Concussion Flashcards
1
Q
Annual number of TBIs
A
- 1.7 million annually
- 80% of individuals go to the ER
- Unsure of how many people receive other medical care or no care
2
Q
Percentages of TBIs and causes
A
- Falls = 35.2%
- MVA = 17.5%
- Struck by or against = 16.5%
- Assault = 10%
- Unknown = 21%
- 83.5% are non-sports related injuries
3
Q
Definition of Concussion
A
- Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by a biomechanical force
4
Q
Mechanism of Injury
A
- Mechanical trauma to the brain as a result of an acceleration/deceleration force
- Direct blow to head, face, or neck
- Direct blow elsewhere on body with impulsive force transmitted to head
- Blast injury
5
Q
Pathophysiology of Mechanical Trauma
A
- Acceleration/deceleration force causes axonal stretching and deformation
- may or may not have LOC (4-10%)
- Rapid onset of short lived impairments
- Symptoms due to functional disturbance
- Neurometabolic changes result without visual abnormalities
- Physiologic changes at cellular level
- Neurons dysfunctional, not destroyed
6
Q
Primary blast injury definition
A
- Produced by contact of blast shockwave with body
- Stress and shear wave occurs in tissues
- Waves reinforced and reflected at tissue density interfaces
- Gas filled organs at risk
7
Q
Primary blast injury - typical injuries
A
Tympanic membrane rupture, blast lung, eye injuries, concussion
8
Q
Secondary Blast Injury definition
A
- Ballistic wounds produced by primary or secondary fragments that extends further than blast wave
9
Q
Secondary Blast Injury - typical injuries
A
- Penetrating injuries, traumatic amputations, lacerations, concussions
10
Q
Tertiary blast injury definition
A
- Blast wave propels individuals onto surface/objects or objects onto individuals - whole body translocation
- Crush injuries caused by structural damage and building collapse
11
Q
Tertiary blast injury - typical injuries
A
- Blunt injuries, crush syndrome, compartment syndrome, concussion
12
Q
Quartenary blast injury definition
A
- other explosion related injury, illness, or disease
13
Q
Quartenary blast injury - typical injuries
A
- Burns, inhalation injury ,injury from environmental containment
14
Q
Quinary injury definition
A
- Injuries resulting from specific additives such as bacteria and radiation
15
Q
What is most common type of blast injury?
A
Secondary
16
Q
Blast injury severities based on
A
- Initial strength of blast
- Environment which blast takes place (worse in closed space, fluid environment, closer distance from blast)
17
Q
Pathophysiology of neurometabolic cascade
A
increase energy demand + decrease blood supply = metabolic crisis –> inflammation
18
Q
Symptoms post-concussion
A
o Headache o Nausea o Vomiting o Balance problems o Dizziness o Fatigue o Trouble falling asleep o Sleeping more or less than usual o Drowsiness o Sensitivity to light or noise or both o Irritability o Sadness o Nervousness o Feeling more emotional o Numbness or tingling o Feeling slowed down o Feeling mentally foggy o Difficulty concentrating o Difficulty remembering
19
Q
Ascending Reticular formation
A
Arousal, attention, sleep-wake cycles, sensory integration
20
Q
Descending reticular formation
A
posture, equilibrium, autonomic function
21
Q
unknown reticular formation
A
control of gaze, eye movements
22
Q
Risk Factors of Concussion (Collins article)
A
Previous concussion Migraine Learning disability Sex (women > men) Age (younger, longer to heal) Motion sensitivity/ocular history
23
Q
Concussion clinical trajectories (Collins Article)
A
- Vestibular
- Ocular
- Cognition
- Migraine
- Cervical
- Anxiety
24
Q
Symptoms of concussion focused on during PT treatment
A
Vestibular
Ocular
Cervical
25
What varies in examination of patient with concussion than other patients?
History and tests & measures
26
Computer Based Neuro testing
cogsport
headminders
ANAM
ImPact
27
Normal Convergence
6-10 cm with corrected vision
28
Postural Control tests
- Dynamic posturography
- BESS Test
- CTSIB
29
What symptoms occur with concussion and whiplash injuries?
```
Headache
balance problems
dizziness
fatigue
sleeping less than usual
numbness/tingling
```
30
Symptoms predicting poor outcome
Foggy feeling
Difficulty concentrating
Vomiting
Dizziness
31
Etiology of dizziness
- Peripheral vestib disorders
- Central vestib disorders
- Orthostatic hypotension
- Ocular motor abnormalities
- Cervicogenic
32
What percentage of people with dizziness have etiology of BPPV?
<5%
33
PT interventions in patients with concussion
- Activity modification/patient education
- Vestibular rehabilitation
- Postural control retraining
- Exertional training
34
Prescription of exercises for concussion patients vs. vestibular hypofunction patients
- Fewer reps
- Decreased frequency
- Monitor for onset of symptoms
- Training for improved processing v. training for motor learning
- Head amplitude of movement 4-5 reps
35
What are the current principles of exertional training in patients with concussions?
Patients should begin training when they can tolerate exercise without provoking symptoms
OLD thought - do not exert until baseline symptoms resolve
36
Return to Play
- Symptom free at rest
- Back to baseline on neurocog exam
- Symptom free after exertion
- Medically cleared
- Complete 5 levels of exertional training
37
5 Stages of Exertional training
o 1. Light aerobic/conditioning, balance exercises in quiet space with limited head movement
o 2. Light to moderate aerobic/conditioning, balance exercises with head movement in gym type area; resistance exercise, low intensity sport specific exercise
o 3. Moderately aggressive aerobic exercises (intervals, stairs, etc.), all forms of strengthening, challenging positional changes, impact activities (running, plyometrics), more aggressive sport specific exercises; add concentration challenges
o 4. Resume aggressive training routines, maximal exertions
o 5. Full physical training activities with contact
38
Medication management of concussions target
1. headache
2. Sleep disturbance
3. Mood disorder
4. Cognitive impairments
39
Second Impact Syndrome
- Catastrophic cerebral edema after apparent TBI/concussion
- 2 hits close succession
- Coma & severe neuro deficits
- Often fatal and occur in young adults
40
Chronic Traumatic encephalopathy
- Neurodegenerative disease occurring years or decades after recovery from acute effects of head trauma
- Repeated axonal pertubations trigger a pathological cascade in susceptible individuals
- Insidious onset in mid-life, gradual course
- Behavioral, cognitive, and motor changes
- Suicide and drug overdose
