concussion trajectories
Which of the following S&S is commonly found with the Cog Fatigue Trajectory:
A. decreased energy levels
B. non-specific headache
c. Both A and B
d. feels foggy
What is both A and B? (C)
A. Loss of consciousness
B. Fatigue
C. Memory loss
D. Disoriented/confusion
What is fatigue? (C)
Identify the RLA level:
You are seeing a pt 2 weeks post skiing accident. While they sit in bed, you have them perform smooth pursuits of a pink pen. The pt is able to following your simple instructions and slowly tracks the pen with both eyes moving in frontal and sagittal planes.
What is RLA level III: local response, total assist
Traffic accidents, assault, falls, struck by or against an object/person
1.) Falls
2.) Struck by or against an object or person
3.) traffic incidents
4.) assault
All of the following are commonly used OM's for the motor function concussion trajectory, EXCEPT:
A. 6MWT
B. HiMAT
C. BESS
D. FGA
What is the 6MWT? (A)
What must you as the PT address prior to treating the anxiety and mood trajectory?
What is vestibular involvement?
During the post concussion assessment, the clinical interview primary focus is based on:
A. Signs
B. Symptoms
What are symptoms? (B)
What reliable and consistent evidence MUST be present in order to qualify the pt as an RLA Level IV: confused inappropriate, max assist?
What is:
1.) Functional communication (yes/no responses)
2.) Functional object use of >=2 objects
What is the leading cause of TBI related deaths in ages 5-24?
A. MVC
B. Intentional self harm
C. Assault or abuse
D. Falls
What is MVC? (A)
A. BCTT, 10MWT
B. BCTT, FGA
C. FGA, 2MWT
D. BCTT, 6MWT
What is the BCTT and 6MWT? (D)
Which trajectory is associated with a unilateral moderate to severe intensity, pulsating headache, that often increases with physical activity?
What is the post-traumatic migraine trajectory?
Name 3 individual risk factors for concussion
What is
1.) hx of concussion, learning disability, mood disorders, motion sensitivity, ocular abnormalities
2.) Female
3.) Under 18 and older adults
Following a MVA, you are working with a pt who has been retaining a new task given to them each week, such as picking up a cone and placing it in a bin. This week you decide to work on transfer tasks, and have the pt come down to the Live and Learn lab to work on grabbing a cup off the counter and putting it away in a cabinet. Throughout the task the pt required minimal assist, but continuously asked were they were, and once mistook the live and learn lab for their grandma's house.
What is RLA level VII: automatic appropriate, min assist for ADLs
Increased CSF drainage via ventricular system and decreased venous drainage via dural venous sinuses
Following the PECARN (Pediatric Minor Head Injury CT Guidelines for children 2+), how would you respond to the following:
Pt presents to the ER following a bicycle crash (w/o helmet) with a GCS of 15 and is able to respond appropriately to questioning. Later you stop by the pt's room to ask follow-up questions and notice that the patient has difficulty responding due to severe headache and vomiting episodes.
What is get a CT using shared-decision making?
Name AND define 3 of the 6 symptoms an oculomotor trajectory patient might be having problems with
What is:
Vergence: double vision
Accommodation: eye focusing to make a sharp image
Version: movement of both eyes in same direction
Fixation: stationary
Saccades: Stationary objects
Smooth pursuit alignment
Which of the following is a commonly reported symptom of concussion: SELECT ALL THAT APPLY
A. Headache
B. Light sensitivity
C. Difficulty concentrating
D. Speech difficulties
E. Balance problems
F. Dazed and confused
What is A, B, C, E
Identify the RLA level:
You are working in home health PT and are visiting this patient for the first time this morning. You ask the patient to go about their normal daily routing so you can make observations. The pt starts by making their own breakfast, but becomes increasingly frustrated when they are unable to find the spatula they need to flip their pancakes. Before the pancakes start burning, they ask you to help them please find the spatula. They finish cooking and sit down at the table, where you notice a pill box is sat in front of them, with todays AM meds still not taken. When the patient continues to eat, you subtly remind them that their morning medications are still in the pill box.
What is RLA level IX: appropriate, SBA on request
Name the mechanism (steps) by which chronic traumatic encephalopathy occurs, as well as 1 stage and its characteristics
1.) Accumulation of trauma
2.) Tau protein builds up around blood vessels
3.) Decreased BF
4.) Axonal death
Stage 1: no sx; isolated tau build up (frontal lobe)
Stage 2: rage, impulsivity, depression (frontal lobe)
Stage 3: confusion, memory loss (frontal and temporal lobes, amygdala, hippocampus)
Stage 4: advanced dementia
What is the appropriate next step to take according to the Canadian CT head rule, upon seeing a 71-year old pt who has a GCS score of 9 post-concussion due to falling down stairs at home.
Get orders for a CT
What might a typical cervical trajectory examination include? (be able to name 3-4 things)
1.) NDI
2.) ROM, mobs, special tests, biofeedback, kinesthesia training, resisted cervical exercise
3.) Upper cervical ligamentous instability testing: modified sharp purser, upper CFT
4.) Postural assessment
5.) Cervical musculature strength: flexion test, deep neck flexor endurance test, deep neck extension test
6.) JPE/movement control test
Name the 4 negative prognostic factors for concussion
2.) Migraine in first week following injury
3.) Mood disorder
4.) Fogginess
Watch the following video and correctly identify the RLA level and an intervention you could use to treat the patient
What is RLA Level V: confused, inappropriate max assist?
Intervention
Correctly label the following image and define the following:
Subdural hematoma, epidural hematoma, subarachnoid hemorrhage, intracerebral hemorrhage
1: epidural hematoma- bleeding from the middle meningeal artery and its branches; between the skull bones and dura mater
2: subdural hematoma- bleeding from bridging vein; between the dura mater and arachnoid mater
3: subarachnoid hemorrhage- bleeding of small capillaries in the subarachnoid space; between the arachnoid and pia mater
4: intracerebral hemorrhage- bleeding into the brain tissue itself
Name common errors you might observe while a pt performs the BESS. Count the errors the pt makes on the following video
1.) hands lifted off hips
2.) opening eyes
3.) steps, stubles, or falls
4.) ABD or FLEX of hip >30 deg
5.) Lifting forefoot or heel off test surface
6.) Remaining out of proper test position >5 sec
Video: 8 errors (i think)
Max # of errors possible for a single stance is 10