PT for individuals with Concussions

Question 1

Acquired brain injury

Answer 1

after birth and applies to children and adults
can occur via traumatic causes such as injury or non traumatic causes such as disease, stroke, infection

Question 2

Examples of non- traumatic brain injury

Answer 2

stroke- hemorrhagic/ischemic
brain tumor
hypoxia/anoxia
dementia
encephalitis

Question 3

Examples of traumatic Brain injuries

Answer 3

diffuse:
-concussion
-diffuse axonial injury
-hypoxia anoxia

focal:
-subdural hematoma
-epidural hematoma

Question 4

Do you routinely image patients to diagnose mTBI

Answer 4

NO

Question 5

Define Concussion

Answer 5

traumatic brain injury induced by biomechanical forces. it may be caused by either a direct blow to the head, face, neck or indirect blow to the body that transmits forces to the head

Question 6

Clinical signs and symptoms reflect a _______ disturbance rather than a structural injury.

Answer 6

functional

Question 7

Do concussions always result of a loss of consciousness?

Answer 7

NO

Question 8

Is there a high prevalence of TBI related ED visits?

Answer 8

yes 2.8 million

Question 9

How do we classify a TBI?

Answer 9

Glasgow coma scale

Question 10

Score of 8 or less on GCS

Answer 10

severe

Question 11

Score of 9-12 on GCS

Answer 11

moderate

Question 12

Score of 13-15 on GCS

Answer 12

mild

Question 13

What are the top 3 causes for all types of TBIs?

Answer 13

falls -49%
MVA- 24%
other- 25%
-unintentionally being struck by or against an object
-unintentional self harm
-assault

Question 14

concussion mechanism is _____ not structural.

Answer 14

physiological

injury occurs resulting in alteration of neuronal membrane
increase cellular demand for ATP
increase glucose demand
deregulation of blood flow in brain
metabolic demand may be greater than supply

Question 15

are abnormalities shown on a neuro-image after a person has a concussion?

Answer 15

No

Question 16

Should an MRI be used to diagnose an MRI?

Answer 16

no

Question 17

What is the timeframe for recovery after a concussion

Answer 17

24 hours to 7-10 days

Question 18

What are some poor prognostic factors?

Answer 18

severity of acute and subacute symptoms
prior concussion
history of anxiety, depression or learning disabilities
cognitive deficits
females have greater risk than males

Question 19

Dizziness on field is associated with prolonged recovery true/false

Answer 19

true

Question 20

Dizziness can be a result of visual, peripheral and central vestibular disturbances

Answer 20

neck tightness, suboccipitals

Question 21

Risk of subsequent concussion increases ___X after the first event

Answer 21

3x

Question 22

What is second impact syndrome

Answer 22

rare but life treatening
results from a second injury when the brain is vulnerable
brain is still healing from the initial injury and is unable to regulate blood flow
Intracranial pressure builds in the brain and brainstem herniation can occur

Question 23

What is Post-concussive syndrome?

Answer 23

Persistence of at least 3 symptoms for >4 weeks

Question 24

Graded symptom checklist reliably identified mTBI for children aged____and older

Answer 24

6

Question 25

Patients with altered mental state at time of injury have increased number and severity of ____

Answer 25

symptoms

Question 26

What is chronic traumatic encephalopathy?

Answer 26

degenerative brain disease found in athletes, military veterans and others with repeated brain trauma families may report mood behavioral or cognitive changes that progressively develop following consecutive injuries

Question 27

When is Chronic traumatic encephalopathy diagnosed?

Answer 27

after death with autopsy

Question 28

What are some signs and symptoms of concussion?

Answer 28

headache nausea vomiting balance/dizziness sensitivity to light/noise fatigue depression trouble falling asleep

Question 29

Signs and symptoms of concussion are rapidly ____ and short lived and resolve _____.

Answer 29

occurring and resolve spontaneously

Question 30

What is the gold standard for evaluating concussions? when does it take place

Answer 30

Sports concussion assessment tool (SCAT-5) within the first 24 hours after injury

Question 31

What information do you need for the Standardized assessment of concussion?

Answer 31

SAC needs to be compared to baseline

Question 32

How many conditions are included in the balance error scoring system?

Answer 32

6 conditions

Question 33

The high level mobility assessment tool is used to assess patients who suffer from what?

Answer 33

high level balance and mobility problems 13 items

Question 34

What do you do in the buffalo concussion treadmill test?

Answer 34

obtain resting HR, BP, VAS, RPE then repeat every minute 1 point for worsening symptoms and 1 point for increasing new symptom

Question 35

What are some warning signs that need immediate referral to emergency care

Answer 35

1. cervical instability/fracture 2. neurologic signs -reflex changes -weakness -sensory chagnes -CN abnormalities -seizure 3. prolonged Loss of conciousness 4. HA that is progressing 5. altered mental status beyond acute stage or deteriorating mental status 6. HTN Autonomic dysregulation

Question 36

Domaine to examine and treat: Cervical spine

Answer 36

Palpation stability testing flexibility mobility testing Cervical strength testing Upper quarter screen

Question 37

What are some exams for cervicogenic dizziness

Answer 37

smooth pursuit neck torsion test joint position error test head neck rotation

Question 38

What are some interventions for cervical spin interventions

Answer 38

ROM Stretching Progressive resistance exercise mobilization suboccipital release proprioceptive training oculomotor and balance retraining

Question 39

After concussion what exam should be used to assess balance

Answer 39

BESS

Question 40

If you observe gaze holding nystagmus or other central signs after concussion what should you do?

Answer 40

refer reflex should normalize within 48-72 hours

Question 41

During VOR if target slips or blurs can be caused by two things what are they

Answer 41

vestibular hypofunction- infection should heal and recover within 24-48 hours caused by central dysfunction- refer concern

Question 42

What is senate bill 40

Answer 42

requires training of coaches on removal from play no same day return to practice notify parent medical clearance for RTP

Question 43

What does the colorado concussion law return to sport state

Answer 43

must be free of concussion symptoms >24 hours attending full days of school tolerating full academic workload off any medication started for concussions no same day return to play with or without scat-5

Question 44

What are some sideline assessment red flags

Answer 44

neck pain tenderness double vision weakness tingling in arm/leg severe or increasing headache seizure or convulsion loss of consciousness deteriorating conscious state vomiting increasing restless

Question 45

When should a kid return to school

Answer 45

brief 24-48 hour period of rest followed by gradual return to activity

Question 46

Treatment cervical spine

Answer 46

soft tissue cervical spine cervical strengthening cervical proprioception

Question 47

treatment cardiovascular deconditioning

Answer 47

buffalo concussion treadmill test graded exercise

Question 48

treatment vestibular involvement

Answer 48

smooth pursuits, saccades, convergence and vertical VOR teach settling technique set patient expectations on symptom development

Question 49

What is the criteria for progression in treatment

Answer 49

decline in symptoms able to remain symptom free during aerobic conditioning tolerate increasing resistance incorporate dual task return to running spriting and agility