L1 Mild TBI

Question 1

define concussion/mild TBI

Answer 1

1. observed/self report of confusion, disorientation, impaired consciousness, memory dysfx around time of injury, loss of consciousness lasting < 30 min
2. alteration of consciousness for 24 hrs (GCS)
3. post traumatic amnesia <24 hrs
4. GCS 13-15 30 min post injury

Question 2

glasgow coma scale is used when?

Answer 2

after a TBI or head trauma
to assess level of consciousness for inpatient setting and track changes

Question 3

components of GCS

Answer 3

eye response
motor response
verbal response

Question 4

GCS scoring: eye

Answer 4

4. eyes open spontaneously
5. open eyes to verbal command
6. eyes open to pain
7. no eye opening

Question 5

GCS scoring: motor

Answer 5

6. obeys commands
7. localizes pain
8. withdraws from pain
9. flexion response to pain
10. extension response to pain
11. no motor response

Question 6

GCS scoring: verbal

Answer 6

5. oriented
6. confused
   3, inappropriate words
7. incomprehensible sounds
8. no verbal response

Question 7

structural damage of mild TBI

Answer 7

no structural changes and minimal to no cell death
as opposed to mod/severe which has structural brain injury and cell death

Question 8

girls vs boys in sports concussions

Answer 8

girls more likely to report
girls more likely to have mental health, severe, or long lasting symptoms
fewer research on girls and concussions
fewer ATs available at games for care of young female athletes
may be more prevalent due to weaker cervical stabilizers in girls

Question 9

CDC definition of mild TBI

Answer 9

caused by blow/jolt to head, causing brain to move back and forth
creates chemical changes and stretches/damages brain cells in more mod injury

Question 10

imaging results of mild TBI

Answer 10

normal MRI or CT
does not mean brain function is normal

Question 11

causes of TBI

Answer 11

direct: local injury
coup/contracoup: acceleration/deceleration injury affecting front and back of brain, stretching in the middle
blast injury with diffuse injury

Question 12

what age groups are most likely to get concussion

Answer 12

10-17 y/o
risk also increases after 70 y/o due to falls

Question 13

red flags after a concussion

Answer 13

headache that worsens
drowsiness, can’t be awakened
can’t recognize people/place
repeated vomiting
confusion/irritability
seizures
weak/numb arms and legs
unsteadiness/slurred speech
worsening dizziness
worsening disequilibrium
double vision

all are possible signs of a brain bleed

Question 14

timeline for improvement in concussion symptoms

Answer 14

7-14 days
maybe 3 weeks

Question 15

s/s of concussion

Answer 15

irritability
anxiety
sadness
inability to sleep
sensitivity to lights and sound
memory loss
concentration and attention decreased
cognitive fatigue from reading
loss of coord/speed/dexterity
balance, ocular function impairment

Question 16

metabolic pathology of concussion

Answer 16

1. axonal damage
2. neuroinflammation
3. ionic dysfunction of glutamate
4. energy crisis

Question 17

axonal damage in concussion

Answer 17

may or may not be present
recovers with remyelination over time
generates lots of the recovery seen after TBI

Question 18

neuroinflammation in concussion

Answer 18

microglia activated by injury, create inflammation
creates excitotoxicity leading to cell damage

Question 19

ionic dysfunction in concussion

Answer 19

membrane homeostasis is disrupted, leading to excess glutamate release
increased excitation reduces brains ability to inhibit when needed

Question 20

energy crisis in concussion

Answer 20

excess excitation leads to mitochondrial dysfunction and energy depletion or oxidative stress
hypermetabolism with more brain areas active than needed
creates fatigue

Question 21

effects of increased brain metabolic activity after concussion

Answer 21

reduced efficiency
reduced information processing
reduced dual tasking
reduced divided attention
increased fMRI brain area activation
increased fatigue
increased sensitivity to environmental stimuli

Question 22

vestibular system takes what input?

Answer 22

1. angular acceleration/rotation
2. head position relative to gravity

Question 23

3 cranial nerves of oculomotor system

Answer 23

3oculomotor

4trochlear

6abducens

Question 24

lateral vestibular tract gets info from:

Answer 24

primarily LE

Question 25

medial vestibular tract gets info from

Answer 25

cervical and thoracic muscles

Question 26

vestibulocerebellar tract control:

Answer 26

coordination

Question 27

Why is visual pathway likely to be injured in concussion? | How many patients % have VOR deficits?

Answer 27

long pathways likely to be stretched with movement of the brain VOR impairments in 29-69% mTBI

Question 28

VOR is?

Answer 28

gaze response - vestibulo-ocular reflex uses vestibular nucleus to move eyes to stabilize gaze while the head is moving allows the eyes to stay focused on objects while the body and/or head it moving by adjusting position

Question 29

dizziness vs vertigo vs disequilibrium

Answer 29

dizziness: light headed feeling/off balance caused by OH, alc, not sleeping, dehydration vertigo: world/room is spinning, caused by inner ear dysfunction disequilibrium: vestibular issue

Question 30

post concussion syndrome | how many %, who is it most common in?

Answer 30

symptoms lasting > 6 weeks (motor, cognitive, behavioral) about 20% of concussions more common in women

Question 31

most common post concussion syndrome symptom

Answer 31

headaches that reoccur

Question 32

physiological effects of post concussion syndrome

Answer 32

neuroinflammation causing brain changes lower hippocampal volume increased cell death smaller thalamus limbic atrophy

Question 33

s/s of post concussion syndrome

Answer 33

headache dizziness fatigue concentration poor anxiety depression irritability reduced sleeo light/noise sensitivity blurred vision inability to habituate enviro stimuli exertion worsening symptoms

Question 34

migraine headache

Answer 34

UL pain with thorbbing/pulsating

Question 35

tension headache

Answer 35

BL headache

Question 36

vestibular symptoms post concussion

Answer 36

disequilibrium, peripheral or central BPPV - peripheral nausea/vomiting/nystagmus - central

Question 37

VPR symptoms post concussion

Answer 37

impaired saccade initiation impaired saccade accuracy slower gaze movements decreased visual motor symmetry

Question 38

autonomic symptoms post concussion syndrome

Answer 38

BP: losses autoregulation reduced exercise tolerance from vasocontriction + anxiety, depression, irritability, sleep loss, memory impairments

Question 39

areas to include in initial concussion examination

Answer 39

VOR autonomic C spine dysfunction once these 3 areas are clear pt can start sport specific training

Question 40

history after concussion

Answer 40

MOI: twist, impact, accel/decel, direction of impact and speed loss of cx post traumatic amnesia loss of orientation after event loss of postural control

Question 41

physical/cervical assessment with mTBI | What are you assessing in cervical exam?

Answer 41

if pt has cervical whiplash and headache neck pain/headache cervical injury causing proprioception/balance issue

Question 42

visual oculomotor assessment after mTBI

Answer 42

eye symmetry: saccades, tracking/reading vision: convergence, accommodation

Question 43

vestibular assessment after mTBI

Answer 43

VOR what direction, velocity, head position provokes symptoms

Question 44

function assessment after mTBI

Answer 44

attention level concentration ability postural control in walking, head movements autonomic function

Question 45

rule out cervical injury after concussion

Answer 45

extension/rotation exam palpate for cervical muscle tenderness facet dysfunction

Question 46

accomodation

Answer 46

ability of eye to adjust lens to focus vision at varying distances from the eye

Question 47

vergence

Answer 47

movement of the eyes in synch and symmetrical to track objects

Question 48

convergence

Answer 48

ability of eyes to move medially towards nose to center vision on close objects

Question 49

Should concussion patient push through symptoms?

Answer 49

No! Stop activity when symptoms start pushing through will only exacerbate the energy crisis/metabolic inefficiency

Question 50

Rivermead self report scale for concussion: assesses what?

Answer 50

assesses physical, cognitive, and behavioral symptoms over time to assess post concussion syndrome

Question 51

King Devick

Answer 51

rapid naming numbers assess eye movement, attention, language, general brain function compare before/after times injury and treatment

Question 52

graded exertional tolerance exam for post concussion syndrome

Answer 52

performed to determine if exertion provokes symptoms such as poor endurance due to autonomic symptoms graded aerobic exercise with incrememtnal increases, marking time, mode and symptoms onset

Question 53

BESS

Answer 53

balance error scoring system used in post concussion syndrome to assess postural control a form of modified CTSIB with 6 positions, 3 firm ground 3 foam, count errors for 20 s each position