Concussions & Asthma (Rodio)

What is the definition of a concussion?

complex pathophysiologic process affecting the brain induced by traumatic biomechanical forces

What does a concussion result from?

-compression force

-tensile force

-shearing force

-can be a direct blow to head, face, neck, or impact on body that causes force to be transmitted to the head

T or F: Concussion will always cause a LOC

False

How do concussion symptoms compare with and without a loss of consciousness?

sx will be less if lose consciousness as the system gets a "shut down" and reset

T or F: Symptoms for concussions always begins immediately

False

Symptoms from a concussion will usually happen when?

usually 8hours after, or when you wake up the next morning as there is increased swelling

How is a diagnosis of concussion made?

indicated by new onset or worsening of at least any of the following:

-any period of LOC or decreased level of consciousness

-a loss of memory of events immediately before or after injury

-any alteration in mental state such as confusion, disorientation, and slowed thinking

What are symptoms of concussion?

-headache

-decreased reaction time

-dizziness

-nausea

-vomiting

-sleep disturbances

-irritability

-emotional changes

-"feelings in a fog"

-difficulty concentrating

-visual disturbances

-sensitivity to light

What is CTE? Describe it

chronic traumatic encephalopathy

-progressive degenerative brain disease found in athletes, military veterans, and others with hx of repetitive brain trauma

-protein Tau forms clumps that spread in brain, killing brain cells

-gradually deteriorate over time, brain atrophies

-long term --> cognitive decline, motor control deficits, mood swings, memory loss

Why can concussions be life threatening? What are signs of this?

-intracranial hemmorrhage

-subdural or epidural hematoma

-signs = severe headache, lethargy, focal neurologic signs, weird neuro related signs (tone, consciousness alterations)

How many sport related TBI in the US each year?

1.6 - 3.8 million

What is the IMPACT?

baseline data exam for a concussion, usually done in schools

What should the concussion evaluation look like?

-ideally, an immediate assessment on the field at time of injury (SCAT3, or child-SCAT3 for 5-12yo)

-CT and MRI doesn't always show abnormal findings

-reassess in few days (PT)

--balance (BESS, tandem, SLS)

--musculoskeletal (c/s ROM, muscle tension, posture)

--oculomotor (gaze stability, convergence, divergence, saccades, smooth pursuit)

--cardio (treadmill tests --> buffalo treadmill protocol)

--return to play protocol

What does the return to play protocol involve for concussion?

-after some time off, can start engaging in activity

-as soon as symptoms arise, go back to day 1 of protocol

What does treatment for concussion involve, specifically with the stages?

rest & recovery:

-rest body & brain

stage 1 = light exercise

-walking, swimming, stationary cycling

stage 2 = some sport specific exercise

-simple running drills

-limit head movements

stage 3 = non contact training

-progressive training with increased intensity

-coordination

-resistance training

stage 4 = full contact practice

-normal training

stage 5 = player rehbailitated

-game play

What is the PCSS?

self report eval tool to look at how concussion symptoms fluctuate and vary with activity, over time, and can compare pre to post

What evaluation tool may help guide concussion treatment?

PCSS

What is the typical recovery for adults and children with concussions?

adults = 7-10 days

children = 2-4 weeks

What are the 4 clusters of sx that are evaluated in the PCSS?

-emotional

-sleep

-thinking

-physical

What is asthma characterized by?

airway inflammation, airway obstruction, and bronchial hyper-responsiveness to stimuli

What percentage of children have dx of asthma?

10%

Does asthma involve the small or large airways?

both!

What are the asthma stimuli and give examples of each?

extrinsic stimuli (allergens, atopic)

-pollen

-mold

-food

-smoke

-drugs

-animal dander

-dust

intrinsic stimuli (non-allergenic)

-viral infection

-exercise

-emotional stress

What causes asthma to occur?

hyper-responsiveness to stimuli, causing an inflammatory response

When is a dx of asthma made? How is it made?

-dx made between 3-5yo

-diagnosis based on:

--hx

--physical exam (ascultation and palpation)

--pulmonary function tests)

What are s&s of asthma?

-breathing worse at night or early in AM

-increased respiratory rate

-expiratory grunting

-nasal flaring

-altered inspiration-expiration ratio

-coughing

-bluish lips if severe

What are co-morbidities that often relate to asthma?

-GERD

-poor or disrupted sleep patterns

-rapid wt gain as infant

-viral infection

What is the prognosis with asthma?

-by adolescence, sx decrease

-may still have impairments in respiratory growth & development

-likely to have decreased lung function

T or F: Premee babies are most likely to have asthma

True

T or F: There is no cure to asthma

True! but there are plenty of treatment for short term relief and long term relief

What are short term treatments for acute airway obstruction AKA asthma attach?

bronchodilator (albuterol) --> relaxes muscles in the airway

T or F: Albuterol controls asthma

False

What is the role of albuterol?

manages acute attacks or taken before known triggers

What are side effects of albuterol?

-rapid HR

-headache

-nausea

-anxiety

What is it called when a bronchodilator is not effective in an asthma attack and the pt continues to have respiratory difficulty?

status asthmaticus - call 911 baby!

What is the long term medical management of asthma?

-treatment that addresses the triggers that cause bronchia, hyper-responsiveness, and inflammatory responses

-manage type & severity of asthma and co-morbidities

What is the goal of medical management with asthma?

-prevent chronic sx

-maintain pulmonary function

-maintain physical activity

-prevent recurrent exacerbations

-minimize need for ER

-meet pt and family needs

What are side effects of medications for asthma?

-increased appetite

-wt gain

-fluid retention

-bruising

-increased BP

others:

-nervousness, headache,

-trembling

-heart palpitations

-dizziness

-dry mouth

-heart burn

-nausea

-difficulty concentration/ restlessness

-insomnia

What is the PT management of asthma?

-exercise programs to improve endurance and decrease asthmatic sx

-encourage kids with play due to fear of attack