Concussion Clinical Profiles - Return to Learn and Sport

Question 1

CDC definition of concussion

Answer 1

type of traumatic brain injury-or TBI caused by a bump, blow, or jolt to the head or by a hit to the body

Question 2

what is the CISG definition of sport related concussion (SRC)

Answer 2

initiation of neurotransmitter and metabolic cascade

possible axonal injury, blood flow change, and inflammation

signs and symptoms can present immediately or evolve over time

no abnormality on standard structural neuroimgaing

Question 3

what are the metabolic changes associated with concussions

Answer 3

calcium influx (in)
potassium efflux (out)
glutamate release (always bad)

Question 4

what does metabolic change affect?

Answer 4

neurotransmission

Question 5

explain blood flow dynamics with a concussion

Answer 5

demand for blood is increased but blood flow rate reduces

Question 6

what is relevant for healthcare providers that treat individuals with SRC

Answer 6

consensus statement on concussion in sport

Question 7

what is the composition of the consensus statement on concussion in sport

Answer 7

12 R’s

Question 8

in the first 24-48 hrs post concussion, what occurs

Answer 8

assessment done by ATC or MD on sideline

Question 9

what does the ATC or MD assess for after concussion

Answer 9

Glascow Coma Scale
C-spine
symptoms
cognition
memory
static balance

Question 10

what will red flags warrant post concussion

Answer 10

further imaging

Question 11

what are the red flags related to concussion

Answer 11

neurological changes
increasing headache
loss of consciousness
deteriorating level of consciousness
repeated vomiting
combative state
seizures
convulsions

Question 12

what is educated to patient’s support system post-concussion

Answer 12

how to assess for red flags and what to do if present

fear of subdural / epidural hematoma

Question 13

when is imaging recommended following SRC

Answer 13

LOC or red flags

Question 14

what does the IMPACT symptom checklist do that most others don’t

Answer 14

assesses psychological symptoms, sleep and balance

Question 15

recommendations during acute phase SRC recovery

Answer 15

relative rest from ADL’s (48hrs)
reduced screen time (48hrs)

light intensity as long as symptoms are only mildly exacerbated

Question 16

what is symptom exacerbated threshold defined as

Answer 16

activity that does not bring on or worsen symptoms from baseline measurements

Question 17

what does recovery have to include

Answer 17

resolution of symptoms

return to learn

return to play

Question 18

what do a majority of individuals with SRC experience prognostically

Answer 18

recovery within 7-10/14 days

Question 19

what do some patients experience post SRC prognostically

Answer 19

recovery within 2-4 weeks
– with follow-up treatment and/or assessment

Question 20

what do a small subset of patients with SRC experience prognostically

Answer 20

persistent symptoms beyond 4 weeks
- will require interdisciplinary care

Question 21

what is the strongest predictor of recovery

Answer 21

severity of initial symptoms

Question 22

risk factors for prolonged recovery include

Answer 22

younger age
female sex
previous concussion(s)
history of learning disorders
history of mental health conditions
history of migranes

Question 23

what are some pre-injury conditions to consider when assessing patient post-SRC

Answer 23

visual, oculomotor, cervical or vestibular problems

sleep disturbances

dysautonomia (ie POTS disease)

pain

Question 24

what are the concussion clinical profiles

Answer 24

vestibular
ocular
cognitive/fatigue
migraine
anxiety/mood

Question 25

s/s of cognitive profile SRC

Answer 25

difficulty: thinking remembering concentrating mental speed fatigue / decreased energy nonspecific headache sleep disturbances change in academic/occupational performance

Question 26

explain headache symptoms in those with cognitive concussion

Answer 26

worsens with cognitive activity

Question 27

what is the assessment for those with cognitive profile SRC

Answer 27

neurocognitive testing

Question 28

risk factors for those with cognitive SRC

Answer 28

continued play after hit attention/learning disorders poor quality of sleep prior to SRC

Question 29

what is neurocognitive testing?

Answer 29

something like IMPACT testing

Question 30

cognitive profile SRC management

Answer 30

academic/work accommodations behavioral regulation stimulant medications

Question 31

vestibular profile SRC s/s

Answer 31

dizziness imbalance nausea lightheadedness fogginess motion sickness

Question 32

when do symptoms of vestibular SRC worsen

Answer 32

head movement

Question 33

risk factor for vestibular SRC profile

Answer 33

prior motion sickness

Question 34

assessment for those with vestibular SRC profile

Answer 34

oculomotor exam (VOMS) postural control (tandem walk f/b with a dual task)

Question 35

likelihood for patient with SRC to be in vestibular profile

Answer 35

50%

Question 36

ocular SRC profile S/S

Answer 36

blurred/double vision trouble focusing frontal HA/pressure fatigue w/reading or computer work

Question 37

assessment of ocular profile SRC

Answer 37

oculomotor exam VOMS

Question 38

explain prognosis of those with ocular profile SRC

Answer 38

risk of prolonged recovery BUT no known risk factors

Question 39

explain management of ocular profile SRC

Answer 39

vestibular rehab habituation

Question 40

s/s of migraine profile SRC

Answer 40

moderate-to-severe pulsating HA with nausea and/or photosensitivity/phonosensitivity

Question 41

what is the most common symptom post concussion

Answer 41

headache

Question 42

what may be associated with migraine profile SRC

Answer 42

sleep dysregulation and anxiety/mood disturbance symptom worsening under stress or exercise decline memory / mental speed on neurocognitive testing risk of longer recovery

Question 43

explain management of migraine / post traumatic headache

Answer 43

aerobics maybe meds -- if migraine, refer to headache specialists

Question 44

symptoms related to anxiety/mood profile SRC

Answer 44

depression anxiety emotional fluctuations moodiness / irritability sleep dysregulation exaggerated/inconsistent symptoms

Question 45

what to be mindful of when treating those with SRC

Answer 45

influence of mental health on physical symptoms patient may not recognize the interconnectedness of psychology and physiology

Question 46

indications of underlying emotional disturbance

Answer 46

inconsistencies in symptoms/performance on neurocognitive testing worsening of symptoms overtime

Question 47

risk factors for anxiety/mood profile SRC

Answer 47

prior mental health condition -- can indicate prolonged recovery

Question 48

anxiety/mood SRC profile management

Answer 48

counseling / psychotherapy cognitive-behavioral therapy exposure therapy

Question 49

modifiers of SRC

Answer 49

cervical / sleep

Question 50

what are cervical modifiers of SRC? what to do with this information?

Answer 50

loss of ROM pain / paresthesias weakness ---- need to follow neck pain CPG

Question 51

sleep modifiers of SRC

Answer 51

excessive daytime sleepiness multifactorial and can be detrimental to other profiles/symptoms related to them

Question 52

what is the timeline associated with return to sport strategy

Answer 52

progression of steps typically takes a minimum of 24 hrs -- may begin step 1 within 24 hrs of injury

Question 53

steps in return to sport strategy

Answer 53

1 - symptom limited activity 2 - aerobic exercise 3 - individual sport-specific exercise 4 - non-contact drills 5 - full contact practice 6 - return to sport

Question 54

explain activity at step 1 of return to sport strategy

Answer 54

daily activities that do not exacerbate symptoms

Question 55

explain the division of stage 2 return to sport

Answer 55

2a - light aerobics (55% of maxHR) 2b - moderate (70% of maxHR)

Question 56

activity related to step 2 return to sport

Answer 56

stationary cycling/walking slow to medium pace start light resistance training if below symptom exacerbated threshold

Question 57

when can steps 4-6 of return to sport protocol begin

Answer 57

resolution of: any symptoms abnormalities in cognitive function

Question 58

in TN who can make return-to-play decisions

Answer 58

MD DO or neuropsychologist w/concussion training

Question 59

explain the steps in return to learn protocol

Answer 59

1 - daily activities below symptom exacerbation threshold 2 - school activities 3 - return to school part time 4 - return to school full time

Question 60

activity related to returning to school part time

Answer 60

gradual introduction of school work may need partial school day or access to rest breaks

Question 61

activity related to return to school full time

Answer 61

gradual progression in activities if a full day can be tolerated without more than mild symptom exacerbation

Question 62

what is mild exacerbation of symptoms quanitified as

Answer 62

no more than 2 pts on a 0-10 scale for less than 30 min when compared to baseline