mTBI

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An mTBI or concussion is a blow/bump/jolt to the ___ resulting in brain to move rapidly ___.

  • in the skull, what movements does the brain do? this is known as what?

  • what changes occur in the brain? sometimes what to brain cells?

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1

An mTBI or concussion is a blow/bump/jolt to the ___ resulting in brain to move rapidly ___.

  • in the skull, what movements does the brain do? this is known as what?

  • what changes occur in the brain? sometimes what to brain cells?

- a blow/bump/jolt to the head resulting in brain to move rapidly back and forth

  • in the skull, the brain bounces around or twists aka coup-contrecoup injury

  • chemical changes in the brain, and sometimes stretching/damaging of brain cells

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2

Concussion signs pt 1:

  1. loss of ?

  2. problems with ?

  3. what look in the eyes?

  4. memory loss?

  5. can they respond to questions?

  1. Loss of Consciousness

  2. problems w/ balance

  3. Glazed look in eyes

  4. Amnesia

  5. Delayed response to questioning or motor responses

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3

Concussion signs pt 2:

  1. forgetting ___, confusion about ___ or position, confusion of game, ___, or opponent

  2. inappropriate what? (2)

  3. 🤮

- Forgetting instructions, confusion about assignment or position, confusion of game, score, or opponent
- Inappropriate crying and laughter
- Vomiting

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4

Concussion S/S: Somatic (9)

- HA
- Light headedness
- Dizziness
- Imbalance
- N/V
- Sensitivity to Light and Noise
- Tinnitus
- Change in Taste
- Visual Disturbances

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5

Concussion S/S: Cognitive (5)

- Attention difficulties
- Memory probs
- Loss of Focus/Concentration
- Difficulty Multitasking
- Difficulty completing mental tasks

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6

Concussion S/S: Sleep (3)

- Sleeping MORE or LESS than usual
- Having trouble falling asleep
- Insomnia

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7

Concussion S/S: Emotional (3)

- Anxiety
- Depression
- Panic Attacks

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8

Prevalence Rate of Concussion:
- ___ to ____ million/year sports related concussion in US
- How many athletes in contact sports will suffer a concussion each year?
- 21% of youth concussion occur where?
- How much % of concussion go undiagnosed?

- 1.6-3.8 million/year
- 1 in 5 athletes
- occur on the field
- 50%

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9

What are 3 other causes for concussion besides contact sports?

Falls, MVA, Military Injuries

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10

For each sports-related and non-sports related concussions, which age range is most likely seen to have a concussion?

- sports-related: ages 14-18 (adolescents/teens)

- non-sports related: age 31 or over (adults)

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11

5 Pre-Injury Risks that can prolong recovery:

  1. hx of what two things?

  2. sex? and sport?

  3. age?

  4. disorder?

  5. what possible factors?

  1. Hx of concussion and migraines

  2. F > M, soccer

  3. Youth

  4. ADHD

  5. Possible genetic factors

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12

4 injury-related risks that can prolong recovery:

  • length of what?

  • what 2 amnesias?

  • delayed removal from?

    • how might this affect the athlete’s performance?

    • what are they more at risk of, what may be damaged?

  1. LOC

  2. Anterograde Amnesia or Retrograde Amnesia

  3. Delayed removal from sports

    • athlete may not perform quite as well

    • more at risk of being premature to return to sport and cause more damage/disrupt neurological system

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13

If a pt has certain symptoms post-injury like dizziness, ____, migraine, or ___ symptoms, how would they recovery process look like? compared to who?

  • and for those who have multiple of these symptoms?

- HA, depressive symptoms

- will take those a little bit longer w/ these symptoms to fully recover from concussion than those who had a concussion and did not have any of these symptoms

  • w/ multiple symptoms: more complex treatment and prolonged recovery

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14

What are the 4 Domains of Impairments to classify concussions?

  1. Musculoskeletal

  2. Vestibulo-oculomotor

  3. Autonomic Dysfunction

  4. Motor Function

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15

Domain of Impairment: Musculoskeletal

Aside from ROM, strength, proprioception and muscle imbalances, what 4 factors about the C/S would you want to consider for your pt, and what might be impaired?

  1. Cervical Pain

  2. WAD

  3. Cervicogenic Dizziness

  4. Cervical Reflexes (COR)

  5. Impaired biomechanics

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16

The COR works w the Vestibular Apparatus to help maintain what, and at what pace compared to VOR?

Maintain gaze w head movement but slower pace of head movement compared to VOR

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17

What 2 reflexes does the Cervical Ocular Reflex (COR) work with and to prevent what?

VOR and Optokinetic reflex to prevent retinal slips during motion

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18

Domain of Impairment: Vestibulo-Oculomotor Pt. 1 (7)

  • think of common symptoms with the vestibular system like vision, balance, HA

• Dizziness
• Balance
• Vertigo
• Blurred Vision
• Headaches
• Nausea/Vomiting
• Photophobia (Sensitivity to light)

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19

Domain of Impairment: Vestibulo-Oculomotor (6)

  • sensitivity to sound, balance, difficulty of 2 skills, nervousness, exhaustion

• Hyperacusis (Sensitivity to sound)
• "foggy"
• Difficulty Reading
• Difficulty Concentrating
• Anxiety
• Fatigue

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20

Is TBI a central or peripheral issue?

BPPV?

- TBI = Central
- BPPV = Peripheral

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21

Domain of Impairment - Autonomic Dysfunction:

The hypothesis for reduced exertion tolerance is that uncoupling of the ___ ANS and the ___ lead to reduced ability to maintain and ___ cerebral blood flow, ___, and HR.

Uncoupling of central ANS and the heart lead to reduced ability to maintain and adjust cerebral blood flow, BP, and HR

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22

Autonomic Dysfunction: This hypothesis would explain post concussion:

- higher reports of what?

- ___ hypotension

- deconditioning resulting in what?

- Higher reports of perceived exertion post concussion
- Orthostatic Hypotension post concussion
- Deconditioning resulting in lifestyle changes

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23

Domain of Impairment - Motor Function:

Altered functional abilities may include:

1) what balance?

2) what control?

3) difficulty with?

4) what is delayed?

5) motor ?

  1. Static/Dynamic Balance

  2. Postural control

  3. Difficulty with Dual Tasks

  4. Delayed reaction times

  5. Motor Coordination

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24

What to ask during the Subjective?

- How long has S/S lasted?
- Clear Red Flags
- Assess C/S and T/S
- Assess MSK involvement
- Asses Vestibular
- Develop Personalized Intervention Plan

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25

How to clear the C/S?

- Canadian C/S Rule
- NEXUS Criteria
- Ligamentous Testing (Alar and Sharp Pursers)
- VBI and CAD >> 5 D and 3 N

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26

Nexus Criteria Assessment: 5 Criteria

- No posterior midline C/S Tenderness
- No evidence of intoxication
- Normal level of alertness
- No focal neurological deficit
- No painful distracting injuries

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27

NEXUS: If all 5 criteria are met what happens?

Imaging is NOT required in order to exclude clinically important CSI

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28

Recovery: How long to AVOID high risk activity?

24-48 hrs

>> Gradually return to activities as tolerated <<

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29

Recovery: Can S/S be elicited during rehab?

YES in order for recovery to occur

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30

Recovery: What to educate the pt? (3)

- Lifestyle modification may be necessary to aid s/s management
- Risk of future concussion
- Expectation of s/s and functional limitations

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31

What type of Exercise is appropriate for Concussion pts?

>> Progressive, symptom guided aerobic training <<
- Feasible
- Safe
- May accelerate resolution and neuro activity

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32

Exercise can show a significant decrease in what?

S/S scores in Post Concussion Symptom Scale

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33

Exercise can show improved what?

Reaction times in ImPACT

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34

Exercise: What can Aerobic Exercise training (early Intervention) reduce in males?

Total time to recovery

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35

Impairment specific AND/OR aerobic exercise can lead to what?

Faster resolution of s/s and enhanced neurological recovery

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36

How to read Post Concussion Symptom Scale:

0 (no s/s) >> 6 (severe s/s)

>> Lower is BETTER <<

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37

Stages of recovery for concussion pts: (4)

- Rest
- Light Activity
- Mod Activity
- Reg Activity

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38

5 Concussion Specific Tests

- BESS
- Star Excursion
- 4 Square Step Test
- HiMat
- FAB
- Violet Crisis Intervention

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