What is a mild TBI?
mTBI involves a traumatically induced physiological disruption of brain function, as manifested by at least one of the following
- any period of loss of consciousness
- any loss of memory for events immediately before or after the accident
- any alteration in mental state at the time of the accident (e.g feeling dazed, disorientated, or confused); and
- focal neurological deficit(s) that may or may not be transient but the severity does not exceed loss of consciousness less than 30 minutes, a GCS score of 13-15 and post trauma amnesia not greater than 24 hrs.
What is a sport related concussion?
How long do symptoms last?
Where is the damage usually found on the brain physically?
head trauma from sport activity which typically results in rapid onset of short lived impairments of neurological function that resolves spontaneously but the signs and symptoms can evolve over a number of minutes to hours
resolution of symptoms usually follows a sequential course but effects can be prolonged
neuropathological changes are reflected functionally but not always physically and so damage usually will not show up in imaging
True or False: The terms concussion and mTBI are typically used interchangeably, despite some experts that believe the term concussion is too generic and has no pathological meaning.
True
What are the symptoms of a concussion that effect thinking/remembering?
- difficulty thinking clearly
- feeling slowed down
- difficulty concentrating
- difficulty remembering new information
What are the symptoms of a concussion that are physical?
- headache
- fuzzy or blurry vision
- nausea or vomiting
- dizziness
- sensitivity to noise or light
- balance problems
- feeling tired, having no energy
What are the symptoms of a concussion that effect the emotions/mood?
- irritability
- sadness
- more emotional
- nervousness or anxiety
What are the symptoms of a concussion that effect sleep?
- sleeping more/less than usual
- trouble falling asleep
What is the problem with using the Glasgow Coma Scale for screening for concussions?
There is a 15-20% chance for individuals to develop traumatic intracranial brain hematomas even if a patient has a perfect 15 GCS score
What is the problem with using the ImPACT screening tool for screening for concussions?
inconsistent results, has high error rates and can be easily misled by neurological factors unrelated to concussions
What does the SCAT5 (sports concussion assessment tool-5th edition) screening tool assess for in concussion screening?
screens with an immediate/on-field assessment that looks for red flags, observable signs, memory assessment, GCS, and assess the C spine
also incorporates an off-field assessment
What does the VOMS (vestibular/ocular-motor screening) tool screen for in possible concussion patients?
How is this screening tool scored?
- assesses smooth pursuits (horizontal and vertical)
- saccades (horiz. and vert.)
- Convergence
- Visual motion sensitivity
- VOR (horiz. and vert.)
scored on a 0-10 scale for headache, dizziness, nausea, and fogginess
What is included in the cervical exam for concussion screening?
ROM
Pain w/ palpation/isometric contraction
What is included in the visual exam for concussion screening?
- extra-ocular eye movements (smooth pursuit, saccades, convergence)
- Vestibular ocular reflex (VOR)
- dynamic visual acuity
How do you test for BPPV?
Test canals (post., ant., and lateral canals)
What is included in the balance exam for concussion screening?
-BESS Test (balance error scoring system) is recommended for sideline screening as it is very similair to mCTSIB but may be better for higher level patients/athletes
Sensory Organization Testing via Modified Clinical Test of Sensory Integration and Balance (mCTSIB)
-this test is better for wide age range or non-athlete patients
True or False: footwear and foot position has not been shown to affect score for the mCTSIB screen.
True
What are some issues for screening young children for concussions? How are these issues addressed?
they may not be able to report symptoms;
look for behavior changes, excess crying, vomiting (soon after injury), and loss of new skills
What are some issues for screening older people for concussions?
- brain atrophy may result in more severe injury due to coup/contre-coup action
- symptoms of mTBI could be attriubted to other co-morbidities such as a seizure, dehydration, dementia, etc.
True or False: Physical Therapists are usually the only other professional besides the referring physician who treats a concussion patient.
False, intervention and management for concussions or mTBIs is a multidisciplinary approach and has a wide cast of professionals
What are the principles for active rehab post concussion?
rest 24-48 hrs. post concussion
start light activity as tolerable after that period; adolescent athletes that rested 5 days had slower recovery
for post-concussive syndrome patients should be given graded cardio exercise and have presenting symptoms treated
