Concussion Flashcards
(16 cards)
What type of injury is a concussion?
Diffuse axonal injury = shearing/stretching of axons
What is a concussion?
A mild TBI = external force that causes the brain to hit against the skull = bruising and swelling of the brain/tearing of blood vessels
General presentation
- GCS
- PTA
- LOC
GCS: 13-15
PTA: < 24 hrs
LOC: 0-30 mins
Highest age group affected by concussion and gender
15-24
Male
Main cause of concussion (top 3)
Falls
Traffic
Assaults
What percentage have persistent symptoms after 4 weeks
30%
Clinical symptoms are …. lived and spontaneously resolve in ….
Short lived
Usually <2-4 weeks
Pathophys
1: External force = brain slams against skull = DAI
2: K+ leaks out of brain cells, calcium enters = abnormal signalling + excess glutamate release
3: Brain tried to restore balance by producing a large amounts of ATP needed
4: Reduced blood flow and calcium overload impair the mitochondria limiting energy production
5: Mismatch between energy demand and supply leads to symptoms eg headache, confusion and slowed thinking
How is the ANS affected and what are the implications?
ANS = SNS will become overactive at rest and underactive during activity
PSN = underactive at rest = difficulties sleeping, etc
Implications: improve ANS balance with the beneficial effects of relative rest (24-48hrs)
In terms of SNS how is HR/HRV affected at rest
HR increases
Decreased HRV
Body isn’t appropriately swapping between sympathetic activity and parasympathetic recovery - heart is beating at more rigid/fixed intervals
Risk factors for delayed recovery from concussion
- High symptom severity
- Age (young/older)
- Females
- Continuing to play
- ADHD
- Mental health difficulties eg depression
What is assessed in concussion tools
- Red flags eg LOC, neck pain
- Signs eg seizure/lying motionless
- GCS
- Cervical spine Ax
- Coordination and ocular motor screening
- Memory Ax
- Athlete background eg previous hospitilisation
- Symptom eval
- Cognitive screen eg 5 words/numbers recited backwards
- Balance
Consensus statement
- Recognise
- Reduce risk eg rule changes ie high tackles /protective equip
- Remove - if in doubt sit them out
- Re-evaluate: thorough clinical Ax eg SCAT
- Rest and exercise = initial 24-48 hrs = light ex & minimise screen time 48hrs
- Refer if symptoms persist 4 weeks
- Rehab eg sub-threshold aerobic symptoms + more than 10 days of dizziness = cervicovestibular rehab
- Recovery: symptom free at rest and exertion. Normal cognition/balance/etc
- RTL - early return to ADL’s/modified school attendance eg rest breaks, extra time to complete assignments/homework, testing adjustments eg delay quiz
- RTS: < 19 not before day 21 post concussion & symptom free for 14 days
- Reconsider
- Retire (persistent symptoms, recurrent concussion)
Refine
What is the graded return to sport
1: Light intensity eg walking
2: Aerobic ex
- A - light eg 55% HR max
- B - Moderate eg 70% max
3: individual sport specific exercise eg running, COD (No activities risk of head knock
SYMPTOM RESOLUTION
4: Non-contact drills
5: Full contact practice
6: RTS
Graded return to learning/ADL
1: Typical activities: graded return. Start with 5-15 mins - no screen time (no more than mild exac)
2: School activites eg homework, reading outside of classroom
3: Return to school part-time
4: Return to school full time
When is cardiovascular and cerebrovascular physiological recovery achieved?
> 80% age predicted max HR x 20 mins without symptoms
