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TBI - 1b Mild TBI Flashcards

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1
Q

how is the SCAT used as a tool

A

eval concussion by assessing cognition, physical damage, and memory recall

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2
Q

what is chronic traumatic encephalopathy (CTE)

A

progressive degenerative disease of brain found in athletes (and others) w hx of repetitive brain trauma - including symptomatic concussions and asymptomatic concussive hits to head

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3
Q

what is the pathophysiology behind CTE

A

trauma triggers progressive degeneration of brain tissue
- including build-up of abnormal protein called tau

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4
Q

when is the onset of CTE in athletes w hx of repetitive brain trauma

A

changes in brain can begin months, years, or even decades after last brain trauma or end of active athletic involvement

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5
Q

what sx is the brain degeneration seen in CTE associated with (7)

A

memory loss
confusion
impaired judgment
impulse control problems
aggression
depression
progressive dementia

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6
Q

how can the presence of tau be assessed

A

biopsy of brain

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7
Q

what type of TBI is the most common of all TBIs

A

mild

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8
Q

what sports have the highest concussion incidence for males vs females

A

males - football
females - soccer

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9
Q

what is a major factor in the incidence of sports-related concussions

A

likely under-reported

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10
Q

why are sports-related concussions likely under-reported

A

LOC is rare (<10%)
close to 50% of athletes don’t feel sx immediately after injury -> go back on field

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11
Q

why would mTBIs be seen in the elderly

A

falls

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12
Q

what gender has a higher incidence of mTBI and why

A

males > females
may be d/t riskier behaviors

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13
Q

why is there a growing number of combat veterans w mTBIs

A

large number of IEDs and better armor
-> more veterans surviving serious attacks

not necessarily from head force, but being in close vicinity to IED that when exploded rattled the brain

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14
Q

what are mTBIs complicated by in combat veterans

A

polytrauma
PTSD

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15
Q

what are the 4 categories of s/sx of mTBIs

A

physical
cognitive
emotional
sleep

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16
Q

what are physical s/sx associated w mTBIs

A

HA, dizziness, balance disturbance, n/v
vestib/ocular disturbances
sensitivity to light/noise

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17
Q

what are s/sx that you should go to the ER for (11)

A

changes in alertness/LOC
persisting confusion
mood changes
HA persists/worsens
seizures
dizziness
walking or balance problems
unequal pupils / unusual mvmts
slurred speech
ms weakness on one/both sides
repeated vomiting

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18
Q

why do you want to keep someone awake or arouse at intervals after a head trauma

A

to check cognition
if feel sleepy and can’t stay alert -> go to ER

from pharm management - want to avoid meds w SE of drowsiness/confusion
- would rather take Tylenol over motrin bc avoid blood thinners

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19
Q

what are 3 components of medical management of a mTBI

A

greater awareness and inc dx
prevent re-injury and manage sx
rest

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20
Q

what is the biggest thing for PTs in terms of medical management of mTBIs

A

education on when to report
- coaches, ATs, athletes

baseline neurotesting for comparison

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21
Q

how does legislation prevent re-injury after a mTBI

A

protects young athletes as coaches required to screen, remove from play until medically cleared

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22
Q

what is the NFL doing to prevent re-injury and manage mTBI sx

A

“Madden rule” and funds for studying concussion & CTE

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23
Q

what is the current recommendation for rest after a mTBI

A

minimize rest to 1-2days and then guide into suitable activity

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24
Q

why is rest an important part of medical management of a mTBI

A

physical and cognitive rest will result in recovery in <2wks for the majority of people

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25
what is the consensus post-concussion
no agreed consensus on what the appropriate amt of rest is clear consensus that some degree of rest is important for a period of time
26
what was the old approach to post-concussion rest that should be avoided now
shut-down/dark closet
27
what is the risk of too much rest post-concussion
social isolation anxiety depression looks a lot like post-concussive syndrome - dizziness, confusion, etc.
28
what is a likely reason for no agreed consensus on the amt of rest needed post-concussion
no RCTs evaluating rest in concussed athletes immediately following a concussion
29
what is relative rest
degree of activity that is reached by careful eval of sx exacerbation brought on by any particular activity
30
what are 3 components of continued medical management
protection neurocognitive assessment meds
31
how should protection be integrated into the medical management of a mTBI in an athlete
prevent first injury, protect against additional injury better helmet delayed return to play non-impact practices
32
how should neurocognitive assessment be integrated into medical management of mTBIs
as soon as possible after injury best if baseline taken preinjury - management should begin before a pt is injured!
33
how should meds be integrated into medical management for mTBIs
used for sx management - avoid meds that might effect pts mental status - avoid anti-inflammatory pain meds bc inc bleeding risk (acetominaphens and tylenol are okay)
34
what are 3 standardized test/measures used in mTBIs
1. standardized assessment of concussion (SAC) 2. immediate post-concussion assessment and cognitive testing (ImPACT) 3. Sport concussion assessment tool - 2 (SCAT-2)
35
what is a standardized test that can be done immediately on the sidelines of a game
SAC
36
what are the 4 things that the SAC assesses
immediate memory orientation concentration delayed recall
37
what is the ImPACT
computerized neuropsychological test battery that measures effects of concussion on brain - taken preseason for baseline scores - post-injury scores can be compared to aid concussion dx
38
what 4 areas does the ImPACT assess
verbal memory visual memory reaction time processing ability
39
who is not appropriate to take the ImPACT
if recently sustained head injury and/or currently experiencing acute sx
40
what is the SCAT-2
standardized method of evaluating injured athletes for concussion
41
what pt population is appropriate for the SCAT-2
athletes ages 13yo+
42
what other tests does the SCAT-2 integrate into the calculation
enables calculation of SAC score and the Maddocks questions for sideline concussion assessment
43
what does the SCAT-2 assess
1. sx 2. cog and physical eval - cog assessment - physical signs - balance and coordination - GCS - Maddocks score
44
what is a balance test that can be done on the sidelines
BESS - balance error scoring system
45
what balance test includes high level tasks (ie dual task, coordination) and doesn't need pre-data
HIMAT - high-level mobility assessment tool
46
what balance test is a self-report on confidence of steadiness/risk of fall
ABC - activity specific balance confidence scale
47
what balance test is a self-report on confidence in various balance activities
DHI - dizziness handicap inventory
48
what are 5 vestibular tests
oculomotor exam vestib ocular reflex tests dynamic visual acuity positional testing vestib/ocular motor screening (VOMS)
49
what are the 3 conditions of the BESS test
double leg stance (feet tg) single leg stance (non-dom foot) tandem stance (non-dom foot back)
50
how do you interpret the score from the BESS
lower score = better balance
51
who is the HIMAT appropriate for
assess high-level motor performance - min mobility requirement is independent amb over 20m w/o ADs (orthoses permitted)
52
how do you interpret the score from the HIMAT
higher the score = better balance
53
what is the purpose of the mCTSIB
means to quantify postural control under various sensory conditions - can determine reliance of systems (visual, somatosensory, vestib)
54
what does the DHI assess
quantify impact of dizziness on daily life by measuring self-perceived handicap
55
what 3 domains does the DHI assess
functional emotional physical
56
how do you interpret a DHI score
the higher the score, the greater the perceived handicap d/t dizziness
57
how do you interpret a ABC score
higher the score = higher the self-perceived confidence
58
what does the VOMS assess
looks at systems in charge of integrating: - balance - vision - movement
59
the VOMS screening tests what 5 areas of vestib (balance) and ocular (vision) motor impairment
smooth pursuits rapid eye movements near point convergence balance vision reflex visual motor sensitivity
60
what are the 3 components of PT for mTBI
1. on site assessment 2. PT interventions - specific to sx 3. return to play and activity
61
what is part of the PT on-site assessment for mTBI
screening use appropriate standardized measure remove from play if mTBI suspected
62
what are examples of PT interventions for mTBI (4)
endurance vestib function cervical dysfunction (ie cervicogenic issues) balance
63
what is the return to play protocol
most able to return in 2-4wks if sustained simple concussion and asymptomatic
64
what type of objective tests are indicated for a pt complaining of: HAs, numbness, neck pain
ortho assessment of cervical and thoracic spine
65
what type of objective tests are indicated for a pt complaining of: dizziness, difficulty concentrating, visual problems, sensitivity to light
oculomotor and vestib screening tests
66
what type of objective tests indicated for all mTBIs
postural stability/balance tests
67
what is the timeline associated with the phases included in return to play protocol
no activity some light activity light practice "yellow shirt" full contact practice full contact play each phase is 24hrs progress to next phase if sx are improving after 24hrs - if sx worsen regress to preceding level and wait 24hrs
68
what are 6 types of PT interventions for mTBIs
1. pt/family ed 2. gradual return to activity/sport 3. vestib rehab 4. sport-specific high-level balance activities 5. dual task training 6. modalities for HA and pain
69
what should you educate the pt and family on as part of a PT intervention
rest! (as tolerated)
70
what are the 5 typical phases of a gradual return to activity/sport protocol
1. no activity and complete/relative rest 2. light exercise for 10-15min 3. sport-specific aerobic activity for 20-30min, no contact 4. on field practice drills, no contact 5. game play with contact
71
why should vestib rehab be included in PT interventions for mTBI
vestib impairment occurs in >1/2 of all athletes s/p concussion
72
what are ex of modalities for HA and pain after a mTBI
ice heat relaxation biofeedback
73
what is the most important thing/goal that PT interventions should work toward
prevent a second injury
74
why is dual-task training an important component to include in PT interventions
combine cognitive and sensorimotor demands can better reveal deficits after mTBI
75
what is a common presentation of individuals w a mTBI when a dual task is introduced
lower gait speed
76
what are examples of a dual task to integrate
obstacle avoidance verbal fluency arithmetic
77
what is a common secondary injury in individuals w a mTBI and why
LE MSK injury awareness might be off impaired NM control - esp higher risk for athletes altered neurocognition
78
what does the literature say about "typical" recovery time
few longitudinal studies of both physio dysfunction & clinical measures *physiological dysfunction probably lasts longer than we think*
79
how is a post-concussive syndrome dx
if 3 or more of the following sx are present beyond "usual recovery period": - HA - dizziness - irritability - insomnia - difficulty memory/concentration - balance impairments - inc/return of sx w activity
80
how long can sx persist in post-concussive syndrome
weeks, months, years
81
what are 4 negative prognostic factors that could lead to a lengthened recovery from a mTBI
hx of previous concussion lack of sufficient rest comorbid psych hx comorbid physical sx
82
why is a hx of previous concussion a negative prognostic factor that could lead to a lengthened recovery from a mTBI
brain takes longer to heal
83
what comorbid psych hx are negative prognostic factors that could lead to a lengthened recovery from a mTBI (3)
anxiety depression substance abuse
84
what comorbid physical sx are negative prognostic factors that could lead to a lengthened recovery from a mTBI (5)
neck pain HAs TMJ pain migraines seizures
85
why is a comorbid psych hx a negative prognostic factor that could lead to a lengthened recovery from a mTBI
physiologic process in brain altered
86
what are risk factors for post-concussive syndrome
more common in females inc w age
87
why is post-concussive syndrome more common in females
less neck ms - dec ability to protect head from wild blows
88
why are sports related injuries less likely than other injuries to result in post-concussive syndrome
athletes tend to have stronger neck ms in general
89
what is the relationship of severity of the blow to post-concussive syndrome
not directly related
90
what are the 3 buckets of treatment for post-concussive syndrome and how do you choose which direction to go
physiologic vestibulo-ocular cervicogenic depends on sx
91
what is a common MOI resulting in cervicogenic sx in post-concussive syndrome
whiplash
92
what causes physiologic sx associated w post-concussive syndrome
d/t continued alterations in global cerebral metabolism
93
what is an intervention to treat physiologic sx associated w post-concussive syndrome
sub-sx threshold aerobic activity exercise
94
what causes vestibulo-ocular sx associated w post-concussive syndrome
dysfunction in vestibulo-ocular system
95
what is an intervention to treat vestibulo-ocular sx associated w post-concussive syndrome
vestibular rehab program
96
what causes cervicogenic sx associated w post-concussive syndrome
dysfunction of cervical spine somatosensory system
97
what is are interventions to treat cervicogenic sx associated w post-concussive syndrome (3)
c-spine manual therapy balance exercises gaze stabilization exercises

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