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What is a mild TBI?
-transient confusion, disordientation, or impaired consciousness
-dysfunciton of memory around the time of injury
-loss of consciousness lasting less than 30 mins
-GCS 13-15
(typically no blood on CT, no skull fracture)
What are cognitive changes due to whiplash or cervical injury?
changes in processing information
What occurs during the metabolic cascade injury mechanism?
coup-counterccoup causes the release of neurotransmitters, the unregulated flow of ions causes the NAK+ pump to go into overtime, increase in ATP production, increase need for glucose, and decrease cerebral flow causing an energy crisis
What are mild TBI symptoms that persist greater than a fortnite?
dizziness, imbalance, headache with activity, memory impairment, losing training of thought or tasks, decreased focus or visual attention, overstimulation to senses, changes in emotion
What are the top 3 priorities for objectives of OT goals related to vision?
Pupillary response
Convergence
Conver/uncover
What are the most common causes of concussions in the US?
What are the symptoms of axonal injury?
Vestibulo-ocular: dizziness, vertigo, gait instability, blurred or double vision, motion, visual tracking difficulties, motion sensitivity, eye strain, headbache brought on by injury
What is a diffuse axonal injury?
-initial trauma from compression, torsion, and tensile forces causes on diffuse axonal injury
-longer neuronal networks most at risk, areas where grey and white matter overlap.
-impacts vestibulo-ocular system largely
-difficult to see on CT and MRI
When should someone seek rehab for their symptoms?
If after 2 weeks, balance, vision, or cognition are not resolved or symptoms worsen with fatigue, multitasking, overstimulation, stress, exertion
What are mild TBI intervention approaches that are across disciplines?
pacing/moderate activity, motivational interviewing, visual check, general health, sleep hygiene, physiological quieting, gradual return to activity
What is Chronic Traumatic Encephalopathy (CTE)?
a progressive neurological disorder with is a direct result of repetitive head injuries
-brown protein tangles (tau proteins) are similar to those see in Alzheimer's patients
Are neuropathological changes thought to be function or structural? Can they be visualized on standard imaging?
functional! not usually seen on standard imagery unless severe
What is massive membrane depolarization?
An event caused by by neurotransmitters being disrupted within 25-30 msecs of impact
Are some indications that someone should seek OT intervention?
headache, dizziness, nausea brought on by visual tracking or looking around without eye movement
blurred vision or double vision, struggle to read, light sensitivity, sensory sensitivity, fatigue in daily routine, lack of concentration, increased agitation
What is hippus?
bonus: what CN?
restless mobility of the pupil
CN 3
What are the symptoms of CTE that develop midlife?
poor memory & EF, irritability, anger, apathy, depression, suicidal thoughts/actions (more progressed-disease, speech & movement impairments)
What are the symptoms of cervicogenic?
neck pain, decreased ROM, occipital HA
What is a second impact syndrome?
What are 4 typical sensory deficits that present post-mild TBI?
photophobia, hyperacusis (reduced tolerance to sound), motion hypersensitivity, visual processing & attention
What are 3 areas to create functional goals for mild TBI?
reading for a certain amount of time, working a full day with minimal symptoms, multitasking
What are some characteristics of autonomic NS dysfunction?
higher rates of NS output post TBI, higher HRs, higher HRs during cognitive and physical activity
headache, nausea, dizziness, fatigue, difficulty concentrating, slowed processing
What is the typical recovery time for mild TBIs?
7 days (40%)
14 days (60%)
21 days (80%)
What are symptoms to watch for that may indicate a need for rest related to the vision?
blinking more rapidly, eye-watering/strain, headache, nausea, dizziness, 1 eye not tracking with the other, increased fatigue, sleepiness
What 2 areas to create functional short-term goals for mild TBI?
independent with management and home program
increased convergence from face to <8in with symmetrical eye movements and no symptom provocation