Final - Concussions

Question 1

concussion

Answer 1

sport related concussion is a traumatic brain injury induced by biomechanical forces

Question 2

pathophysiology

Answer 2

increase in neuronal depolarization - decrease K and increase Ca
increase Na K pump so you need more ATP and increased glucose metabolism
hypermetabolism decreases cerebral blood flow and increase glucose demand
depressed metabolism warrants unchecked Ca accumulation and can lead to cell death

Question 3

neurochemical changes in brain after concussion

Answer 3

will correct on its own within 2-4 days but repeated will not

Question 4

impairments of neurological function

Answer 4

rapid onset and short lived for minutes to days - can be up to 5 days until it comes out

Question 5

CT and concussion?

Answer 5

no - functional not structural unless its a bleed

Question 6

loss of consciousness and concussion

Answer 6

not a lot so dont get reported - less than 2 mins has no bearing of severity but more than 2 is more complex and CT is warranted

Question 7

how to identify a concusion

Answer 7

obersvation of event and B after

Question 8

when in doubt

Answer 8

sit them out for 24 hours for slightest suspicion and y days if one is diagnosed

Question 9

scat 5

Answer 9

5th symposium
sideline assessment and most tested/validated and quick and cheap stand alone tool - health care providers
most effective within first few days - longer the less valid
not sole diagnostic but an aid
standard for 13 and up
child for less than 12 yr - gen maturity

Question 10

3 red flags

Answer 10

vomitting
staggering
slurred speech

Question 11

6 observable signs

Answer 11

witnessed 
motionless - wind? thoughts? 
balance/gait 
confusion/inappropriate responses 
blank/vacant stares 
facial injuries

Question 12

maddocks

Answer 12

appropriated to environment and make it a convo

• venue
• half of game
• who scored last
• team played last week
• did you win last game?

Question 13

glasgow coma scale

Answer 13

best eye response
best verbal response
best motor
15/15 decrease and call an ambulance

Question 14

cervical spine assessment - 3

Answer 14

clear midline neck pain first
AROM
limb strength and sensation

Question 15

symptom score

Answer 15

fill out on their own and watch them
- more honest and fine motor functioning and focus, redo symptoms every time you see them
athlete background - age, gender, ed lvl, concussion hx, confounding things
26 symptoms 0-6

Question 16

cognitive testing

Answer 16

orientation - month, day, year, time
immediate mem - 5-10 unrelated words 3 times and repeat
digits backwards - increasing length
months in reverse order

Question 17

neurological screen

Answer 17

read out loud
PROM cervical
smooth tracking with no double vision
coordination of hand to nose
tandem gait - 10 m - eyes closed if needed
balance - double, single, non dominant, tandem, eyes closed, softer surface, turn your head - only count big errors

Question 18

delayed recalled

Answer 18

what were the 5/10 words i gave you?

Question 19

decision

Answer 19

scores from tests, and clinical judgment - when you decide to do a scat, the decision has been made that you are not going back - 24 hours

Question 20

tough on concussion guidelines

Answer 20

parachute canada and rugby

Question 21

no red flags?

Answer 21

no ER

Question 22

initial rest - 4

Answer 22

`alcohol, med (can be given from med professionals and med supervisions and they are resting , but we weant to know your symptoms), driving, PA

Question 23

treatment

Answer 23

detailed assessment - history, cognitive exam, visual and vestibular testing, cervical examination, other as warranted - physical exertiaonal, coordinaton - then do these while PA

Question 24

treatment plan

Answer 24

individualized

Question 25

complete vs relative rest

Answer 25

24-48 hrs decrease stim and sleep as much as you want - anxiety can mess up things and fck with the chemicals after 48 do as much as you can as long as you dont increase symptoms - or your brain gets good at doing nothing

Question 26

sleep hygiene

Answer 26

after 48 go back to typical sleep pattern - bed and wake up at the same time

Question 27

mental health

Answer 27

tell them the recovery rates

Question 28

academic and work

Answer 28

up to ind

Question 29

early interventions

Answer 29

good - PA after 48 hours 2 20 min walks a day

Question 30

treatmnet

Answer 30

cervical, visual, vestibular, cognitive, physiologic, anxiety, migraine - likely to express after concussion when in the family

Question 31

return to learn

Answer 31

have a convo - ASAP, breaks as needed, modified days, options on individualized basis, tolerate testing and hw - dont miss school becasue that makes them more anxious

Question 32

return to sport

Answer 32

``` school/work first stage not days must be symptom free stage before progress cant have 2 stages in 24 hours sport specific ```

Question 33

5 stages of returning to sport

Answer 33

``` light exertional - 20 min bike mod exertional - 20 min jog sport specific drill full practice without contact full practice with contact return to sport ```

Question 34

time line for return to play

Answer 34

min 7 days 2 rest and 5 RTP

Question 35

recovery

Answer 35

75-85% recover in less than 2 wks, kids 4 wks, 2% that dont recover on their own and have symptoms that go above a year

Question 36

second impact syndrome

Answer 36

``` sequential concussive blow while experiencing symptoms from prev acute metabolic response 4 days most critical long term brain damage possible <21 greater chance of sudden death ```

Question 37

baseline testing

Answer 37

``` does not change treatment <18 not recommended >18 limited clearing confounders and good hx can play some role in prevention - migraine anxiety and depression learning disability cervical muscle weakness motion sickness impaired visual perception ```

Question 38

the 3 cs

Answer 38

cerebral - orientation, concentration, mem cerebellar - balance and motor cranial nerves - neurological functioning

Question 39

cerebral main signs

Answer 39

``` LOC intellectual emotional though content sensory language ```

Question 40

cognitive tests

Answer 40

effect of head injury on cognitive function - status and improvement - serial 7s, months in reverse order

Question 41

how to test for optic nerve

Answer 41

blurred vision - read close up and far away - cerebral injury

Question 42

rhomberg test

Answer 42

static - normal sway eye closed and hands at side one foot, tandem, soft surface

Question 43

coordination - 4

Answer 43

finger to nose tandem walk standing heel to knee

Question 44

physical exertion - side line RTP

Answer 44

``` go through the whole thing and wait 15 mins if they only have bad balance, then ask in private if they want to go back sports specific pushup situp bear crawl burpies ```

Question 45

how many days for all your symptoms to go away?

Answer 45

21

Question 46

when to stop on stationary bike on day 1

Answer 46

when you feel bad