Concussion Flashcards
1
Q
What is a concussion or mild traumatic brain injury (mTBI)?
A
A concussion is a complex pathophysiological process affecting the brain, induced by direct or indirect biomechanical forces.
2
Q
What percentage of concussion patients experience vestibular and oculomotor deficits?
A
50-60% of concussion patients experience vestibular and oculomotor deficits (Brogilo et al., 2015; Mucha et al., 2014).
3
Q
What biomechanical forces contribute to a concussion?
A
Rotational acceleration and/or deceleration forces contribute to concussions.
4
Q
How does a concussion affect the vestibulo-ocular system?
A
A concussion can cause disruption of vestibulo-ocular pathways, leading to dizziness, balance issues, and visual disturbances.
5
Q
What is the resting membrane potential in a cell?
A
The resting membrane potential is -70 mV on the inside of the cell, creating a potential difference with a more positive environment outside.
6
Q
Where is sodium (Na+) concentration higher at rest?
A
Na+ concentration is higher outside the cell at rest.
7
Q
How does the sodium-potassium pump affect the cell’s charge?
A
The sodium-potassium pump maintains a less positive (more negative) charge inside the cell by actively transporting Na+ out and K+ in.
8
Q
What triggers depolarization in a nerve action potential?
A
Depolarization is triggered when the membrane potential reaches -55 mV, opening voltage-gated sodium channels (VGC), allowing Na+ to move into the cell.
9
Q
What happens at 30 mV during an action potential?
A
At 30 mV, voltage-gated potassium channels (VGC) open, allowing K+ to move out of the cell, initiating repolarization.
10
Q
How does depolarization affect the cell’s charge?
A
Depolarization makes the inside of the cell more positive as Na+ rushes in.
11
Q
Why does repolarization follow depolarization?
A
Repolarization follows depolarization to restore the resting membrane potential by moving K+ out of the cell.
12
Q
What happens during repolarization after an action potential?
A
During repolarization, Na+ is moved out of the cell (3 ions) and K+ is moved in (2 ions), restoring the resting membrane potential.
13
Q
How does membrane permeability change during repolarization?
A
The membrane becomes more permeable to K+ and less permeable to Na+.
14
Q
What triggers neurotransmitter release at the synapse?
A
The presynaptic neuron activates voltage-gated channels (VGCs) for an influx of Ca++, which triggers vesicle formation.
15
Q
What role does calcium (Ca++) play in synaptic transmission?
A
Ca++ influx causes vesicles to form and transport glutamate to the synaptic cleft.
16
Q
What happens after glutamate is released?
A
Glutamate binds to receptors on the postsynaptic neuron, activating VGCs for Na+ influx.
17
Q
How does Na+ affect the postsynaptic neuron?
A
Na+ influx continues the action potential in the postsynaptic neuron.
18
Q
What is a metabolic crisis after a concussion?
A
A metabolic crisis occurs when the brain experiences an energy mismatch due to increased energy demand and decreased energy supply following a concussion.
19
Q
What causes the metabolic crisis in concussion?
A
A concussion leads to ionic imbalances, excessive glutamate release, and impaired ATP production, resulting in a temporary energy deficit.
20
Q
How does a concussion affect glucose metabolism?
A
Glucose demand increases while cerebral blood flow decreases, leading to an energy crisis in the brain.
21
Q
Why is the brain vulnerable during the metabolic crisis?
A
The brain is more susceptible to further injury due to reduced energy availability and impaired ability to maintain homeostasis.
22
Q
What happens immediately after a concussion impact?
A
Massive glutamate release and widespread depolarization of brain cells.
23
Q
What occurs in the first 5-6 minutes post-concussion?
A
Disrupted ion levels across the membrane.
24
Q
What happens within 0-30 minutes after a concussion?
A
Glucose uptake increases to restore ionic balance.
25
How does a concussion lead to oxidative stress?
Free radicals are produced immediately and continuously, damaging DNA and cell membranes.
26
What happens 30 minutes post-concussion?
Prolonged decrease in glucose uptake and cerebral blood flow.
27
How does mitochondrial dysfunction contribute to a metabolic crisis?
Hours to days post-injury, mitochondria absorb excess Ca++, leading to an energy crisis.
28
What are the long-term effects on axons after a concussion?
Disruption of axonal transport, swelling, and eventual axonal disconnection.
29
What is ionic flux in a metabolic crisis after a concussion?
Ionic flux occurs when trauma causes mechanoporation of the lipid membrane, leading to ion imbalances.
30
What happens to ion movement after a concussion?
K+ moves out of the cell, while Na+ and Ca++ move in due to the leaky lipid membrane.
31
How does ionic flux affect neuronal function?
It results in a depressive state of ligand-gated channels, disrupting normal signaling and energy balance.
32
What causes an energy crisis after a concussion?
Depolarization forces ionic pumps into overdrive, leading to hyperglycolysis and depletion of intracellular energy reserves.
33
How long does impaired glucose metabolism last post-concussion?
Glucose metabolism can be impaired for 7-10 days after the initial hyperglycolysis phase.
34
Why can glucose levels be high despite metabolic dysfunction?
Following the hyperglycolysis phase, glucose metabolism is impaired, leading to elevated glucose levels even in patients with a normal Glasgow Coma Scale.
35
How does a concussion alter neurotransmission?
Calcium flux is disrupted, leading to excess glutamate and an over-excitatory state.
36
What role does glutamate play in post-concussion altered neurotransmission?
Excess glutamate overstimulates neurons, causing excitotoxicity and impairing normal function.
37
How do glutamate receptor alterations affect the brain post-concussion?
Changes in glutamate subunit receptors interfere with neuroplasticity, electrophysiology, and memory formation.
38
What happens during glutamate release in a metabolic crisis?
Glutamate is released into the extracellular space, and excessive amounts impair synaptic function.
39
How does excessive glutamate affect neurotransmission?
Excess glutamate impairs neurotransmission at synapses, leading to a build-up of Ca++ inside the cell.
40
What causes cytoskeletal damage after a concussion?
Physical damage to microstructural components and altered Ca++ flux lead to the collapse of neurofilaments.
41
How does Ca++ flux affect the cytoskeleton?
Ca++ flux activates enzymes like calpains, which break down cellular structures, contributing to axonal damage.
42
How does axonal stretch impact the neuron?
Axonal stretch disrupts microtubules, leading to cellular "clumping" and decreased nerve conduction potential.
43
Why are unmyelinated axons more prone to injury after a concussion?
Unmyelinated axons are more vulnerable to mechanical injury and are less protected than myelinated axons.
44
What is the relationship between white matter damage and cognitive impairments?
Damage to white matter is more strongly associated with cognitive impairments, as it affects neural communication and processing.
45
How does a concussion disrupt nerve pathways?
A concussion causes microscopic damage to brain cells, stretching or tearing nerve fibers, which disrupts communication between brain regions.
46
What symptoms result from disrupted neural signaling in a concussion?
Symptoms such as dizziness, headaches, cognitive difficulties, and impaired balance occur due to altered communication along affected neural pathways.
47
What is the range of linear force required for a concussion?
70-120 g’s of linear force.
48
What is the range of rotational force required for a concussion?
5,582-9,515 rad/s² of rotational force.
49
What force is generally associated with concussions?
Forces greater than 96.1 g’s and 5,582 rad/s² are typically seen in concussions.
50
What linear force is required to cause a subdural hematoma?
316 g of linear force is required for a subdural hematoma, according to estimates from MVA.
51
What is the force seen in hockey-related concussions?
18.4 g of linear force and 1465 rad/s² of rotational force.
52
What is the force seen in soccer headers for U14 girls?
20.4 g of linear force and 1940 rad/s² of rotational force.
53
What is the force seen in soccer headers for college girls?
19.8 g of linear force.
54
What percentage of concussions in soccer come from heading the ball?
Less than 10% of concussions in soccer are from heading the ball; the majority are from player contact.
55
What is the force from a jab in Olympic boxing?
58 g of linear force.
56
What is the force from a cross hook in Olympic boxing?
6343 rad/s² of rotational force.
57
What force is seen in motor vehicle accidents (MVA)?
Force in MVAs varies depending on speed and direction, but it can often exceed 100 g with high speed.
58
What is the mechanism of injury (MOI) for a concussion?
Any impact or force that causes damage to the brain.
59
What is the minimum requirement for diagnosing a concussion?
At least one symptom must be present.
60
What are the most common somatic symptoms of a concussion?
Headache (71%), Dizziness (55%), Fatigue (50%), Visual blurring/double vision (49%), Photophobia (47%), Balance problems (43%).
61
What are the most common cognitive symptoms of a concussion?
Feeling slowed down (58%), Difficulty concentrating (57%), Fogginess (53%), Memory dysfunction (43%).
62
Why are children more vulnerable to concussions?
Children have ongoing brain development, increased metabolic demands, more vulnerable brain structures, immature autoregulatory mechanisms, longer symptom duration, and axons that are not fully myelinated.
63
What should be done during on-field concussion management?
Team responsibility includes ruling out life-threatening concerns. Sideline assessment involves knowing your patient, using SCAT 6, performing cervical spine assessment, and CN testing in under 1 minute. When in doubt, sit out.
64
What are the red flags on the SCAT 6 for concussion?
Neck pain or tenderness, Seizure or convulsion, Double vision, Loss of consciousness, Weakness or tingling in more than 1 arm or legs (spinal cord injury), Deteriorating conscious state, Vomiting, Severe or increasing headache, Increasingly restless, agitated, or combative, GCS <15, Visible deformity of the skull.
65
How is concussion severity and outcome determined?
Severity and outcome are determined by the number of symptoms and the duration of symptoms.
66
What defines Persistent Concussion Symptoms (PCS)?
PCS is defined as more than 3 persistent symptoms at rest lasting 30 or more days following a concussion (Baker et al, 2012).
67
What are the causes of Persistent Concussion Symptoms (PCS)?
Autonomic dysregulation, which is an imbalance between the sympathetic and parasympathetic systems. This can affect blood flow, digestion, anxiety/stress, sleep problems, hormone imbalances, and cognitive problems.
68
What role does inflammation play in Persistent Concussion Symptoms (PCS)?
Increased inflammation is linked to the gut-brain axis, where gut permeability leads to immune response and inflammation. This affects the brain, causing symptoms like fatigue, fogginess, headaches, and difficulty concentrating. It is influenced by diet and stress, and prolonged inflammation can lead to hormone imbalances. Treatment includes diet adjustments.
69
How do visual, vestibular, and cervical systems contribute to Persistent Concussion Symptoms (PCS)?
If one of these systems sends different information to the brain, it can cause a feeling of disconnection and being "off." Often, untreated cervical issues contribute to these symptoms. WAD (Whiplash Associated Disorder) and concussion share similar symptoms, and any concussion can have WAD.
70
What are some mitigating factors for Persistent Concussion Symptoms (PCS)?
Sleep, as females report more sleep problems, and greater sleep disturbance is linked to more headaches. Mood changes are strongly correlated with cognitive problems. Negative expectations can worsen outcomes; patients told they would do poorly on cognitive tests performed poorly, while those told they would do well due to recovery performed better.
71
How does early physical activity affect Persistent Concussion Symptoms (PCS)?
Early physical activity leads to a lower risk of PCS compared to those who remain inactive (Grool et al., 2016). Active rehab is associated with a greater reduction in PCS (Chan et al., 2017), and cognitive and physical exertion during the first month post-injury is linked to improved outcomes (Sawyer et al., 2016).
72
What is Second Impact Syndrome?
Second Impact Syndrome occurs when a second concussion happens before the first has fully healed, leading to rapid and severe brain swelling, often catastrophic. The process starts with decreased self-regulation of blood flow in the brain after the initial concussion. A second impact, even with minimal force, can trigger another metabolic crisis, causing increased intracranial pressure, severe edema, possible herniation, irreversible brain damage, and/or death. It most often affects athletes under 21 years old.
73
What are the signs and symptoms of Second Impact Syndrome?
Catastrophic increase in intracranial pressure includes vasomotor paralysis, edema, massive swelling, herniation, and potentially death. Signs include dilated pupils (with light exposure), loss of eye movement, unconsciousness, respiratory failure, and death.
74
What are the key components of Day 1 in concussion management?
Baseline testing, assessment, treatment, and education.
75
What are the most common forms of baseline testing for concussions?
Computerized Neurocognitive Testing (ImPACT), SCAT 6, BESS test, and symptom checklist.
76
What is ImPACT Testing and what does it assess?
ImPACT (Immediate Post-Concussion Assessment and Cognitive Test) is a computerized neurocognitive test that assesses reaction time, attention, and short-term memory. It uses a series of memory-type tasks and takes 5-7 minutes to complete. It helps determine whether an athlete should be removed from activity and aids in tracking recovery.
77
What is the SCAT 6 test and what does it include?
SCAT 6 (Sports Concussion Assessment Tool) is a standardized tool used to assess a concussed athlete. It includes symptom checklists, cognitive and physical assessments, and balance tests. It is a comprehensive evaluation that helps clinicians determine the severity of a concussion and whether the athlete is fit to return to play.
78
What is the BESS test and how is it used?
The BESS (Balance Error Scoring System) test is a balance assessment used to identify deficits in balance following a concussion. It involves standing on different surfaces and in various stances while the tester counts errors. It’s used to assess balance dysfunction, which is a common symptom of concussions.
79
What does the Symptom Checklist assess in concussion baseline testing?
The Symptom Checklist is a series of questions where the athlete rates the severity of various symptoms related to a concussion, such as headache, dizziness, fatigue, and sensitivity to light. It helps track the athlete's symptoms and recovery over time.
80
What are Cognitive Neuropsychological Tests (CNT) and how are they used?
Cognitive Neuropsychological Tests (CNT) are used to measure mild degrees of cognitive impairment. They help assess cognitive functions like memory, attention, and problem-solving. CNTs can also gauge the effectiveness of an intervention, tracking changes in cognitive function over time.
81
What are key factors for success after a concussion?
Success after a concussion involves finding a trained professional, eating healthy, moderate rest for 24-48 hours, early rehabilitation with sub-symptom threshold exercise, and careful use of the BCTT. Cervical spine manual therapy, vestibular therapy, and addressing the ocular motor system are also important for recovery.
82
What are the dietary recommendations post-concussion?
Increase intake of Omega-3 fatty acids (EPA, DHA, and ALA) to aid with recovery. It is especially important to increase EPA and DHA which can be found in food and supplement form.
83
What should be done within the first 24 hours post-concussion?
Provide early nutrition, at least half the number of calories the athlete would consume on a regular basis. Do not restrict protein or calories.
84
What should you eat if you’re feeling nauseous after a concussion?
Consume a bland diet with familiar foods such as bananas, rice, applesauce, and toast.
85
What is the most important thing to recommend for hydration post-concussion?
Drink plenty of water! Recommend half the body weight in ounces (e.g., weight 150 lbs = 75 oz of water per day).
86
What should be avoided post-concussion?
Caffeine and alcohol. They can cause issues for the recovering brain.
87
What should be avoided in terms of food after a concussion?
Processed sugar/foods. It is better to replace them with natural, low-glycemic sweeteners like coconut sugar, agave, or honey. If soda is a must, recommend regular soda over diet/zero-calorie sodas.
88
What is the problem with artificial sweeteners post-concussion?
They trick the brain into thinking they have consumed calories, which can interfere with recovery.
89
Should fad diets be followed after a concussion?
No, a balanced diet is needed for the brain's recovery.
90
What are some good habits to maintain post-concussion?
Exercise regularly at a low to moderate level.
91
What is a good strategy for meals after a concussion?
Eat smaller meals more frequently.
92
What should be done to stay prepared with food?
Pack healthy snacks.
93
What should be emphasized in post-concussion nutrition?
Moderation and variety in your diet.
94
What is the purpose of the Buffalo Concussion Treadmill Test (BCTT)?
To assess cardiovascular fitness and determine the impact of exertion on concussion symptoms.
95
How does the BCTT work?
The patient begins walking on a treadmill at a low intensity, with the speed and incline gradually increased every 2 minutes until symptoms are provoked or a target heart rate is achieved.
96
What symptoms does the BCTT help assess?
It helps assess symptoms like dizziness, headaches, and fatigue during physical activity.
97
When is the BCTT typically used?
It is used after the initial rest period to safely determine the patient's tolerance to exercise post-concussion.
98
What is the purpose of the Buffalo Concussion Treadmill Test (BCTT)?
To assess the degree of exercise tolerance in patients with concussion, identify the Heart Rate Threshold (HRt) at which symptoms worsen, and establish a safe level of exercise for recovery.
99
How does BCTT help in concussion recovery?
It helps differentiate between concussion and other conditions like cervicogenic post-traumatic disorder and identifies physiological factors contributing to symptom exacerbation.
100
Why is identifying the Heart Rate Threshold (HRt) important?
It helps to identify the point at which concussion symptoms are triggered, guiding safe exercise levels and recovery progression.
101
What are the absolute contraindications for the Buffalo Concussion Treadmill Test (BCTT)?
Acute myocardial infarction, high-risk unstable angina, uncontrolled cardiac arrhythmias, symptomatic severe aortic stenosis, uncontrolled symptomatic heart failure, acute pulmonary embolus or infarction, acute myocarditis or pericarditis, and acute aortic dissection.
102
What are the relative contraindications for the Buffalo Concussion Treadmill Test (BCTT)?
Left main coronary stenosis, moderate stenotic valvular heart disease, electrolyte imbalance, severe arterial hypertension (>200 mmHg systolic or >110 mmHg diastolic), tachyarrhythmia or bradyarrhythmia, hypertrophic cardiomyopathy and other forms of outflow tract obstruction, mental or physical impairment leading to inability to exercise adequately, and high-degree atrioventricular block.
103
What is Step 1 of the Buffalo Concussion Treadmill Test (BCTT) protocol?
Step 1: Pre-Test Readiness Assessment. Once absolute and relative contraindications have been ruled out, determine if the patient is able to go through the BCTT by assessing their current subjective status. If the score is 7 or greater, do not continue. If the score is 6 or less, the patient may perform the BCTT.
104
What is Step 2 of the Buffalo Concussion Treadmill Test (BCTT) protocol?
Step 2: The warm-up. Set the patient up on the treadmill at 2.5 mph with a 0% incline for 2 minutes.
105
What is Step 3 of the Buffalo Concussion Treadmill Test (BCTT) protocol?
Step 3: The test. Increase speed to 3.3 mph with a 0% incline (3.0 mph for younger patients). After each minute, increase the incline by 1%. Continue for up to 15 minutes, to 15% incline. The test is performed with a heart rate monitor.
106
What is the Fail Criteria for the Buffalo Concussion Treadmill Test (BCTT)?
The patient experiences an increase (worsening) of their overall wellbeing score by 3 or more points (compared to their pre-test score).
107
What is the Pass Criteria for the Buffalo Concussion Treadmill Test (BCTT)?
The patient does not experience a worsening in their overall condition by 3 or more points before hitting one of the stopping criteria: reaching their age-adjusted max heart rate (220 minus their age) or reaching max exertion on the Borg Scale (18-20).
108
What does the Buffalo Concussion Treadmill Test (BCTT) help determine?
It helps determine the intensity to perform exercise.
109
How often and for how long should a patient exercise when prescribing an exercise protocol based on the BCTT?
The patient should exercise at least 5 times per week for 20-30 minutes at a rate of 80-90% of their symptom threshold.
110
What percentage of symptom threshold should non-athletes or deconditioned individuals exercise at?
Non-athletes or deconditioned individuals should exercise at 80% of their symptom threshold.
111
What percentage of symptom threshold should athletes or patients in strong physical condition exercise at?
Athletes or patients in strong physical condition should exercise at 90% of their symptom threshold.
112
What does passing the 80% level of sub-threshold heart rate (HR) indicate?
If a patient passes this level, the autonomic nervous system (ANS) is probably not the issue. Further evaluation should focus on vestibular, cervical, or other related systems.
113
What are the goals of cervical and VOMS testing?
To assess and address potential cervical dysfunctions (e.g., muscle tension, joint mobility) and vestibular/ocular motor impairments, both of which can contribute to concussion-related symptoms.
114
What does a cervical screen assess?
It assesses the cervical spine's range of motion (ROM), vertebrobasilar insufficiency (VBI), transverse ligament, alar ligament, and, if needed, the semicircular canals.
115
What does the VOMS (Vestibular Oculomotor Screen) assess?
It assesses: Smooth Pursuit, Convergence, Horizontal Saccades, Vertical Saccades, Horizontal VOR (Vestibular Ocular Reflex), Vertical VOR, and Visual Motion Sensitivity (VOR cancellation).
116
How is the VOMS (Vestibular Oculomotor Screen) scored?
Symptoms are rated on a scale from 1-10 following each activity. A score of 2 or greater is considered positive.
117
What is the connection between VOMS and fMRI?
On fMRI, the gaze and attention networks overlap (Corbetta et al, 1998). Attention and cognition often improve as vision is addressed in PT.
118
What is the purpose of the Smooth Pursuit test in VOMS?
Assesses the ability to track an object at slow speeds with smooth and controlled eye movements.
119
What is considered a "normal" result for the Smooth Pursuit test in VOMS?
The patient should be able to follow a target held at 3 feet away, moving 1.5 feet to the right and left, or up and down, without issues. Eye movements should be slow and controlled.
120
What are signs of an "abnormal" result in the Smooth Pursuit test in VOMS?
Signs include “catch-up” movements (rapid, jerky movements), losing track of the target, or difficulty following the target. These indicate impaired smooth pursuit.
121
What is the purpose of the Saccades test in VOMS?
Assesses the ability to adjust to rapid changes in eye movement by making quick, accurate shifts of gaze between two points.
122
What is the setup for the Saccades test in VOMS?
The test involves having the patient look at two points 3 feet apart and rapidly shift gaze back and forth for up to 10 repetitions.
123
What is considered a "normal" result for the Saccades test in VOMS?
Normal results involve accurate and smooth shifts in gaze with no difficulty in adjusting to the changes.
124
What is considered an "abnormal" result in the Saccades test in VOMS?
Abnormal results include poor judgment in distance between the points, overshooting or undershooting the target, or difficulty maintaining smooth eye movements.
125
What is the purpose of the Convergence test in VOMS?
Assesses the ability of both eyes to move in opposite directions and focus on a near target without experiencing double vision.
126
How is the Convergence test performed?
The patient focuses on a near target, and the distance is measured at which they begin to experience double vision (not blurriness). The test is repeated three times at middle, high, and low distances.
127
What is considered a "normal" result for the Convergence test in VOMS?
Normal convergence is considered when the patient experiences double vision at a distance of 10 cm or less in adults.
128
What is considered an "abnormal" result in the Convergence test in VOMS?
Abnormal results occur when double vision is experienced at a distance greater than 10 cm, indicating impaired convergence.
129
What is the purpose of the Vestibulo-Ocular Reflex (VOR) test in VOMS?
Assesses the ability to stabilize gaze as the head moves, testing the reflex that coordinates eye movements with head movements to maintain visual stability during motion.
130
How is the VOR test performed?
The patient moves their head 20º horizontally and vertically at 180 bpm for 10 repetitions while attempting to maintain visual focus on a target.
131
What is considered a "normal" result for the VOR test in VOMS?
Normal: The patient can maintain visual stability during head movements, with no significant difficulty stabilizing gaze.
132
What is considered an "abnormal" result in the VOR test in VOMS?
Abnormal: The patient experiences difficulty stabilizing gaze, showing signs of visual instability, or reporting symptoms like dizziness or discomfort during the test.
133
What is the purpose of the Visual Motion Sensitivity (VOR-C) test in VOMS?
Assesses the patient's ability to suppress the Vestibulo-Ocular Reflex (VOR) during rotational movements and maintain visual focus.
134
What symptoms does the Visual Motion Sensitivity (VOR-C) test help identify?
Helps identify symptoms related to difficulty in cars, busy environments, and visual disturbances during movement.
135
How is the Visual Motion Sensitivity (VOR-C) test performed?
The patient stands (or sits) with arms outstretched and thumbs up, moving their eyes and thumbs together while maintaining focus on the thumb.
136
What is the protocol for performing the Visual Motion Sensitivity (VOR-C) test in VOMS?
Perform the test at 50 bpm for 5 repetitions, having the patient stabilize vision while their head moves.
137
What is considered a "normal" result for the Visual Motion Sensitivity (VOR-C) test?
Normal: The patient can maintain visual stability at 50 bpm for 5 repetitions without significant difficulty or symptoms.
138
What is considered an "abnormal" result for the Visual Motion Sensitivity (VOR-C) test?
Abnormal: The patient experiences difficulty maintaining visual stability or reports dizziness, visual disturbance, or other symptoms during the test.
139
What is the main focus when treating concussion impairments?
Treat the specific impairments identified, such as vestibular, cervical, or cognitive issues.
140
Why is VOMS considered important for treatment?
VOMS serves as a useful tool to identify impairments and track progress, and it becomes part of the patient's homework.
141
What type of exercise is recommended for concussion recovery?
Sub-symptom threshold exercise is recommended to gradually increase tolerance without exacerbating symptoms.
142
How should exercise progress in concussion treatment?
Exercise should progress at the patient's speed, with close communication to ensure symptoms are managed effectively.
143
Why is communication important in concussion rehabilitation?
Good communication helps ensure that the patient progresses at a safe pace, and any symptom exacerbation is addressed promptly.
