Concussion

Question 1

T or F: Concussions often have normal imaging

Answer 1

T

Question 2

Should patients w/ concussion have absolute rest?

Answer 2

No

Question 3

If a pt is feeling normal after 6-7 days does this mean that their brain is back to normal

Answer 3

No

Question 4

how much force normally causes a concussion

what kind of force most commonly causes a concussion

Answer 4

70-120g or 5582-9515 rad of rotational force

concussions are most commonly caused by rotational force

Question 5

T or F: the majority of impacts we see in football and the majority of headers in soccer are less than what is required to cause a concussion

Answer 5

T

Question 6

What is the criteria for a concussion

what is the most common symptom?

Answer 6

MOI, 1 symptom present

Most common somatic: headache
most common cognitive: feeling slowed down

Question 7

What should you do first for a player that has sustained a concussion on the field

Answer 7

clear cervical spine and VBI

perform CN tests if indicated

Question 8

Concussion red flags

Answer 8

Neck pain or tenderness

seizure or convulsion

double vision

loss of consciousness

weakness or tingling/burning in more than 1 arm and leg

deteriorating conciousness

vomiting

severe or increasing headache

increasing restlessness, agitation

GCS < 15

Visible deformity of skull

Question 9

What is the criteria for Persistent concussion symptoms

Answer 9

More than 3 persistent symptoms AT REST

30 or more days following a concussion

Question 10

What are the 3 causes of persistent concussion syndrome

Answer 10

1. autonomic dysregulation
2. inflammation (gut-brain axis)
3. visual/vestibular/cervical

Question 11

How do we treat inflammation due to the gut-brain axis in concussion

Answer 11

diet recommendations

they need water, protein, healthy fats

dont restrict calories

Avoid: Caffeine and alcohol, processed foods, artificial sweeteners, fad diets

Question 12

T or F: When we are administering a test to a player on the field, or in a follow up, we should let them know they might score poorly on this since they have a concussion

Answer 12

F, don’t tell patients that theyll do poorly, instead encourage them to do well

Question 13

Patients with ____________ have a lower risk of post concussion syndrome than those without

Answer 13

early physical activity

Question 14

What is second impact syndrome

Answer 14

2nd concussion occurs before the 1st concussion has properly healing

Question 15

Second concussion syndrome happens most often in

Answer 15

athletes under 21

Question 16

What are signs second impact syndrome

Answer 16

Catastrophic increase in intracranial pressure causes:

Dilated pupils
Loss of eye movement
unconsciousness
Respiratory failure
death

Question 17

Day 1 of treating a concussion consists of

Answer 17

Baseline testing
assessment
treatment
education

Question 18

What kind of foods do people with concussions need to eat?

Answer 18

omega 3 fatty acids

protein

need to eat atleast half the number of calories

NO FAD DIETS `

Question 19

How much water is recommended for after a concussion per day

Answer 19

.5 oz for every lb of bodyweight

Question 20

What foods should someone with a concussion avoid

Answer 20

Caffine/alcohol

sugar/processed foods

artificial sweeteners

fad diets

Question 21

What kind of nutritional habits help w/ concussion

Answer 21

eat smaller meals more frequently

emphasize moderation and variety

Question 22

At what day post-concussion should a person do the BCTT

Answer 22

day 2

Question 23

What are the contraindications of BCTT

Answer 23

Electrolyte imbalance

Extreme hypertension 200/110

arrythmias

most bad sounding cardiac conditions

Question 24

On a scale of 0-10, their symptoms must be under ______ to do the BCTT

Answer 24

6/10 or less

7/10 do not do BCTT

Question 25

The warm up speed for the BCTT is ________ How does it increase

Answer 25

2.5mph with 0% incline for 2 mins for warmup official test starts at 3.3 with 0% incline increase incline by 1% every minute for 15 mins

Question 26

what is the failing criteria of the BCTT

Answer 26

worsening of overall wellbeing score by 3 or more points

Question 27

what is the passing criteria of the BCTT

Answer 27

Pt reaches their age adjusted max HR (220-age) or reaches max exertion before symptoms increase by 3/10

Question 28

When perscribing an exercise protocol for concussion, make sure the patient is exercising atleast ______________ a week for ___________ minutes at a rate of __________________

Answer 28

5 times a week 20-30 mins at 80-90% of their symptom threshold

Question 29

Workouts should be _____________ compared to the symptom threshold Athletes: Non-Athletes:

Answer 29

80-90% Athletes: 90% non-athletes: 80%

Question 30

What is performed on day 3 of concussion

Answer 30

Cervical and VOMS testing

Question 31

How is VOMS tested in concussion and what is considered positive

Answer 31

Rate symptoms (headache, dizziness, nausea, fogginess) each gets a score of 1-10 for each activity Smooth pursuit Saccades- horizontal Saccades - vertical Convergence VOR horizontal VOR vertical Visual motion sensitivity SCORE OF GREATER THAN 2 IS POSITIVE

Question 32

for VOMS testing, a score of __________ out of 10 is considered positive for any component of the test

Answer 32

2

Question 33

How can a PT likely improve attention and cognition in concussion patients

Answer 33

by addressing VOMS/vision deficits

Question 34

T or F: to test vergence, we measure the distance to which the patient experienced blurriness

Answer 34

F, double vision

Question 35

How many times do we repeat the convergence test

Answer 35

3 times, middle, high, and low

Question 36

Pt reports difficulty in cars, busy events, what part of VOMS do they likely need to work on

Answer 36

VORC visual motion sensitivity

Question 37

After how many days should someone with a concussion be participating in exercise and at what intensity ?

Answer 37

after 2 days should have them wotkout at estimated HR max or 80 % treshold

Question 38

When do you know that you have to dec the intensity with someone that has suffered from a concussion ?

Answer 38

RULE OF THREEs Symptoms include dizziness headache nausea lightheadedness Fogginess inc symptom increases by 3 points

Question 39

If someone has cervical concussion symptoms what is tx looking like ?

Answer 39

Manual therapy DNF activation Mobility/breathing

Question 40

If someone is having vestibular symptoms post concussion what is tx focused on?

Answer 40

Pt vestib eval and tx help settle symptoms

Question 41

what does mardsen ball help improve ?

Answer 41

Works in vision and ocular movement and helps improve peripheral awareness

Question 42

True or false Children recover faster than adults following a concussion ?

Answer 42

FALSE

Question 43

_________ Improve GAZE STABILITY by increase the gain of the VOR

Answer 43

ADAPTATION

Question 44

________ Reduce sensitivity through repeated exposure

Answer 44

Habituation

Question 45

_________ use of other strategies to replace lost of compromised function

Answer 45

Substitution

Question 46

What kind of exercise are you going to want to implement with someone that has recently suffered from a concussion ?

Answer 46

AEROBIC exercise

Question 47

What does interval training look for concussions symptoms ?

Answer 47

30-60s 50-80% cardio 2+ minutes of breathing work Inhale 4s hold 1s exhale 8s

Question 48

T or F HIIT is not recommended for people after a concussion

Answer 48

T