MSK: Concussion Flashcards by Chavez Girls

T or F: Concussions often have normal imaging

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A concussion is not the coup-countercoup, rather it is

a metabolic crisis!

huge change in ion concentration (ca+, glutamate), brain unable to meet energy demands

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First 2 days after concussion should focus on

education
1-2 relative rest
not sit in dark room
light walks
good nutrition

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Should patients w/ concussion have absolute rest?

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after 2 days, pt should be started on what?

subthreshold program bc exercise is the best medicine!

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Duration and intensity for subthreshold program

80% BCTT
goal is 30-45 min
do not want longer than 45 min!! brain needs to heal

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Should a pt be able to do RT in the acute phase?

NOT ENCOURAGED during the acute phase bc its anaerobic, we need oxygen to get to the brain and should focus on aerobic training

if they do, < 30% 1RM

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Especially in acute phase, aerobic exercise should be done in a ____ _____, and symptoms should be monitored!

controlled environment

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Stop exercise on rule of 3:

an increase in 3 symptoms (dizziness, headache, nausea, lightheadedness, fogginess)

one symptom increases by 3 points

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For the average person, CV exercise should be completed at ___% of the symptom-limited heart rate achieved on the BCTT.

Athletes can increase to ___%

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it is recommended that symptoms stay below a _____ increase from baseline and resolve back to baseline within __ hour/s.

2/10
1

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Should you always use the same BCTT test results?

no, after one week you should conduct a new test, find new symptom limited max heart rate and increase their exercise intensity accordingly

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When is HITT appropriate?

NOT EARLY

close to return to sport

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Concussion symptom categories

ocular - tx focus on repeated exposure to visual stimulus
vestib - help settle s/s
cognitive - work on memory, dual tasking
cervical - (WAD) MT, DNF activation, mobility

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VOMS screen

smooth pursuit
horizontal and vertical saccades
convergence
horizontal and vestibular ocular reflex (VOR)
visual motion sensitivity (VOR-C)

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How to structure progression of ocular tx (what do you start, with, what to progress to and when?)

failed test becomes treatment - start with what they cant do, log s/s

progress as tolerated - balance, busy background, add cognitive comp

DO NOT push pt, allow s/s to increase 2 levels from baseline

allow rest between ocular movements!

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HART chart works on what

convergence, uses near and far vision, visual acuity, smooth pursuit

also works on endurance!

2 charts, one close on far

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What does the brock string work on?

convergence

step 1: focus on first ball, should see a V

step 2: focus in middle ball, should see an x

step 3: focus on lat ball, should see reverse V or A

can they convergence and focus on one point at different distances?

other option: 3/4 dot card

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VOR1 utilizes fixation on a ____ target at ___bpm

VOR2 utilizes fixation on a ____ target at ____ bpm

stationary, 20-300

moving, 10-150

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Goal for VOR tx parameters

2 min of continuous gaze stability (doesnt get blurry), 3x in a row, 3 times/day

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Besides VOR 1 and 2 what are the other ocular treatments?

active eye movements between 2 targets

remembered/imaginary targets

you know these from vestib

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What does the Marsden Ball work on

works on vision and ocular movement, PERIPHERAL AWARENESS, spatial awareness (when walking)

tracking, letter/number identification

not doing this day 1

ball goes side to side = smooth pursuit
ball goes towards and away from you = convergence
ball in circle = smooth pursuit + convergence (making it more dynamic)

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What is a key thing to educate pts on during vestib treatment

may feel worse before you feel better

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Prognosis fir expected recovery times (for vestib tx?)

adults
college athletes
high school athletes
middle school athletes

2-3
7-10
14-21
28-35

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what s/s should you refer patient to MD or ED if they worsen durinv vestibular tx?

pts shows signs of HA, seizures, visual disturbances, N/T, extremity weakness, drowsiness

vestib tx

adaptation (increase VOR gain) habituation (reduce sensitivity) substitution balance and gait optokinetic stimulation (busy background videos/simulations) BPPV maneuvers

why is cognitive tx important after concussion

stimulates brain, re-establishes neural pathways that may have been disrupted in the injury "exercising" the brain

benefits of cognitive tx

faster recovery time, QOL improves, decreased post concussion s/s, enhanced nueroplasticity, improved cognitive performance

Ex of cogntiive tx

games - spot it, rush hour, uno, memory

Cervical tx

MT - mobs/manips, METs (incorporates eyes!), STM (guarding from whiplash) modalities DNF activation mobility/breathing

breathing exercises can help post concussion how?

decrease sympathetic system

muscle spindles in the neck converge afferent info with visual and vestibular systems to the cerebellum/cerebrum contributing to our bodys sense of head and neck position. How might this be affected in a concussion pt?

pts may have disturbances to cervical afferent input leading to abnormalities with sensorimotor control of neck and head aka proprioception is messed up

Tx for joint position sense

head laser - works on endurance, fine motor control of neck muscles, proprioception con progress to standing, walking, using mazes track how long they can go without symptoms start with small head movements and progress

What can be used in end stage concussion tx to provide unexpected stimuli that is necessary for concussion tx?

blaze pods dynavision

R2LEARN STAGE 1

physical and cognitive rest yes: board games No: TV, reading, driving When s/s free 24hr, go to stage 2

R2LEARN STAGE 2

start light cognitive activity 30 min cognitive (reading, TV) still no schoolwork when they can tolerate 30 min cognitive activity... introduce schoolwork, when they tolerate 60 min of schoolwork (30 min x 2), go to stage 3

R2LEARN STAGE 3

start part time school part time school w max accommodations NO homework when they tolerate 2 hours (120 min) of cog activity in 30-45 min intervals, stage 4

R2LEARN STAGE 4

Part time school add 30 min of homework max, classroom testing with accommodations inc school time, dec accommodations NO standardized tests once tolerating 4 hours (240 min) in 25-60 min chunks, stage 5

R2LEARN STAGE 5

FULL time school full days at school, dec accommodations 1 test per day, 60 min of homework when tolerating full school day with no accommodations, stage 6

R2LEARN STAGE 6

FULL time school all classes, all hw, all testing, all EC activities, no accommodations return to learn completed, Return to play!

RETURN TO PLAY PROTOCOL

everything past this was not on lecture

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

how much force normally causes a concussion what kind of force most commonly causes a concussion

70-120g or 5582-9515 rad of rotational force concussions are most commonly caused by rotational force

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

What is the criteria for a concussion what is the most common symptom?

MOI, 1 symptom present Most common somatic: headache most common cognitive: feeling slowed down

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

clear cervical spine and VBI perform CN tests if indicated

Concussion red flags

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

What is the criteria for Persistent concussion symptoms

More than 3 persistent symptoms AT REST 30 or more days following a concussion

What are the 3 causes of persistent concussion syndrome

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

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

diet recommendations they need water, protein, healthy fats dont restrict calories Avoid: Caffeine and alcohol, processed foods, artificial sweeteners, fad diets

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

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

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

early physical activity

What is second impact syndrome

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

Second concussion syndrome happens most often in

athletes under 21

What are signs second impact syndrome

Catastrophic increase in intracranial pressure causes: Dilated pupils Loss of eye movement unconsciousness Respiratory failure death

Day 1 of treating a concussion consists of

Baseline testing assessment treatment **education**

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

omega 3 fatty acids protein need to eat atleast half the number of calories NO FAD DIETS `

How much water is recommended for after a concussion per day

.5 oz for every lb of bodyweight

What foods should someone with a concussion avoid

Caffine/alcohol sugar/processed foods artificial sweeteners fad diets

What kind of nutritional habits help w/ concussion

eat smaller meals more frequently emphasize moderation and variety

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

after 2 days?

What are the contraindications of BCTT

Electrolyte imbalance Extreme hypertension 200/110 arrythmias most bad sounding cardiac conditions

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

6/10 or less 7/10 do not do BCTT

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

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

what is the failing criteria of the BCTT

worsening of overall wellbeing score by 3 or more points

what is the passing criteria of the BCTT

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

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

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

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

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

What is performed on day 3 of concussion

Cervical and VOMS testing

How is VOMS tested in concussion and what is considered positive

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

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

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

by addressing VOMS/vision deficits

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

F, double vision

How many times do we repeat the convergence test

3 times, middle, high, and low

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

VORC visual motion sensitivity

MSK: Concussion Flashcards

(76 cards)