mTBI

Question 1

What is the definiton of an mTBI/Concussion?

Answer 1

A clinical syndrome characterized by immediate transient alternation in brain function, including alteration of mental status and level of consciousness, resulting from mechancial force or trauma.

• Glasgow coma scale score: 13-15
• Loss of consciousness (LOC) = around 30 min or less
• Post-Traumatic Amensia (PTA) < 24 hours

Question 2

What is the pathophysiology of an mTBI?

Answer 2

Trauma from acceleration, deceleration can result in

• compressive: “crushing” force
• tensile: “stretching” force
• shearing: torsional force

Trauma from contact/blow to head: fracture, contusion

Question 3

What are some of the characteristics of an mTBI?

Answer 3

Must have at least 1 of the following

• LOC may occur, but not necessary
• Loss of memory for events before or after the accident
• Alteration in mental state (dazed, disoriented, confused)
• Rapid onset of focal neurological impairments that may or may not spontaneously resolve
  *

Question 4

Commonly Reported Symptoms in Patienths with mTBI include:

Answer 4

Question 5

Physcial therapy evaluation and treatment after mTBI includes:

Answer 5

• Areas of Management per CPG
  
  • Vestibulo-oculomotor Impairments
  • Cervical Musculoskeletal Impairments
  • Motor Function Impairments
    
    • High level balance dysfunction
  • Autonomic/Exertional Tolerance Impairments
• Other issues per O’Sullivan
  
  • Cognitive issues: attention and dual-task performance
  • Post-traumatic headache
  • Patient education

Question 6

What are risk factors for prolonged recovery?

Answer 6

• severity of acute and subacute symptoms
• post-injury headaches (HA)
• post-injury depression
• teenage years/high school (girls > boys)
• post-traumatic amnesia
• delayed removal from play
• pre-esiting mental health issues/family HX
• ADHD

Question 7

A PT examination for mTBI should assess:

Answer 7

• Arousal, Attention, Cognition
• Symptoms: Self Report Tools
• Vestibular
  
  • Saccadic Eye Movement, Smooth Pursuits (Reading)
  • Vestibular Ocular Reflex (VOR)
  • Dynamic Visual Acuity (DVA), Gaze Stability Test (GST)
  • BPPV Testing
• Balance
• Dual Tasking Ability
  
  • Static
  • Dynamic

Question 8

The following are all examples of what?

• Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)
• Standardized Assessment of Concussion (SAC)
• Sensory Organization Test (Neuro-Com)
• Other tests and measures as indicated
• Post Concussion Symptom Scale (PCSS)
• Concussion Symptom Inventory (CSI)
• Sport Concussion Assessment Tool (SCAT5)

Answer 8

mTBI Outcome Assessments

Question 9

What is the Buffalo Concussion Treadmill Test (BCTT)

Answer 9

• Mean age of 15 years
• Treadmill (TM) at a consistent speed, incline increased by 1% each minute
• Reasons for Stopping
  
  • Symptom exacerbation: ≥ 3 (0-10) point change from resting
  • Fatigue: (RPE ≥ 17)
• Outcomes:
  
  • Significant shortening of recovery time
  • 0% of the prescribed exercise group met prolonged recovery criteria
• Sub-Symptom Threashold Exertion:
  
  • results bases
  • requires methond for monitoring HR
  • safe test for early phase of recovery

Question 10

Graduated return-to-sport (RTS) strategy

Answer 10

• 10% of athletes who passed cognitive testing at rest failed after exercise
• Many recently concussed athletes show normal cognitive functioning at rest and post exercise, 30% of them performed exhibited cognitive deficits.
• Desire to stay in the game, fear of letting down teammates, inability to recognize their symptoms => may place them at risk of subsequent injury and more serious cognitive impairment

Question 11

What can treatment for an mTBI include?

Answer 11

treatment: respect symptoms

• Aerobic and Strengthening Exercises
• Vestibular Treatment
  
  • Gaze Stabilization Exercises
• Balance Exercises, Advanced Gait Activities
• Dual Tasking
• Treat the neck
• Education
  
  • Symptoms
  • Second Impact Syndrome

Question 12

The following are all part of consesus statment about what topic?

• An initial period of 24–48 hours of both relative physical rest and cognitive rest is recommended before beginning the RTS progression.
• There should be at least 24 hours (or longer) for each step of the progression. If any symptoms worsen during exercise, the athlete should go back to the previous step.
• Resistance training should be added only in the later stages (stage 3 or 4 at the earliest). If symptoms are persistent (eg, more than 10–14 days in adults or more than 1 month in children)
• The athlete should be referred to a healthcare professional who is an expert in the management of concussion.

Answer 12

mTBI: Return-to-Play

Question 13

Graduated return-to-school stratergy

Answer 13

Question 14

The following are symptoms of what condition?

Symptoms present >/= 3 months

• Can cause post traumatic migraines
• Can cause post traumatic vestibular dysfunction
• Can cause post traumatic cognitive deficits

Answer 14

Post-Concussion Syndrome (PCS)

Question 15

What is the appropriate PT response to the following concerning mTBI’s?

• BPPV that doesn’t clear in 3 treatments / visits
• Lack of improvement in symptoms or function despite full compliance
• Suspected vision problems beyond mildly impaired vergence issues
• Persistent cognitive complaints
• Plan of care reaches a month with no significant change in symptom severity
• Imaging is indicated based on mechanism of injury or LOC

Answer 15

Refer out