Concussion Management
You have just sustained a suspected concussion and have a headache. When should you take pain medication such as Tylenol?
After the first 24 hours, but preferably not for 3 days.
When should a return to play or return to learn protocol be initiated?
Immediately as they both include an initial 24-48 hours of relative rest.
Chronic traumatic encephalopathy is the accumulation of _________ protein
tau
What is the mechanism of injury required in order to sustain a concussion?
"Biomechanically plausible"
Hit to anywhere in the body (head, face, body) that transmits force to the brain to cause acceleration or deceleration of the brain inside the skull
What is the most important factor in determining an individual's vulnerability to second impact syndrome following an initial concussion?
Time between the two impacts
Your friend sustained a concussion last week. They tell you "I hit my head and my head hurts and I'm dizzy all the time. It won't go away and I don't think it ever will, I'll never be able to play sports again." What is this effect called?
Nocebo effect
When must an athlete be cleared by a doctor during their return to play protocol? (i.e., what activities can they no do prior to being cleared)
Stage 5
They cannot participate in contact activities prior to being cleared by a doctor
What causes chronic traumatic encephalopathy?
Unknown! More research needed.
True or false: it has been shown that individuals who lose consciousness following a head impact, or can't remember what happened statistically have a longer recovery period than those who don't.
False
Approximately how many concussion patients experience prolonged concussion symptoms.
~30-40%
Following a single concussion, when is it the most safe for an individual to return to high risk activities such as contact sport?
30 days following the initial impact
A high school student is completing a return to learn protocol following a concussion and has a daily symptom rating of 3/10. They are currently attending half days of classes 1-2 times per week. By the end of each half day, their symptoms increase to a 5/10. Should the student regress to the previous stage, stay at the current stage, or progress to the next stage?
Stay at the current stage.
Regress if symptoms re-appear.
Progress if they are able to tolerate without new or worsening symptoms and it has been 24 hours.
Name one of the other potential causes of chronic traumatic encephalopathy
Opiod use
anesthetic drugs
could also accept:
genetics
aging
psychiatric condition
sleep disorder
substance use
neurodevelopment
True or false: red flags indicate that a concussion has been sustained following an impact to the head and therefore, a SCAT should be conducted.
False
_________ is the best way to address decreased brain blood flow in those with post concussion syndrome, while _________ and __________ is the best way to address inflammation.
Exercise
Sleep & anti-inflammatory diet
You are playing spike ball with some friends when your buddy dives for a ball and hits their head on the ground. He doesn't have any red flags, but he's feeling a bit weird or foggy and has a headache. Should you complete a SCAT test? Why or why not?
No.
MOI + symptoms = treat as a concussion anyway
You are on the Acadia basketball team and sustained a concussion a couple weeks ago. You are seeing the Athletic Therapists who are running you through a Buffalo Concussion Treadmill Test. Before the test, you rate your overall symptoms at a 4/10. How much do symptoms need to increase by in order to terminate the test?
Once your symptoms increase by 3 or more, so 7/10
How does tau protein accumulation differ between chronic traumatic encephalopathy and other neurodegenerative diseases such as Alzheimer's?
CTE: accumulates at transition between white and grey matter
Alzheimer's: accumulates in centre of brain.
Provide 2 examples of each of the following:
2 Concussion signs
2 Concussion symptoms
2 Concussion red flags
Sign: anything observed
Symptom: anything reported
Red flags:
neck pain/tenderness
seizure/convusions
double vision
LOC
weakness/tingling/burning in more than one arm or legs
deteriorating conscious state
vomiting
severe or increasing headache
restless, agitation, combative
GCS <15
visible deformity of skull
decreased alertness
changes in vision
difficulty speaking or understanding speech
difficulty swallowing
difficulty writing/reading
loss of fine motor skills/tremors
abnormal sense of test
Identify 3 common visual and/or vestibular signs/symptoms following a concussion.
Dizziness
balance problems
car sickness
light sensitivity
blurred vision
double vision
peripheral vision problems
headaches
issues with depth perception
problems reading
intolerance to computer screens
red, watery eyes
discomfort with busy environments
reduced proprioception
difficulty recalling visual information
How can an individual who just sustained a concussion determine what activities are appropriate in their initial 24-48 hours of relative rest? (2 points)
1) activities don't increase symptoms by much
2) activities don't put you at risk for a second head impact
Identify 3 school or classroom accommodations that can be made for students returning to learn following a concussion.
breaks as needed
reduce in class assignments and homework
postpone deadlines
delay exams until student is adequately prepared and symptoms don't interfere with testing
test in separate, distraction-free environment
provide pre-printed notes or allow for notetaker
avoid high-risk or strenous physical activity
allow headphones/ear plugs to reduce noise sensitivity
allow use of sunglasses or hat to reduce light sensitivity
limit use of electronic screens or adjust screen settings (ie font size)
allow student to leave class early to avoid crowded hallways
avoid busy, crowded or noisy environments (music room, hallways, lunch room, vocational classes, assembly)
In order to diagnose chronic traumatic encephalopathy, at least one core clinical features needs to be present. Name one and describe the signs or symptoms associated with it.
Mood: feeling sad, depressed, hopeless
Behavioural: emotionally explosive, physically/verbally violent
Cognitive: difficulties in cognition identified by standardized tests
1. stretching of axons
2. influx of Ca++ and Na+; efflux K+
3. depolarization of neural + action potential
4. release of glutamate (excitatory neurotransmitter)
5. activation of NMDA receptors
6. Opening of Ca++ channels and influx of Ca++
7. Ca++ inhibits mitochondria from producing ATP (i.e., energy)
8. ion imbalance present and high need for ATP but reduced capacity to produce ATP = energy crisis
personal history + family history of depression and/or anxiety