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CATA 437 final > Concussion > Flashcards

Concussion Flashcards

(68 cards)

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1
Q

what is a concussion

A

TBI caused by a direct blow to the head, neck or body resulting in an impulsive force being transmitted to the brain that occurs during sport or exercise

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2
Q

concussion impact types

A

direct contact

inertial contact (acceleration)

shear forces caused by rotational acceleration (primary predominant mechanism of concussion)

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3
Q

primary mechanism of concussions

A

shear forces caused by rotation

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4
Q

concussion mechanism determined by

A

amount of mechanical energy from acceleration transferred to the brain and vascular tissue

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5
Q

which population sustains more concussions

A

high school athletes > college

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6
Q

physiology of concussion

A

acceleration/deceleration = injury
nerve is deformed = shearing and stretching motion

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7
Q

physiology cascade of events

A
  1. neurotransmitters are released and influx of ions
  2. binding of glutamate to excitatory amino acids receptor
  3. leads to further neuronal depolarization with efflux of potassium and calcium
  4. the Na+ K+ pump works in overtime to try and restore neuronal membrane
  5. this requires increased use of ATP
  6. increase in glucose metabolism “hyper-metabolism” + diminished cerebral blood flow = cellular energy crisis !
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8
Q

most important part of physiology

A

energy crisis

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9
Q

what impairs the mitochondria, ATP production, and neural connectivity

A

calcium

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10
Q

what does calcium accumulation do

A

can directly activate pathways leading to cell death

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11
Q

what are changes in the brain metabolism following a concussive episode called

A

metabolic vulnerability

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12
Q

second impact syndrome

A

second head injury (hit) before the complete recovery of the initial injury

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13
Q

second impact syndrome physiology

A

results from the dysfunctional cerebral blood flow autoregulation leading to increased intracranial pressure
herniations = rapid pressure develop and deterioration and leading to death within 2-5min

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14
Q

concussion prevention

A

neck strength
ability to actively engage neck muscles and resist linear/rotational acceleration (neuromuscular training)

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15
Q

helmets and mouthguards

A

may help but more research is needed

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16
Q

symptoms of concussion may develop within

A

48-72 hours

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17
Q

% of people who experience persistent symptoms

A

up to 30% of children and adults

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18
Q

how much time do persistent symptoms last on average

A

2 weeks + for adults
4 weeks+ for children

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19
Q

what are persistent concussion symptoms associated with

A

mental health problems
declines in QOL
difficulties returning to sport, school and ADLs

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20
Q

risk factors for concussion outcomes

A

history of concussions
history of migraines
diagnosis of learning disability or ADHD
sex ( more females)
age (younger)

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21
Q

does a SCOAT6 replace a clinical assessment

A

no

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22
Q

what does the scat 6 include

A

symptoms
cognitive recall
BP
cervical evaluation
neuro exam
timed tandem gait
modified VOMs

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23
Q

what is the most commonly reported symptom during clinical assessments?

A

75% of patients experience headaches.

dizziness at time of injury AND migraines in the first week post injury BOTH require special attention

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24
Q

how do you evaluate symptoms

A

combination of self reported questionnaires and clinical interview questions

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25
what do you categorize symptoms into
trajectories
26
what are the different trajectories
vestibular ocular-motor cognitive post-traumatic migraines cervical anxiety/mood
27
S/S - cognitive
fatigue decreased energy levels non-specific H/A (increase with cognitive activity) sleep disturbances difficulty concentrating symptoms increase at the end of the day
28
vestibular - S/S
dizziness foggines nausea feeling of being detached anxiety overstimulation
29
what increases vestibular S/S
busy environments rapid head and body movements
30
Ocular motor -S/S
localize frontally based headaches fatigue distractibility difficulties with visually based classes pressure behind the eyes difficulty with focus
31
what can intensify symptoms - ocular motor
full days of work or school
32
common complaints
33
anxiety mood - S/S
anxiety ruminative thoughts hypervigilance feelings or being overwhelmed sadness hopelessness sleep distrubances headaches dizziness fogginess fatigue
34
what needs to be treated before anxiety
vestibular symptoms
35
post traumatic migraine -S/S
unilateral headache pulsating photo/phono sensitivity increased with physical activity
36
what exacerbates symptoms with post traumatic migraine
stress sleep dysregulation anxiety emotional changes caffeine
37
differentiating headaches - vestibular migraines
NS problem that causes repeated dizziness may have H/A
38
differentiating headaches - cervicogenic
secondary H/A referred pain caused by cervical spine dysfunction reduced ROM of neck increased S/S with movement of the C/S
39
differentiating headaches - concussion
H/A that develops within 7 days post injury or after regaining consciousness resembles a migraine C1-3 and trigeminal nerve lead to referred hemi cranial pain
40
cervical - S/S
headache and neck pain
41
can have a concussion without C/S affected
yes but very rare
42
tests to help differentiate C/S injury from concussion
cervical joint reposition error test smooth pursuits neck torsion flexion-rotation test head-neck differentiation test motor control
43
purpose of smooth pursuits neck torsion test
test cervical spine stimulates cervical proprioceptors NOT vestibular
44
+ve smooth pursuits neck torsion
symptoms increase with head rotation in comparison to neutral position (rotation side is side of the problem)
45
purpose of cervical joint position error test
looks a proprioceptive abilities
46
purpose of flexion rotation test
dysfunction in the C0-C2 to help determine C/S dysfunction and cervicogenic headaches
47
+ve flexion rotation test
firm resistance pain limited ROM
48
common impairment following concussion
vestibular and ocular motor
49
symptoms of vestibular impairement
unstable vision difficulty focusing motion discomfort difficulty in visual environments imbalance and dizziness
50
VOMS
smooth pursuits vertical and horizontal saccades near point of convergence vestibulo-ocular reflex (VOR) visual motion sensitivity (VMS)
51
note changes in ___ with VOMS
headaches dizziness fogginess nausea
52
abnormal distance for near point convergence
> 6cm
53
benign
not life threatening
54
paroxysmal
comes in sudden, brief spells
55
positional
it gets triggered by certain head positions or movement
56
vertigo
a false sense of rotational movement
57
benign paraoxymal positional vertigo
crystals dislodged to semicircle canals and interfere with normal fluid movement
58
hallpike-dix text
patient long sitting with head rotated 30-45º therapist holds head and pt is then assisted into supine position with head slightly below horizontal plane and position maintained for 30-60s
59
orthostatic hypotension testing
helps differentiate causes of dizziness take BP after 15 min of resting take BP standing
60
+ve test for orthostatic hypotension testing
2-3 min of standing a drop of 20 mmHg in systolic and/or 10 mmHg in diastolic
61
Head impulse
assess angular vestibular ocular reflex
62
buffalo concussion treadmill test
63
conventional neuroimaging is what with concussions
90% normal
64
brain CT of MRI
contribute little to concussion eval should be used when suspicion of an intracerebral or sturctural lesion
65
Functional MRI
demonstrates activation patterns that correlates with symptoms severity and recovery
66
how much rest is too much
normal 24-48 hours no optimal time yet
67
neuroplasticity of the brain after concussion
injured brain tries to use another area for the same thing
68
after 3 months of concussion symtoms still experienced, what occurs in the brain?
changes in neuroplasticity and becomes the body's new norm

CATA 437 final (5 decks)

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