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CATA 437 final exam > Concussion > Flashcards

Concussion Flashcards

1
Q

Primary predominant mechanism of concussions

A

Shear forces caused by rotational acceleration

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2
Q

Average concussive head impact - linear acceleration value

A

62.4 +/- 29.7 g force

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3
Q

Physiology - what happens after acceleration/deceleration injury occurs

A

Nerve (axon) is deformed (shearing and stretching motion)

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4
Q

Neurotransmitters are released and influx of ions - what happens after

A

binding of glutamate to excitatory amino acids receptor

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5
Q

What does calcium do during concussions recovery?

A

Impairs mitochondria and ATP production
Calcium accumulation can directly activate pathways leading to cell death

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6
Q

The metabolite normalization process after a concussive episode is an _______, rather _____ in the first 2 weeks, and ____ between 22 and 30 days

A

exponential phenomenon
slow
faster

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7
Q

What is a second impact syndrome?

A

Condition in which a person experiences a second head injury before the complete recovery of the initial injury

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8
Q

Cerebral herniation

A

Rapid pressure develop and deterioration and leading to death within 2-5 minutes

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9
Q

Normalization of NAA concentrations(in other words, ATP stores) may occur only after what

A

after the cerebral energy state has fully recovered

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10
Q

what preventive method is more important that neck strength?

A

Ability to actively engage neck muscles and resist linear and rotational acceleration is more important

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11
Q

Is the mouthguard a good prevention method?

A

Conflicting results

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12
Q

Is the helmet a good prevention method?

A

May reduce concussion severity and duration of symptoms as well as SRC odds if direct head impact

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13
Q

How do we define persisting post-concussive symptoms?

A

Symptoms lasting 2 weeks or longer for adults and 4 weeks or longer for children

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14
Q

Is there a gold standard for diagnosis of concussions?

A

NOPE, rely on symptoms report

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15
Q

Risk factors for concussion outcomes (protracted recovery)

A
  • history of concussions
  • history of migraines
  • ADD/ADHD
  • females
  • younger
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16
Q

What acute symptom should signal a red flag and a possible longer recovery in our ax?

A

Dizziness

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17
Q

Does the SCOAT6 include blood pressure measurement?

A

YES

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18
Q

What are the 6 clinical trajectories of concussions?

A

Vestibular
Ocular-motor
Cognitive/fatigue
Post-traumatic migraine
Cervical
Anxiety/mood

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19
Q

S/S of cognitive/fatigue trajectory

A

fatigue
decreased energy levels
non-specific H/A
sleep disturbances

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20
Q

Common to see increase of symptoms at end of the day
Difficulties concentrating
Increase headache with cognitive activity

A

Cognitive/fatigue trajectory

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21
Q

What is the physiology behind the cognitive/fatigue trajectory?

A

Energy crisis because of the lack of ATP related to the mitochondria

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22
Q

Testing shows deficit in what, for cognitive/fatigue

A

Memory
Processing speed
Reaction time

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23
Q

S/S - vestibular trajectory

A

Dizziness, fogginess, nausea, and feeling of being detached, anxiety, and overstimulation in more complex environments

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24
Q

Increase in sx in busier, more stimulating environments
Rapid head or body mvt may increase sx

A

Vestibular trajectory

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25
Q

Testing shows deficit in what, for vestibular

A

Vestibular and ocular motor screening

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26
Q

S/S - ocular motor trajectory

A

localize, frontally based H/A, fatigue, distractibility, difficulties with visually based classes, pressure behind eyes, and difficulty with focus

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27
Q

Difficulties with extended time in front of computer screens or reading
Full days of work/school may increase sx vs decrease on weekends

A

Ocular motor trajectory

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28
Q

Testing shows deficits in what, for ocular motor

A

Convergence and/or accommodation measurements

29
Q

S/S - anxiety/mood trajectory

A

increase in anxiety, including ruminative thoughts, hypervigilance, feelings or being overwhelmed, sadness, and or hopelessness

30
Q

Report sleep disturbances, with inability to quiet minds or stop thinking and worrying

A

Anxiety/mood trajectory

31
Q

Testing shows deficits in what, for anxiety/mood

A

some vestibular dysfunction testing may provoke symptoms (treat before anxiety)

32
Q

S/S of post-traumatic migraine trajectory

A

Unilateral, moderate to severe intensity headache, pulsating quality, nausea, photosensitivity, phono sensitivity

33
Q

What activities increase sx for post-traumatic migraine trajectory

A

Stress
Sleep dysregulation
Anxiety/emotional changes
Dietary trigger (caffeine)

34
Q

How do you differentiate cervicogenic headaches from the others?

A

Often comes with reduced ROM of the neck, usually 1 side and increase in sx with motion of C/S or pressure

35
Q

S/S - cervical trajectory

A

Headache and neck pain

36
Q

What is important to focus on during ax of cervical trajectory?

A

Characterization of the headache and location

37
Q

Smooth pursuit neck torsion test stimulates cervical proprioceptors or vestibular?

A

NOT vestibular
ONLY cervical proprioceptors

38
Q

What is a +ve smooth pursuit neck torsion test

A

symptoms increase with head rotation in comparison to neutral position

39
Q

What is the cervical joint position error test?

A

Laser test
Patient sitting
Have patient actively go through max neck flexion/come back neutral

40
Q

Why is the cervical joint position error test important for RTP?

A

Because it will reflect how the muscles are able to react fast when loaded

41
Q

Purpose of the flexion-rotation test

A

Dysfunction in the C0-C2 to help determine C/S dysfunction and cervicogenic headaches

42
Q

What is a +ve flexion-rotation test?

A

firm resistance is encountered
pain
limited ROM

43
Q

Symptoms of vestibular impairment

A

Unstable vision
Difficulty focusing
Motion discomfort
Difficulty in visual environments
Imbalances
Dizziness

44
Q

VOMS stands for

A

Vestibular Ocular Motor Screening

45
Q

5 domains of VOMS

A

Smooth pursuits
Vertical and horizontal saccades
Near point of convergence
Vestibulo-ocular reflex (VOR)
Visual motion sensitivity (VMS)

46
Q

What are the 4 mains symptoms to ax?

A

Headache
Dizziness
Nausea
Fogginess

47
Q

Review VOMS document

A

Read procedures

48
Q

Abnormal distance in cm between the target and the tip of the nose

A

More than 6cm

49
Q

Most common symptom in prolonged recovery

A

Dizziness

50
Q

What is Benign Paraoxymal Positional Vertigo?

A

Crystals dislodged to semicircle canals interfere with normal fluid movement

51
Q

Benign

A

is it not life-threatening

52
Q

Paraoxymal

A

it comes in sudden or brief spells

53
Q

Positional

A

it gets triggered by certain head positions or movement

54
Q

Vertigo

A

a false sense of rotational movement

55
Q

What is the Hallpike-Dix Test?

A

Patient is long sitting with head rotated 30-45d
Therapist holds head and patient goes supine with head a bit below horizontal + hold for 30-60 sec

56
Q

+Ve Hallpike-Dix test

A

Dizziness and nystagmus

57
Q

What is the goal of the orthostatic hypotension testing?

A

Help to differentiate causes of dizziness

58
Q

Explain the orthostatic hypotension testing + what is a +Ve

A

Have patient lay for 15 minutes to get resting BP
Have patient stand up and take BP
+ve = if within 2-3 minutes drop of 20 mm Hg in systolic BP and/or 10 mm Hg in diastolic BP

59
Q

What do you need to do before you do the head impulse test

A

Clear cervical spine for adequate pain free ROM and vertebral artery test

60
Q

Test used to assess angular vestibular ocular reflex (aVOR)

A

Head impulse test

61
Q

Purpose of the Buffalo Concussion Treadmill Test

A

Help determine how much aerobic activity is safe following a concussion (even acute)

62
Q

Failed Buffalo test

A

Max exertion is reach or 3 point increase in Likert scale or rapid progression of symptoms or patient reports inability to continue safely

63
Q

Passed Buffalo test

A

Patients meets their max HR (220-age) or 18-20 RPE on Borg Scale has not worsened condition before worsening of symptoms

64
Q

Which type of imaging demonstrates activation patterns that correlate with symptom severity and recovery in concussion?

A

Functional MRI (fMRI)

65
Q

What was found in early studies done with fMRI

A

Suggest that an increase in CVR is a response to the tissue demands that require oxygen/nutrients and removal of metabolic waste

66
Q

How much time after the injury should you initially rest physically and cognitively?

A

24-48h

67
Q

Consequence of 3+ months of concussion symptoms

A

Change in neuroplasticity and becomes bodies new normal

68
Q

What are ‘‘The Musts’’ for concussions?

A
  • written concussion management plan on file
  • evals - from trained staff
  • no same day RTP
  • athletes cleared by physicians
  • acknowledgement (education, reporting)
69
Q

What test would also be +ve if Hall Dike test is +ve ?

A

Head impulse test

CATA 437 final exam (6 decks)

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