Concussion And Testing Flashcards by sophia carrasco

What kind of brain injury is a concussion considered

Mild traumatic brain injury

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What kind of deficits will a person w a concussion have (50-60%) of the time

Vestibular and oculomotor deficits

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What is our AP at rest

-70

Na+ is high outside

Cell is less postivie on the inside

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What is the sodium threshold and what moves in ? What is the potassium threshold and what moves out

-55 , calcium

30 , potassium

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What matter typically gets affected w a concussion

White matter

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Waht matter is mostly heavily myelinated axons and connects brain regions to help with learning , attention , and motor control and peaks in middle age

White

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What matter is mostly neuronal cell bodies and processes and transmits information and controls movements , memory and emotion amd fully develops in ur 20s

Gray

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On impact of a concussion what releases

Massive glutamate release and depolarization of brain cel;s

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What kind of axons are more prone to injury

Unmyelinated

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What is white matter damages more associated with

Cognitive impairments

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How much linear force is require for a concussion

70-120 g’s

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How much force is required for a subdural hematoma

316g

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What is the common force in hockey for a concussion (g and rad)

18.4 g
1465 rad

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How much force is seen w soccer headers for U 14 girls and colle girls

U14 girls
20.4 g;
College girls
19.8g

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How much force is seen from a Olympic boxer for a jab (g) and a cross hook (rad)

6343

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What is the criteria for a patient to have a concussion

MOI
1 symptom present

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What is the most common symptom of a concussion

Headache

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What are the common cognitive SYMTOMS?? And somatic ??

feeling slowed down
-difficult concentrating
-fogginess
-memory dysfucntion
headache
-dizziness
-fatigue
-visual blurring/ double vision
-photophobia a
-balance problem

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What are other somatic symptoms someone with a concussion can feel

nausea
vomiting
-phonophobia

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Are children or older adults more vulnerable to concussion

Children

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What are children more vulnerable to concussion

on going brain development
increased metabolic demand
more vulnerable brain structure
longer SYMTOMS duration
axons not fully myelinated

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What should u immediately do on field for a concussion

Rule out life threatening concerns

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What is the sideline assessment for concussion

know pt
SCAT 6
cervical spine assessments
perform CN testing in under 1 min
when in doubt sit out

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What does the SCAT 6 ask

postive observable signs
GCS < 15
neck pain , tenderness or loss of ROM
coordination or ocular motor screen abnormal
memory question score < 5

If any of these are yes then remove from play

What are the SCAT 6 red flags (10)

- neck pain or tender - seizure or convulsion - double vision - LOC - weakness or tingling in more then 1 arm or leg - deteriorating conscious state - vomiting - severe or increasing headache - restless , agitated or combative -GCS < 15 - visible deformity og the skull

What 4 things does the vestibular screening tool have

- vergence - VOR - cervical - balance

when determining the outcome and severity of concussion what matters

Number of symptoms Duration of symptoms

What is the **persistent concussion symptoms**

More than 3 persistent symotms at rest 30 or more days following a concussion

What is the 3 **causes** of PCS

Autonomic dysregualtion Inflammation Visual , vesetobualr and cervical systems

What does **autonomic dysregulation** affect for PCS (6)

1. Blood flow 2. Digestion 3. Anxiety/stress 4. Sleep problems 5. Hormone imbalances 6. Cognitive problems

What is the **gut brain axis**

Leads to increased permeability of gut

Who reports more sleep problems with PCS

Females which leads to more HA

What is associated with **greater reduction of PCS**

Active rehab - early physical activity

What is second impact syndrome

When 2nd conciussion occurs before the 1st concussion has properly healed

Who is the second impact syndrome most common in

Athletes under 21

What can happen w catastrophic increase in intracranial pressure w second impact syndrome

- vasomotor paralysis -edema -massive selling -hernimation -death

What are signs are **second impact syndrome**

- dilated pupils (w light) - loss of eye movement - unconsciousness - respiratory failure -death

What should u do **day 1** w a concussion

- baseline testing - assessment -treatment -education ** big

What are the 5 common forms of baseline testing for concussion

- computerized nueorgocitive testing - imPACT testing - SCAT 6 - BESS test - symptoms checklist

What does teh **imPACT testing** assess

Reaction time Attention Short term memory

What 4 things does it take for success after concussion

1. Find a good trained professional 2. Eating healthy 3. Moderate rest for 24-48 hours 4. Early rehabilitation

What is included in early rehab for concussion

1. Sub-symptom threshold exercise! 2. Too much can be detrimental (use the BCTT) 3. Cervical spine manual therapy 4. Vestibular therapy 5. Ocular motor system

What **acids** should u increase intake of **post concussion**

Omega 3 fatty acids

How much should the pt eat post concussion

Half the number of calories the athlete would consume Do not restrict protein or calories during the time

What is the **most important thing** to recommend for deitrary changed post concussion

Water!!! Half ur body weight in OZ

What things should u avoid after a concussion (4)

- caffeine and alcohol -processed sugar/foods - artificial sweeteners - fad diets

What test should u do **day 2 of concussion**

Buffalo concussion treadmill test

What does teh BCTT assess

Degress of exercise tolerance in pt post concussions

What does teh BCTT identifity and help with

Identify the HR at which concussion specific SYMTOMS occurs Help establish a safe level of exercise from treatment and differentiate between concussion and other possible diagnoses for symtoms

• Acute myocardial infarction • High-risk unstable angina • Uncontrolled cardiac arrhythmias causing symptoms or hemodynamic compromise • Symptomatic severe aortic stenosis • Uncontrolled symptomatic heart failure • Acute pulmonary embolus or infarction • Acute myocarditis or pericarditis • Acute aortic dissection These are all what kind of contras fro BCTT

Absolute

• 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 • High-degree atrioventricular block These are all what kind of contras for BCTT

Realtive

What are teh 3 seps of the BCTT protocol

Step 1: pre test readiness assessment (RPE) (if over 7 dont do it Step 2: warm up ( 2.5 mph w 0 incline for 2 mins) Step 3: the test

What is the test for BCTT protocol

Increased speed to 3.3 mph w 0 incline and after each minute increased incline by 1% , continue for up to 15 minutes to 15% incline Perform w HR monitor

What is the fail criteria for the BCTT

Patient experiences an increase (worsening) of their overall wellbeing score by 3 or more

How would a patient pass teh BCTT

Pt does not experience worse overall condtions by 3 or by reaching their age adjusted max HR or reaching max exertion on borg scale

What do u do **day 3 of concussion**

Cervical and VOMS testing

What is assessed in the cervical screen (5)

• Assess the cervical spine for ROM • Assess VBI • Assess transverse ligament • Assess alar ligament • Assess semicircular canals if needed

What is include in the VOMS (vestibular) screen

- smooth pursuit - convergence - saccades horizontal and vertical - VOR horizontal and vertical - VOR cancellation