127
Q

What are some other possible features of CTE aside from patchy distributions of tau deposits?

A
  • Amyloid-B(AB)
  • Transactive DNA-binding protein 43 (TDP43)
  • Degeneration of Axons
128
Q

Why is CTE controversial?

A
  • Many people get mTBI, yet CTE uncommon
  • Dismissal of repetitive head injury in sport does not increase understanding of CTE

kin 424 - medical aspects of sport (11 decks)

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