Concussion

Question 1

Describe the blood test for a concussion

Answer 1

• Banyan Brain Trauma Indicator
• Measures levels of proteins that are released from the brain into blood & measured within 12 hrs of head injury
• Able to predict the presence of intracranial lesions on a CT scan most of the time

Question 2

Describe the King-Devick Test

Answer 2

• Assesses eye movement in children with reading difficulty
• Quantifies saccadic movements & has been proposed for both oculomotor assessment & acute diagnosis in concussion patients
• Patients require a baseline measurement of valid post-injury comparison

Question 3

Describe the vestibular ocular motor screening (VOMS) for concussion

Answer 3

• Baseline symptoms: headache, dizziness, nausea, & fogginess
• Assessed items: Smooth pursuit, saccades horizontal & vertical, convergence, VOR horizontal & vertical, and visual motion sensitivity test
• Cut oof scores of ≥2 symptoms after any VOMS item resulted in high rates of identifying concussion
• Combination of VOR, VMS, & NPC distance scores resulted in a positive prediction rate of 0.89 for identifying concussion

Question 4

Describe the Buffalo Concussion Treadmill Test (BCTT)

Answer 4

• Speed 3.6mph for pts >5’5” & 3.2mph for pts ≤5’5”
• Starting incline = 0º
• After 1 min set incline to 1º and ask RPE & sx severity
• Repeat each minute
• Once treadmill reaches max incline speed is increased by 0.4mph each minute in lieu of increased incline
• Once test is terminated speed is reduced to 2.5mph & incline returned safely back to 0º for a 2 min cool down

Question 5

The BCCTT continues until… OR

Answer 5

• Max exertion: RPE of 19.5 reported
• Terminated by examiner due to symptom exacerbation that causes significant increase in pain or symptom severity
• Examiner notes a rapid progression of complaints b/w symptom reports, pt appears faint or unsteady or determines that continuing constitutes significant health risk for the patient
• Patient reports an inability to continue the test safely

Question 6

Predictive capacity of BCTT

Answer 6

• ΔHR (HRt (standing HR) minus resting HR) correlated with duration of clinical recovery in pts who were prescribed relative rest or a placebo stretching program but not for pts prescribed sub threshold aerobic exercise
• ΔHR ≤50 bpm on BCTT was 70ish% predictive of delayed recovery in concussed adolescents prescribed the current standard of care

Question 7

Importance of active recovery in concussion patients

Answer 7

• Progressive sib-symptom threshold aerobic exercise within 1 wk of concussion safely improved recovery from SRC (sports related concussion) in adolescents with concussion symptoms compared with a placebo-like stretching intervention
• Recommendation for relative rest was not as effective as prescribing sub symptom threshold aerobic exercise to adolescents after acute SRC

Question 8

Is rest as a treatment plan for a concussion bad?

Answer 8

• Female patients prescribed rest had rather dramatic increase in symptoms the day after being seen in the clinic suggesting that a prescription for rest after SRC may be particularly problematic for female adolscents

Question 9

How does cognitive behavioral therapy break the pain catastrophizing scale cycle

Answer 9

• Reducing negative cognitions
• Transforming negative emotions
• Implementing healthier coping skills

Question 10

Standard pain catastrophizing scale cognitive behavioral therapy protocols typically include

Answer 10

• Psychoeducation
• Affect education
• Relaxation strategies
• Mindfulness
• Biofeedback
• Imagery
• Distraction strategies
• Cognitive restructuring
• “Pacing” for return to school & play