CNS tx (TBI, class 5)

Question 1

after concussion, difficulty tolerating ___

Answer 1

medication, drugs, screens, alcohol

lower tolerance

also E.g.
sensitive to alcohol

Question 2

concussion

Answer 2

mood changes

erratic/withdrawn/impatient
not like themselves

depressed/anxious

Question 3

avoid screens for ____ after concussion (mTBI)

Answer 3

48 hours

Question 4

after concussion, physical activity ?

Answer 4

walking & light PA is important for recovery
—> light aerobic exercise

circulation (?)

but avoid rigorous exercise

Question 5

rocking/shaking for mTBI (concussion) patient

Answer 5

possibly avoid rocking/shaking as it could disturb vestibular system of pt with concussion

Question 6

if patient has seizure on table?

Answer 6

LOWER TABLE AS FAR AS POSSIBLE

(electric table)

get them as low as possible in case they fall off the table

Question 7

atypical/other triggers for seizure/epilepsy

Answer 7

illness

lack of sleep & late meal

stress

Question 8

HOLD-RELAX — where not to use

Answer 8

SPASTIC PT

Question 9

..

Answer 9

…

Question 10

TBI

Answer 10

traumatic brain injury

Question 11

mTBI =

Answer 11

mild traumatic brain injury

Question 12

mTBI aka

Answer 12

concussion

Question 13

mTBI (concussion) define

Answer 13

a mild TBI with functional changes but without structural damage

Question 14

(brain) contusion

Answer 14

more serious than a concussion. Involves bruising or bleeding along the brain surface.

—> Extent of damage depends on size and location of the contusion

Question 15

brain contusion

Answer 15

“A brain contusion is a bruise to the brain that causes bleeding and swelling. It’s a type of traumatic brain injury (TBI) that’s usually caused by a strong blow to the head. “

Question 16

seizure disorders aka

Answer 16

epilepsy

Question 17

define Seizure Disorders (Epilepsy)

Answer 17

explosive episodes of uncontrolled and excessive electrical activity in the brain leading to sudden change of behavior or level of consciousness.

Question 18

classification of TBI

Answer 18

mild
moderate
severe

Question 19

mild TBI:

—> duration of unconsciousness

—> glasgow coma scale

—> post-traumatic amnesia

Answer 19

<30 mins unconsciousness

13-15 Glasgow coma scale

<24 hours post-trauma amnesia

Question 20

moderate TBI:

—> duration of unconsciousness

—> glasgow coma scale

—> post-traumatic amnesia

Answer 20

30min to 24 hours duration of unconsciousness

9-12 Glasgow coma scale

1-7 days post-trauma amnesia

Question 21

severe TBI:

—> duration of unconsciousness

—> glasgow coma scale

—> post-traumatic amnesia

Answer 21

> 24 hours duration of unconsciousness

3-8 Glasgow coma scale

> 7 days post-trauma amnesia

Question 22

Glasgow coma scale

Answer 22

Used to objectively describe the extent of impaired consciousness in all types of traumatic brain injuries

The lower the score, the worse the injury

Question 23

Glasgow coma csale score

Answer 23

A score of 15 means you’re fully awake, responsive and have no problems with thinking ability or memory

A score of 13-14 means a mild head injury

A score of 9-12 would indicate a moderate head injury

Having a score of 3 - 8 means you’re in a coma and have a severe brain injury. Immediate emergency care is required

Question 24

concussion (mTBI) is

Answer 24

A traumatic brain injury caused by a direct blow to the head,
neck or body resulting in an impulsive force being transmitted to the brain

This initiates a neurotransmitter and metabolic cascade, with possible axonal injury, blood flow change and inflammation affecting the brain.

Symptoms and signs may present immediately, or evolve over minutes or hours, and commonly resolve within days, but may be prolonged.

Question 25

concussion resolution time

Answer 25

The neurometabolic cascade following concussion should normally resolve within 4-6 weeks

Question 26

concussion SSx after 4-6 weeks?

Answer 26

If symptoms persist beyond that time (and cannot be explained by other means), the person is said to be experiencing persistent post-concussion syndrome

Question 27

how common is persistent post-concussion syndrome?

Answer 27

PPCS symptoms develop in 20-30% of concussed patients

Question 28

coup-contracoup

Answer 28

"Coup-contrecoup is a mechanism that describes bruising of the brain that occurs after a direct blow to the head. It involves both a coup injury at the site of impact and a contrecoup injury on the opposite side of the brain. "

Question 29

contracoup injury

Answer 29

"A bruise that occurs on the opposite side of the brain from the impact site. This is caused by the brain rebounding and hitting the opposite side of the skull. "

Question 30

coup injury

Answer 30

"A bruise that occurs directly beneath the site of impact. This is caused by mechanical trauma, often from a small, hard object. "

Question 31

coup-contracoup =

Answer 31

a coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was hit.

Question 32

concussion vs loss of consciousness

Answer 32

You do not need to lose consciousness to have a concussion

Question 33

which directional force is most likely to lead to loss of consciousness & PPCS

Answer 33

ROTATIONAL force Rotational force is the most likely to lead to loss of consciousness and is the most likely to lead to persistent post concussion symptoms

Question 34

note concussion vs whiplash

Answer 34

Concussion and whiplash often occur together People who suffer a concussion, in the majority of cases, also suffer a whiplash injury. Some researchers are recommending that guidelines for the care of both are amalgamated.

Question 35

concussion tx

Answer 35

Imaging can be done to rule out structural damage ---> MRI, and CT scans Rest ---> Sleep at night and naps throughout the day if needed ---> Rest breaks during the day Avoiding vigorous activity NSAIDs to control headaches Avoid bright lights and electronics Limit activities that require heavy concentration or intense focus

Question 36

concussion & activity

Answer 36

not intense but light/regular cardiovascular exercise for bloodflow is valuable for recovery

Question 37

severe cases/concussion tx options

Answer 37

In severe cases: physical therapy, speech therapy, recreation therapy and occupational therapy may be needed

Question 38

symptom exacerbation during physical activity post exercise

Answer 38

light exercise that does not more than mildly exacerbate symptoms is OK

Question 39

how long after concussion is light cardio OK?

Answer 39

initial 24-48 hours following a concussion

Question 40

concussion vs screens

Answer 40

reduced screen time 48 hours post injury is great may be OK to gradually increase screen time after 48 hours

Question 41

PPCS SSx

Answer 41

Autonomic dysfunction Headaches Dizziness Loss of concentration and memory Ringing of the ears Emotional and psychological changes Sleep changes Vision changes

Question 42

massage vs PPCS

Answer 42

Remove noxious stimuli no bright lights Position and pillow for comfort (be aware of dizziness and/or onset of symptoms with neck movement (cervicogenic dizziness)) Avoid rocking/shaking Promote relaxation Encourage and support light aerobic exercise Refer to chiro/physio/MD that are well trained in concussion assessment and treatment (BTT, VOM)

Question 43

two types of seizures

Answer 43

focal (partial) seizures generalized seizures

Question 44

focal (partial) seizures

Answer 44

Seizure is limited to a single area of the brain (60% of cases) 2 categories of focal seizures: ---> Without loss of consciousness ---> With impaired awareness

Question 45

focal seizure without loss of consciousness

Answer 45

May experience changes in the way thing look, feel, smell, taste or sound. Can result in involuntary movements or abnormal sensations like dizziness

Question 46

focal seizure with impaired awareness

Answer 46

Change or loss of consciousness Appear to have a blank stare or have a repetitive movements like hand rubbing or (lip) smacking, or start walking in circles

Question 47

Generalized Seizures

Answer 47

Involves more of a diffuse area and is seen approximately 30% of cases 2 types: ---> Absence (petit mal) ---> Tonic-clonic (grand mal)

Question 48

generalized seizure --> petit mal (absence)

Answer 48

brief loss of awareness and often facial movements lasting up to 10 seconds ---> Often people have no memory of what happens during the seizure

Question 49

generalized seizure --> grand mal (Tonic-clonic)

Answer 49

intermittent contract-relax pattern in muscles and are associated with loss of consciousness ---> Can last for several minutes

Question 50

tonic-clonic etymology

Answer 50

"The term "tonic-clonic" comes from the words "tonic" and "clonic" and describes the two phases of a seizure. "Tonic" means stiffening, and "clonic" means rhythmical jerking. "

Question 51

which seizure type more common

Answer 51

focal (partial) seizure ---> 60% of cases

Question 52

seizure tx

Answer 52

Antiseizure medication and cannabinoids are used to reduce the frequency of seizures Mild sedatives Understanding triggers if there are any (flashing lights, smells/odors)

Question 53

seizures vs massage

Answer 53

Understand and remove triggers Follow first aid (left) if seizure occurs It is sensible to work from a template of gentle, relaxing massage techniques

Question 54

seizure -- other massage considerations

Answer 54

Adjust face rest to ensure comfort Limit position changes if client is experiencing dizziness If client has difficulty communicating establish a form of communicating (e.g. raising hand) Avoid techniques that cause the client to rock or shake

Question 55

CI/precautions TBI/seizure

Answer 55

AVOID ROCKING/SHAKING avoid intense techniques avoid stimulatory tx if goal is to sedate