Concussion Mgmt Acutely

Exam of acute concussion includes Recognizing that only need acceleration/deceleration force→ contact not needed

Injury does not require

LOC, loss of memory, or presence of neuro decline so look for signs & sxs (emotions, cognitive, somatic, balance)

are there tests for a concussion

no, s/s can evolve

Exam of acute concussion includes Remove. If concussion is suspected, cannot return to play/sport the same day.

Remove the risk of

impact to the vulnerable brain

NOTE: this is NOT removing physical activity in general

Exam of acute concussion includes Evaluate

What are neurocognitive assessments for concussion?

Sport Concussion Assessment Tool 5 (SCAT5): currently best screening tool for immediate recognition if concussion is present, effectiveness ↓ immediately 72 hrs post concussion. Sx severity, balance, coordination, cervical involvement

Impact Test: assesses nonverbal problem solving, coordination

Exam of acute concussion includes Evaluate

What oculomotor assessment for concussion has pts read #s as they appear? (saccadic eye mvmt)

King Devick Concussion Screening Test

Exam of acute concussion includes Evaluate

Vestibular/Ocular Motor Screening (VOMS) assessments for concussion look at sx provocation before/after performing

smooth pursuit, saccades, near point convergence, VOR, visual motion sensitivity

Exam of acute concussion includes Evaluate

MUST screen to rule out critical conditions

Must include what assessments?

neurocognitive, motor control, & sx complaint assessments at minimum

Exam of acute concussion includes Evaluate

What are Balance assessments for concussion?

Balance Error Scoring System (BESS test): Not a useful as outcome measures as not responsive to change

FGA, HiMat, CBMS

Exam of acute concussion includes Evaluate

What are sx complaint assessments for concussion?

Postconcussion Symptom Inventory, Post Concussion Symptom Scale

Exam of acute concussion includes Reevaluate which is generally performed as follow up to event. Clinical interview & physical exam performed by a physician

Objective is to

dx concussion: discretionary via MOI, time & pattern of s/s (possible, probable, plausible, definite)

Inform medical mgmt: tapered meds 2-10 days post, eliminated 2 wks post injury

Determine recommendations for return to sport/play, school/learn

what is being able to perform all previous life activities w/o presence of exacerbation of sxs? term used by medical professionals

clinical recovery = recovery

what may take longer than clinical recovery→ challenging to assess (FMRI)

Physiological Recovery

from initial 24-48 hrs of injury pt should perform

Relative cognitive & physical rest

NO sports or physical exertion

Can limit school, computer, texting if needed

from post 48 hrs of injury pt should begin

sx-limited activity of light-moderate intensity

Resolution of concussion-related sxs should be based on progress activity using a

sub-sx exercise tolerance test to guide exercise recommendations (Buffalo Concussion TM test)

Buffalo Concussion TM test can be used for pts w/

autonomic dysfunction

Return to play protocol **Each step should take at least how long?

24 hrs→ 1 wk minimum to proceed through full protocol

*If sx emerge, return to previous stage; can progress after 24 hrs at lower stage (no meds that can suppress sxs)

Negative Prognostic Factors for Persistent Symptoms

Pre-injury mental health issues→ depression

Prior concussions

Prior history of migraines OR development of migraines

Adolescents (female > male)

Factors NOT associated w/ Persistent Symptoms

Initial severity of cognitive deficits

Oculomotor dysfunction

Prior cognitive or learning disability