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NMR II > Exam 2: Concussion > Flashcards

Exam 2: Concussion Flashcards

1
Q

What are the 4 diagnostic criteria for a concussion?

A
  1. GCS score of 13-15
  2. Loss of consciousness < 30 min
  3. Post Traumatic Amnesia < 24 hrs
  4. Lack of acute abnormalities on CT and MRI
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2
Q

What diagnostic imaging will show signs of concussion?

A

fMRI, blood flow, metabolic imaging

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3
Q

What percentage of concussions are associated with loss of consciousness?

A

< 10%

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4
Q

What is the pathophysiology associated with concussion?

A
  • Disruption to neuronal circuits
  • Dysregulation of K/Na pump
  • Increased cerebral metabolism
  • Decreased cerebral blood flow
  • Increased glutamate
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5
Q

What are the 4 domains of concussion symptoms?

A
  1. Cervical musculature
  2. Vestibulo-ocular
  3. Autonomic dysfunction and exertional intolerance
  4. Motor function
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6
Q

What symptoms are considered to be cervical musculature impairments?

A

Neck pain, dizziness, impaired postural control, limited proprioceptive input

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6
Q

What symptoms are considered to be vestibulo-ocular impairments?

A

Vertigo, blurred vision, light sensitivity, headaches, sensitivity to sound, balance impairments, fatigue, tinnitus

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6
Q

What symptoms are considered to be autonomic dysfunction and exertional intolerance?

A

Poor autonomic regulation: inability to regulate HR, BP, cerebral blood flow in response to exercise and positional changes

Symptoms: pounding headache, fatigue, dizziness, nausea

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6
Q

What symptoms are considered to be motor function impairments?

A

Impaired postural control, motor coordination, motor abilities with dual task, increased reaction time, increased risk of musculoskeletal injuries

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6
Q

How long until symptoms of a concussion typically resolve?

A

7-10 days

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6
Q

What does PPCS stand for?

A

Persistent Post-Concussive Symptoms

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7
Q

What percentage of people with a concussion will present with PPCS?

A

10-20%

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8
Q

After what time period are concussion symptoms considered PPCS in children?

A

Symptoms after 4 weeks

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9
Q

After what time period are concussion symptoms considered PPCS in adults?

A

Symptoms after 14 days

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10
Q

What are indications for a slow recovery from a concussion?

A

Young age, female, prior concussion history, migraine history, history of depression and anxiety, ADHD, genetic factors, psychosocial factors

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11
Q

What are injury related indications for a slow recovery from a concussion?

A

Post traumatic amnesia, loss of consciousness, delayed removal from sport

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12
Q

What is Second Impact Syndrome?

A

A second concussion before a patient has fully recovered from the first than can have devastative effects

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13
Q

What is the pathophysiology of Second Impact Syndrome?

A

Cerebral edema and cerebral metabolism have not returned to baseline. Brain is unable to regulate pressures that results in rapid accumulation of edema and brain herniation

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14
Q

What does CTE stand for?

A

Chronic Traumatic Encephalopathy

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15
Q

What is CTE?

A

A progressive degenerative disease associated with repetitive mild brain injury

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16
Q

What are some conditions that professional athletes are at a higher risk for?

A

ALS, Parkinson’s, Alzheimers, dementia

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17
Q

What is involved in pre-participation testing for concussion?

A

Medical and family history, full neurologic assessment, SCAT6, SMHAT, ImPACT

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18
Q

What does the ImPACT assess?

A

Attention, working memory, response variability, reaction time, problem solving

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19
Q

What is part of the immediate screening for a concussion?

A

Screen for multiple-system involvement, cervical spine pathology, identify if there is a moderate or severe brain injury, administer medical attention

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20
Q

When should you send someone with a suspected concussion for emergency care?

A
  1. Deteriorating condition, orientation within 4 hrs
  2. GCS < 13
  3. Cervical spine injury
  4. Open skull fracture
  5. Progressive symptoms or new neurologic signs such as repeated vomiting, seizures, pupil asymmetry
21
Q

How will a patient with a concussion present after a blow to the head?

A

Decreased orientation or alterations in cognition, physical symptoms, emotional or behavioral changes, GSC 13-15 within the first 24 hours

22
Q

What are the three sideline examinations for concussion?

A

SCAT6, BESS, VOMS

23
Q

What ages should the Child SCAT6 be administered to?

A

12 and under

24
Q

What timeframe can the SCAT6 be administered in?

A

Within the first 72 hours, but as soon as possible

25
Q

What is included in the SCAT6 assessment?

A

Neuro screen, red flag assessment, Maddock’s Rules, Modified BESS, GCS

26
Q

What does BESS stand for?

A

Balance Error Scoring System

27
Q

What does the BESS examine?

A

Postural control with and without shoes, with different foot positions, and on different surfaces

28
Q

How is the BESS scored?

A

Counting the number of errors per trial

29
Q

What does VOMS stand for?

A

Visual Ocular Motor Screen

30
Q

What does the VOMS assess?

A

Smooth pursuits, saccades, convergence, VOR, visual motion sensitivity

31
Q

What are the general recommendations after an acute concussion?

A

Diagnose ASAP, monitor for worsening function, no return to play, refer to medical provider, relative rest for 24-28 hrs

32
Q

Describe relative rest

A

Reduced screen time, allowed to perform ADLs and activities that do not exacerbate symptoms

33
Q

How long should you prescribe relative rest after a concussion?

A

24-48 hours

34
Q

What four key areas should you assess when seeing a patient following a concussion?

A
  1. Cervical spine
  2. Vestibular system
  3. Exercise tolerance
  4. Motor function
35
Q

What are examples of how to assess the cervical spine when treating a concussion?

A

ROM, trigger point assessment, exam of cervical dizziness, TMJ, muscle strength, endurance of cervical and scapular muscles

36
Q

What are examples of how to assess the vestibular system when treating a concussion?

A

Smooth pursuits, saccades, vergence, accommodation, ocular alignment, etc.

37
Q

What is the prognosis for vestibular systems following a concussion?

A

If vestibular or ocular abnormalities are still present 2-3 weeks after the concussion, it is associated with delayed recovery

38
Q

Why is it important to test exercise tolerance following a concussion?

A

To measure autonomic dysfunction

39
Q

After a concussion, will there be any abnormalities with resting HR and BP?

A

HR may be elevated at rest

40
Q

How do you measure HR and BP following postural changes during a concussion examination?

A

Have patient supine for two minutes then measure their blood pressure when they transition to standing

41
Q

What are the cutoffs for measuring changes in BP from supine to standing?

A

SBP: drop of greater than 20 mmHg

DBP: drop of greater than 10 mmHg

42
Q

When assessing exercise tolerance, what change in RPE is indicative to stop the test?

A

+3 on the RPE

43
Q

Briefly describe the Buffalo Concussion Treadmill Test

A

Start the speed at 3.0 mph and increase the incline by 1 degree every minute. Record patient RPE, symptoms, and HR at each minute. Once you reach max incline, start to increase speed

44
Q

What are considerations for assessing motor function following a concussion?

A

Stead state balance, postural sway, dual task, anticipatory and reactive balance, gait activities, outcome measures

45
Q

What are the two SOMs that can be used in the clinic following a concussion?

A

SCOAT and PCSS

46
Q

When is it appropriate to use the SCOAT following a concussion?

A

After day 3

47
Q

What is included in the SCOAT?

A

Assessment of cognitive function, HR and BP in two positions, cervical spine examination, neuro exam, tandem gait, dual task, modified VOMs

48
Q

What does PCSS stand for?

A

Post Concussive Symptoms Scale

49
Q

What is the PCSS?

A

22 item scale where patient rates their current concussive symptoms

50
Q

Why is aerobic exercise important in recovery from a concussion?

A

Facilitates recovery through reducing symptoms, earlier return to work, improved reaction time, faster recovery, and less anger

51
Q

Describe sub-symptom threshold aerobic exerciser

A

No more than a 2-point increase in symptoms that go away within one hour of stopping exercise. Repeat 3x per week within the HR threshold

52
Q

What four factors should be considered when returning to learning following a concussion?

A

Environment, physical, curricular, testing

53
Q

Briefly describe the return to sport protocol following a concussion

A

Step 2 after 24-48 hours following injury. Need to tolerate each stage without increase in symptoms. Must remain in each stage for at least 24 hours

54
Q

What is the minimum time out of sport following a concussion?

A

One week

55
Q

What is the average length of time it takes an athlete to return to sport following a concussion?

A

One month

NMR II (27 decks)

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