mTBI

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?

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

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

Concussion signs pt 2:

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

7. inappropriate what? (2)

8. 🤮

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

Concussion S/S: Somatic (9)

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

Concussion S/S: Cognitive (5)

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

Concussion S/S: Sleep (3)

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

Concussion S/S: Emotional (3)

- Anxiety
- Depression
- Panic Attacks

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%

What are 3 other causes for concussion besides contact sports?

Falls, MVA, Military Injuries

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)

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

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

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

What are the 4 Domains of Impairments to classify concussions?

1. Musculoskeletal

2. Vestibulo-oculomotor

3. Autonomic Dysfunction

4. Motor Function

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

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

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

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)

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

Is TBI a central or peripheral issue?

BPPV?

- TBI = Central
- BPPV = Peripheral

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

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

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

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

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

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

NEXUS: If all 5 criteria are met what happens?

Imaging is NOT required in order to exclude clinically important CSI

Recovery: How long to AVOID high risk activity?

24-48 hrs

>> Gradually return to activities as tolerated <<

Recovery: Can S/S be elicited during rehab?

YES in order for recovery to occur

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

What type of Exercise is appropriate for Concussion pts?

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

Exercise can show a significant decrease in what?

S/S scores in Post Concussion Symptom Scale

Exercise can show improved what?

Reaction times in ImPACT

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

Total time to recovery

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

Faster resolution of s/s and enhanced neurological recovery

How to read Post Concussion Symptom Scale:

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

>> Lower is BETTER <<

Stages of recovery for concussion pts: (4)

- Rest
- Light Activity
- Mod Activity
- Reg Activity

5 Concussion Specific Tests

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