Concussion

Question 1

Concussion

Answer 1

-graded I-III

Question 2

Brain Injury Continuum

Answer 2

• concussion
• mild brain injury
• moderate brain injury
• severe brain injury

Question 3

Grade I

Answer 3

• conscious but confused

- <15 min

Question 4

Grade II

Answer 4

• Conscious but has amnesia

- >15 min

Question 5

Grade III

Answer 5

-unconscious seconds or minutes

Question 6

What happens in concussion

Answer 6

• coup-contrecoup
• contusions
• axonal shearing/diffuse axonal injury

Question 7

Response to concussion

Answer 7

• microglia eat away dead tissue

- inflammation

Question 8

S/Sx

Answer 8

• headache
• dizziness
• NV
• loss of consciousness
• difficulty concentrating
• memory loss
• change in appetite
• difficulty sleeping
• irritability
• sadness

Question 9

1/3 concussions from:

Answer 9

-sports

other=MVA, falls

Question 10

Cause of concussion in age 1-2 years

Answer 10

-child abuse

Question 11

adolescent concussion causes (age 15-24)

Answer 11

realted to risk-taking behaviors (biking, sports etc)

Question 12

Elderly concussion cause

Answer 12

-falls

Question 13

Challenges with Elderly

Answer 13

• age-related issues
• variable baseline cognition and memory
• comorbidities
• medication (intrathecal bleeding)

Question 14

Diagnosis of Concussion

Answer 14

• SCAT 3 (20 min)
• Maddock’s Question (8 questions)
• SAC (6 min)
• BESS (5 min, balance)
• Canadian CT Head Rule
• Sports Palm Card
• Acute Concussion Evaluation Form(ACE)

Question 15

NFL Sideline Concussion Assessment Tool

Answer 15

• includes baseline test during pre-season
• given again at time of injury

-based on SCAT-2

Question 16

Acute Concussion Evaluation

Answer 16

• CDC recommended form for diagnosing concussions

- emergency & physician version

Question 17

Biochemical Markers of Concussion

Answer 17

• circulating proteasome activity in children with mild head injury
• significant increase after injury

Question 18

Complications

Answer 18

• 2x higher risk of epilepsy w/n first 5 years
• cumulative concussions: progressive impairments
• post concussion syndrome
• Second impact syndrome
• comvulsive motor phenomenon
• chronic traumatic encephalopathy
• Chronic Traumatic Encephalomyopathy

Question 19

Postconcussion Syndrome

Answer 19

• dizziness
• headaches
• thinking difficulties

-last up to several months

Question 20

Second Impact Syndrome

Answer 20

• getting a 2nd concussion before 1st has reslolved

- cause rapid and fatal cerebral edema

Question 21

Convulsive Motor Phenomena

Answer 21

-benign tonic posturing and/or convulsions immediately after concussion that resolve quickly

Question 22

Chronic Traumatic Encephalopathy

Answer 22

• progressive neurodegenerative disease caused by total brain trauma
• diagnosed only after death with Tau protein)

Question 23

Chronic Traumatic Encephalomyopathy

Answer 23

-motor neuron disease similar to ALS

Question 24

Brain chemistry changes my not resolve for:

Answer 24

at least 30 days

Question 25

Second Impact Syndrome can lead to:

Answer 25

-massive increase in intracranial pressure and brain herniation-->death

Question 26

Acute Concussion Management

Answer 26

- emergency management - clear with onsite HCP - clear CS injury - SCAT or other assessment sideline - assess cognition, CN integrity, balance - monitor next few hours/days

Question 27

if it lasts more than 10 days

Answer 27

it may indicate more than a mild brain injury (more than concussion)

Question 28

Best Practice

Answer 28

- don't return to play same day - physical/cognitive rest - progress to dual-task - return to play gradual - pt should be asymptomatic and on no meds that may mask S/Sx

Question 29

Progression of Rehab Stages

Answer 29

-only progress to next level if pt is asymptomatic for 2 hours

Question 30

Principles of Rehab

Answer 30

- balance - neurocognitive retraining - reaction training - avoid overloading sensory and motor systems - maintain postural control during dual tasks

Question 31

Gold Standard For Diagnosis

Answer 31

-none